Hepato-Biliary Pathology Flashcards
What are the two blood supplies of the liver?
Hepatic artery
Portal vein
What is the function of the liver?
Protein synthesis
Fat and carb metabolism
Detoxification of drugs, toxins and alcohol
The majority of drugs taken orally are metabolised by what?
First pass metabolism
Which organ has a role in first class metabolism?
Liver
Where is albumin made?
Liver
How can liver failure occur?
As a complication of acute liver injury or chronic liver condition
Give an example of a chronic liver condition which can lead to liver failure.
Cirrhosis of the liver
List some acute liver injuries.
Bile duct obstruction
Hepatitis (drugs, alcohol, viruses)
What is hepatitis?
Inflammation of the liver
Why is it important that the liver gets rid of bile?
Bile is intrinsically toxic and if in the liver for too long, can cause toxicity
Which viruses cause hepatitis in acute liver injury?
Hep. A
Hep. B
Hep. C
Hep. E
Other viruses
What are the three outcomes of viral hepatitis?
- Complete resolution
- Liver failure
- Progression to chronic hepatitis and cirrhosis
Which types of hepatitis is it more common to have resolution with?
A and E
Which types of hepatitis is it more common to have liver failure with?
A, B, E
Which types of hepatitis is it more common to have progression to chronic hepatitis and cirrhosis with?
B and C
Which types of hepatitis are food and waterbourne?
A and E
->that’s why you usually get full resolution after an infection
Which type of hepatitis can you get a vaccination to help protect agasint it?
Hep. B
What happens in alcoholic liver disease?
Response of liver to excess alcohol- alcohol gives oxidative damage to cells of the liver
What does alcoholic hepatitis progress into?
Cirrhosis
What causes alcoholic hepatitis?
Fatty changes to the liver
Which term means fatty changes in the liver?
Steatosis
What is jaundice caused by?
Increased circulating bilirubin
Which part of the body is noticeably affected by jaundice?
Whites, or conjunctiva, of the eyes
Which organ breaks down blood cells?
Spleen
What are the three pathways of bilirubin metabolsim?
Pre-hepatic
Hepatic
Post-hepatic
What happens in the pre-hepatic pathway of bilirubin metabolism?
Breakdown of haemoglobin into haem and globin.
Haem is converted into bilirubin.
Bilirubin released into circulation.
What happens in the hepatic pathway of bilirubin metabolism?
Uptake of bilirubin by hepatocytes.
Conjugation of bilirubin in hepatocytes.
Excretion of conjugated bilirubin into biliary system.
What does bile do?
Disperses fat
What happens in the post-hepatic pathway of bilirubin metabolism?
Transport of conjugated bilirubin in biliary system.
Breakdown of conjugated bilirubin in intestine.
Re-absorption of bilirubin.
Which pathway does bilirubin get reabsorbed into?
Entero-hepatic circulation
What can cause pre-hepatic jaundice?
Increased release of haemoglobin from red blood cells.
What can cause hepatic jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
Define cholestasis.
Accumulation of bile within hepatocytes or bile canaliculi
What are some of the causes of cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs; therapeutic and recreational
Which two categories can drug related cholestasis be classified as?
Predictable or unpredictable
What is meant by predictable cholestasis?
Dose related
What is meant by unpredictable cholestasis?
Not dose related
Which conditions can cause bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
What else may block the bile duct?
Tumours
What is primary biliary cholangitis?
Organ specific autoimmune disease which predominantly affects women.
Which sign in serology suggests the bile system isn’t working properly?
Raised alkaline phosphatase
What are some of the pathological changes that occur in primary biliary cholangitis?
Granulomatous inflammation of bile ducts
Loss of intra-hepatic bile ducts
What is primary sclerosing cholangitis?
Chronic inflammation and fibrous obliteration of bile ducts
What is primary sclerosing cholangitis associated with?
Inflammatory bowel disease
What can both types of cholangitis progress to?
Cirrhosis of the liver
What are you at a higher risk of if you have primary sclerosing cholangitis?
Cholangiocarcinoma
What is hepatic cirrhosis?
Healing of the liver by fibrosis because of continual damage
Can liver cirrhosis be revered?
No
What is the only treatment option for those with cirrhosis of the liver?
Liver transplant
What are the causes of cirrhosis?
Alcohol
Hepatitis B and C
Immune mediated liver disease
Metabolic disorders
Obesity
Name two immune mediated liver dieases.
Acute-immune hepatitis
Primary biliary cholangitis
Which too metabolic disorders may cause cirrhosis?
Excess copper- Wilson’s disease
Excess iron- primary haemochromatosis
Describe the pathology of cirrhosis.
Loss of normal liver structure, replaced by fibrous tissue and nodules of hepatocytes
What are some of the complications of cirrhosis?
Liver failure
Abnormal blood flow leading to portal hypertension
Increased risk of hepatocellular carcinoma
What are some risk factors for gallstones?
Obesity
Diabetes
What is cholecystitis?
Inflammation of the gallbladder
What can acute cholecystitis cause to happen?
Empyema
What happens in chronic cholecystitis?
Chronic inflammation and fibrosis of gallbladder
What are some causes of bile duct obstructions?
Gallstones
Bile duct tumours
Benign stricture
External compression- tumours
What are the effects of a bile duct obstruction?
Jaundice
No bile in duodenum
Infection of bile proximal to obstruction
What may happen if there is a prolonged bile duct obstruction?
Secondary biliary cholangitis
