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Year 2- GIT > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

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1
Q

What are the two blood supplies of the liver?

A

Hepatic artery
Portal vein

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2
Q

What is the function of the liver?

A

Protein synthesis
Fat and carb metabolism
Detoxification of drugs, toxins and alcohol

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3
Q

The majority of drugs taken orally are metabolised by what?

A

First pass metabolism

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4
Q

Which organ has a role in first class metabolism?

A

Liver

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5
Q

Where is albumin made?

A

Liver

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6
Q

How can liver failure occur?

A

As a complication of acute liver injury or chronic liver condition

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7
Q

Give an example of a chronic liver condition which can lead to liver failure.

A

Cirrhosis of the liver

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8
Q

List some acute liver injuries.

A

Bile duct obstruction
Hepatitis (drugs, alcohol, viruses)

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9
Q

What is hepatitis?

A

Inflammation of the liver

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10
Q

Why is it important that the liver gets rid of bile?

A

Bile is intrinsically toxic and if in the liver for too long, can cause toxicity

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11
Q

Which viruses cause hepatitis in acute liver injury?

A

Hep. A
Hep. B
Hep. C
Hep. E
Other viruses

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12
Q

What are the three outcomes of viral hepatitis?

A
  1. Complete resolution
  2. Liver failure
  3. Progression to chronic hepatitis and cirrhosis
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13
Q

Which types of hepatitis is it more common to have resolution with?

A

A and E

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14
Q

Which types of hepatitis is it more common to have liver failure with?

A

A, B, E

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15
Q

Which types of hepatitis is it more common to have progression to chronic hepatitis and cirrhosis with?

A

B and C

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16
Q

Which types of hepatitis are food and waterbourne?

A

A and E

->that’s why you usually get full resolution after an infection

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17
Q

Which type of hepatitis can you get a vaccination to help protect agasint it?

A

Hep. B

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18
Q

What happens in alcoholic liver disease?

A

Response of liver to excess alcohol- alcohol gives oxidative damage to cells of the liver

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19
Q

What does alcoholic hepatitis progress into?

A

Cirrhosis

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20
Q

What causes alcoholic hepatitis?

A

Fatty changes to the liver

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21
Q

Which term means fatty changes in the liver?

A

Steatosis

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22
Q

What is jaundice caused by?

A

Increased circulating bilirubin

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23
Q

Which part of the body is noticeably affected by jaundice?

A

Whites, or conjunctiva, of the eyes

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24
Q

Which organ breaks down blood cells?

A

Spleen

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25
Q

What are the three pathways of bilirubin metabolsim?

A

Pre-hepatic
Hepatic
Post-hepatic

26
Q

What happens in the pre-hepatic pathway of bilirubin metabolism?

A

Breakdown of haemoglobin into haem and globin.
Haem is converted into bilirubin.
Bilirubin released into circulation.

27
Q

What happens in the hepatic pathway of bilirubin metabolism?

A

Uptake of bilirubin by hepatocytes.
Conjugation of bilirubin in hepatocytes.
Excretion of conjugated bilirubin into biliary system.

28
Q

What does bile do?

A

Disperses fat

29
Q

What happens in the post-hepatic pathway of bilirubin metabolism?

A

Transport of conjugated bilirubin in biliary system.
Breakdown of conjugated bilirubin in intestine.
Re-absorption of bilirubin.

30
Q

Which pathway does bilirubin get reabsorbed into?

A

Entero-hepatic circulation

31
Q

What can cause pre-hepatic jaundice?

A

Increased release of haemoglobin from red blood cells.

32
Q

What can cause hepatic jaundice?

A

Cholestasis
Intra-hepatic bile duct obstruction

33
Q

Define cholestasis.

A

Accumulation of bile within hepatocytes or bile canaliculi

34
Q

What are some of the causes of cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs; therapeutic and recreational

35
Q

Which two categories can drug related cholestasis be classified as?

A

Predictable or unpredictable

36
Q

What is meant by predictable cholestasis?

A

Dose related

37
Q

What is meant by unpredictable cholestasis?

A

Not dose related

38
Q

Which conditions can cause bile duct obstruction?

A

Primary biliary cholangitis
Primary sclerosing cholangitis

39
Q

What else may block the bile duct?

A

Tumours

40
Q

What is primary biliary cholangitis?

A

Organ specific autoimmune disease which predominantly affects women.

41
Q

Which sign in serology suggests the bile system isn’t working properly?

A

Raised alkaline phosphatase

42
Q

What are some of the pathological changes that occur in primary biliary cholangitis?

A

Granulomatous inflammation of bile ducts
Loss of intra-hepatic bile ducts

43
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrous obliteration of bile ducts

44
Q

What is primary sclerosing cholangitis associated with?

A

Inflammatory bowel disease

45
Q

What can both types of cholangitis progress to?

A

Cirrhosis of the liver

46
Q

What are you at a higher risk of if you have primary sclerosing cholangitis?

A

Cholangiocarcinoma

47
Q

What is hepatic cirrhosis?

A

Healing of the liver by fibrosis because of continual damage

48
Q

Can liver cirrhosis be revered?

A

No

49
Q

What is the only treatment option for those with cirrhosis of the liver?

A

Liver transplant

50
Q

What are the causes of cirrhosis?

A

Alcohol
Hepatitis B and C
Immune mediated liver disease
Metabolic disorders
Obesity

51
Q

Name two immune mediated liver dieases.

A

Acute-immune hepatitis
Primary biliary cholangitis

52
Q

Which too metabolic disorders may cause cirrhosis?

A

Excess copper- Wilson’s disease
Excess iron- primary haemochromatosis

53
Q

Describe the pathology of cirrhosis.

A

Loss of normal liver structure, replaced by fibrous tissue and nodules of hepatocytes

54
Q

What are some of the complications of cirrhosis?

A

Liver failure
Abnormal blood flow leading to portal hypertension
Increased risk of hepatocellular carcinoma

55
Q

What are some risk factors for gallstones?

A

Obesity
Diabetes

56
Q

What is cholecystitis?

A

Inflammation of the gallbladder

57
Q

What can acute cholecystitis cause to happen?

A

Empyema

58
Q

What happens in chronic cholecystitis?

A

Chronic inflammation and fibrosis of gallbladder

59
Q

What are some causes of bile duct obstructions?

A

Gallstones
Bile duct tumours
Benign stricture
External compression- tumours

60
Q

What are the effects of a bile duct obstruction?

A

Jaundice
No bile in duodenum
Infection of bile proximal to obstruction

61
Q

What may happen if there is a prolonged bile duct obstruction?

A

Secondary biliary cholangitis

Year 2- GIT (37 decks)

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