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GI -S > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

1
Q

What is the structure of the liver and what makes the structure unusual?

A

Large vascular soft organ with a tough capsule.

Has a dual blood supply from hepatic portal vein and hepatic artery

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2
Q

What are the functions of the liver?

A

Protein synthesis
Metabolism of fats and carbohydrates
Detoxification of drugs and toxins including alcohols

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3
Q

What is Liver Failure?

A

Run out of hepatocytes that are functioning

Functions of the liver can’t happen or at least not at the normal level

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4
Q

What causes liver failure?

A

Acute liver injury

Chronic liver injury (i.e. cirrhosis)

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5
Q

What conditions are included in acute liver injury?

A

Hepatitis:
-Virus, Alcohol, Drugs

Bile duct obstruction (leaks out of biliary system into liver)

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6
Q

What are the virus’ of Hepatitis?

A 
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Other Virus'
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7
Q

What is the pathology of Viral Hepatitis?

A

Inflammation of the liver

Cell damage and death (individual cells)

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8
Q

What are the outcomes of Viral Hepatitis?

A

Recovery
(A and E)

Liver failure if severe damage to liver
(A, B and E)

Progression to Chronic Hepatitis and Cirrhosis
(B and C)

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9
Q

What is the progression of alcoholic liver disease?

A 
Response of liver to excess alcohol
Fatty Change
Alcoholic hepatitis
-Acute Inflammation
-Liver Cell Death 
-Liver Failure
Progress to cirrhosis
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10
Q

What is Jaundice?

A

Increased circulating Bilirubin due to altered metabolism

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11
Q

What is the pre-hepatic pathway for the metabolism of bilirubin?

A

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

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12
Q

What is the hepatic pathway for the metabolism of bilirubin?

A

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin to facilitate secretion
Release of conjugated bilirubin into bile canuliculi

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13
Q

What is the post-hepatic pathway for the metabolism of bilirubin?

A

Transport of conjugated bilirubin in the biliary system
Digestion of conjugated bilirubin to bilirubin
Some reabsorption of bilirubin into circulation

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14
Q

Describe the different classifications of jaundice.

A

Pre-Hepatic
Increased release of haemoglobin from RBC’s (haemolysis)

Hepatic

  • Cholestasis
  • Intra-Hepatic Obstruction

Post-Hepatic

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15
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canuliculi

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16
Q

What are the causes of cholestasis?

A

Viral Hepatitis
Alcoholic Hepatitis
Liver Failure
Drugs: Both recreation and therapeutic

17
Q

What are the two subdivisions of drug induced cholestasis?

A

Predictable = Dose related

Unpredictable = Not dose related

18
Q

What are the causes of Intra-Hepatic Bile Duct Obstruction?

A 
Primary biliary cirrhosis
Biliary Sclerosing Cholangitis
Tumours of the liver
-Hepatocellular carcinoma
-Tumours of Intra-Hepatic ducts
-Liver metastasis
19
Q

What is primary biliary cirrhosis?

A

Autoimmune disease

Affecting predominantly women

20
Q

What blood tests can point towards primary biliary cirrhosis?

A

Anti-mitochondrial autoantibodies in serum

Raised serum Alkaline Phosphatase

21
Q

What is the pathology of primary biliary cirrhosis?

A

Granulomatous inflammation involving bile ducts
Loss of intrahepatic bile ducts
Progression to cirrhosis

22
Q

Give a summary of Primary Sclerosing Cholangitis

A

Chronic inflammation and obliteration of bile ducts
Loss of intrahepatic bile ducts
Highly associated with inflammatory bowel disease

Outcomes are:

  • Progression to cirrhosis
  • Increased risk of development of cholangiocarcinoma
23
Q

What is hepatic cirrhosis?

A

End stage chronic liver disease

response of liver to chronic injury

24
Q

List the causes of cirrhosis

A 
Alcohol
Hepatitis B and C
Immune mediated liver disease
-Autoimmune hepatitis
-Primary billiary cirrhosis
Metabolic
-Excess iron (Haemachromatosis)
-Excess Copper (Wilson's Disease)
Obesity (Diabetes mellitus)
Cryptogenic (Most common)
25
Q

What is the pathology of liver cirrhosis?

A

Diffuse process involves whole liver
Loss of structure
Replaced by nodules of hepatocytes and fibrous tissue

26
Q

What are the complications of liver cirrhosis?

A

Altered liver function (liver failure)
Abnormal blood flow (portal hypertension)
Increased risk of hepatocellular carcinoma

27
Q

What are the 3 types of liver tumour?

A

Hepatocellular carcinoma
-Malignant tumour of hepatocytes

Cholangiacarcinoma
-Malignant tumour of bile duct epithelium

Metastatic Tumours
-Common site of metastases (BREAST, LUNG, COLON, stomach, pancreas)

28
Q

What are the post-hepatic causes of jaundice?

A

Cholelithiasis (gallstones)
Diseases of the gallbladder
Extra-hepatic duct obstruction

29
Q

What are the risk factors for gallstones?

A

Obestity
Diabetes Mellitus

Very common occurrence without any risk factors

30
Q

What is the pathology of diseases of the gallbladder?

A

Acute cholecystitis

Chronic Cholecystitis

31
Q

What is acute cholecystitis?

A

Acute inflammation of the gallbladder

  • Empyema
    • Risk of perforation of gallbladder
    • Biliary Peritonitis

Repeat episodes can cause progression to chronic cholecystitis

32
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of the gallbladder

33
Q

What are the causes of common bile duct obstruction?

A 
Gallstones
Bile Duct Tumours
Benign Stricture
External Compression 
-Tumour of head of pancreas
-Lymphadenopathy of portal hepatis lymph nodes
34
Q

What are the effects of common bile duct obstruction?

A 
Jaundice
No bile secreted into duodenum
Infection of bile proximal to blockage
-Ascending Cholangitis
Secondary biliary cirrhosis if prolonged obstruction

GI -S (29 decks)

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