Hepato-Biliary Pathology Flashcards
What is the structure of the liver and what makes the structure unusual?
Large vascular soft organ with a tough capsule.
Has a dual blood supply from hepatic portal vein and hepatic artery
What are the functions of the liver?
Protein synthesis
Metabolism of fats and carbohydrates
Detoxification of drugs and toxins including alcohols
What is Liver Failure?
Run out of hepatocytes that are functioning
Functions of the liver can’t happen or at least not at the normal level
What causes liver failure?
Acute liver injury
Chronic liver injury (i.e. cirrhosis)
What conditions are included in acute liver injury?
Hepatitis:
-Virus, Alcohol, Drugs
Bile duct obstruction (leaks out of biliary system into liver)
What are the virus’ of Hepatitis?
Hepatitis A Hepatitis B Hepatitis C Hepatitis E Other Virus'
What is the pathology of Viral Hepatitis?
Inflammation of the liver
Cell damage and death (individual cells)
What are the outcomes of Viral Hepatitis?
Recovery
(A and E)
Liver failure if severe damage to liver
(A, B and E)
Progression to Chronic Hepatitis and Cirrhosis
(B and C)
What is the progression of alcoholic liver disease?
Response of liver to excess alcohol Fatty Change Alcoholic hepatitis -Acute Inflammation -Liver Cell Death -Liver Failure Progress to cirrhosis
What is Jaundice?
Increased circulating Bilirubin due to altered metabolism
What is the pre-hepatic pathway for the metabolism of bilirubin?
Breakdown of haemoglobin into haem and globin
Haem is converted to bilirubin
Bilirubin released into circulation.
What is the hepatic pathway for the metabolism of bilirubin?
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin to facilitate secretion
Release of conjugated bilirubin into bile canuliculi
What is the post-hepatic pathway for the metabolism of bilirubin?
Transport of conjugated bilirubin in the biliary system
Digestion of conjugated bilirubin to bilirubin
Some reabsorption of bilirubin into circulation
Describe the different classifications of jaundice.
Pre-Hepatic
Increased release of haemoglobin from RBC’s (haemolysis)
Hepatic
- Cholestasis
- Intra-Hepatic Obstruction
Post-Hepatic
What is cholestasis?
Accumulation of bile within hepatocytes or bile canuliculi
What are the causes of cholestasis?
Viral Hepatitis
Alcoholic Hepatitis
Liver Failure
Drugs: Both recreation and therapeutic
What are the two subdivisions of drug induced cholestasis?
Predictable = Dose related
Unpredictable = Not dose related
What are the causes of Intra-Hepatic Bile Duct Obstruction?
Primary biliary cirrhosis Biliary Sclerosing Cholangitis Tumours of the liver -Hepatocellular carcinoma -Tumours of Intra-Hepatic ducts -Liver metastasis
What is primary biliary cirrhosis?
Autoimmune disease
Affecting predominantly women
What blood tests can point towards primary biliary cirrhosis?
Anti-mitochondrial autoantibodies in serum
Raised serum Alkaline Phosphatase
What is the pathology of primary biliary cirrhosis?
Granulomatous inflammation involving bile ducts
Loss of intrahepatic bile ducts
Progression to cirrhosis
Give a summary of Primary Sclerosing Cholangitis
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
What is hepatic cirrhosis?
End stage chronic liver disease
response of liver to chronic injury
List the causes of cirrhosis
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)
What is the pathology of liver cirrhosis?
Diffuse process involves whole liver
Loss of structure
Replaced by nodules of hepatocytes and fibrous tissue
What are the complications of liver cirrhosis?
Altered liver function (liver failure)
Abnormal blood flow (portal hypertension)
Increased risk of hepatocellular carcinoma
What are the 3 types of liver tumour?
Hepatocellular carcinoma
-Malignant tumour of hepatocytes
Cholangiacarcinoma
-Malignant tumour of bile duct epithelium
Metastatic Tumours
-Common site of metastases (BREAST, LUNG, COLON, stomach, pancreas)
What are the post-hepatic causes of jaundice?
Cholelithiasis (gallstones)
Diseases of the gallbladder
Extra-hepatic duct obstruction
What are the risk factors for gallstones?
Obestity
Diabetes Mellitus
Very common occurrence without any risk factors
What is the pathology of diseases of the gallbladder?
Acute cholecystitis
Chronic Cholecystitis
What is acute cholecystitis?
Acute inflammation of the gallbladder
- Empyema
- Risk of perforation of gallbladder
- Biliary Peritonitis
Repeat episodes can cause progression to chronic cholecystitis
What is chronic cholecystitis?
Chronic inflammation and fibrosis of the gallbladder
What are the causes of common bile duct obstruction?
Gallstones Bile Duct Tumours Benign Stricture External Compression -Tumour of head of pancreas -Lymphadenopathy of portal hepatis lymph nodes
What are the effects of common bile duct obstruction?
Jaundice No bile secreted into duodenum Infection of bile proximal to blockage -Ascending Cholangitis Secondary biliary cirrhosis if prolonged obstruction
