Hepato-Biliary Pathology Flashcards
What two structures supply the liver to give it a dual blood suppply?
Hepatic artery
Hepatic portal vein
What are the three functions of the liver?
Protein synthesis
Fat and carbohydrate metabolism
Detoxification of drugs and toxins including alcohol
What causes jaundice?
Increased circulating bilirubin caused by an altered metabolism making the skin yellow
Where is haemoglobin broken down in the body?
Spleen
What is converted to bilirubin and what causes pre-hepatic jaundice?
The haem part of haemoglobin
Increased release of haemoglobin from red cells
Where is bile from hepatocytes first excreted into and where after that?
Bile canaliculi
Duodenum
What causes hepatic jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What causes cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs
What causes an intra-hepatic bile duct obstruction?
Primary biliary cirrhosis
Primary sclerosing cholangitis
Liver tumours
What is primary biliary cirrhosis (PBC)?
Organ specific auto-immune disease that causes granulomatous inflammation involving bile ducts with the loss of intra-hepatic bile ducts leading to cirrhosis
What is primary sclerosing cholangitis (PSC)?
Chronic inflammation with fibrous obliteration of bile ducts leading to a loss of intra-hepatic bile ducts leading to cirrhosis and it is associated with IBD
What do PBC and PSC have in common?
They both lead to the loss intra-hepatic bile ducts and the progression of cirrhosis
What does PBC show on LFT blood results?
Raised Alk phos
What are the three types of liver tumour that present?
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours
Where does a hepatocellular carcinoma affect?
Malignant hepatocyte tumour
Where does a Cholangiocarcinoma affect?
Malignant tumour of the bile duct epithelium
What do most tumours present in combination with?
Some stage of cirrhosis
What are the risk factors for cholelithiasis (Gallstones)?
Obesity
Diabetes
What can gallstones lead to?
Inflammation
*Acute/Chronic Cholecystitis
What can acute inflammation of the gallbladder lead to?
Empyema which could result in gallbladder perforation and biliary peritonitis Ending in chronic inflammation
What does chronic cholecystitis cause?
Thickening of the gallbladder wall with pain in the RUQ and gallstones can cause obstruction if they leave the gallbladder
What can cause a bile duct obstruction?
Bile duct tumour
Gallstones
Benign structre & External compression - Tumour elsewhere
What are the effects of a bile duct obstruction?
No bile excreted into the duodenum
Ascending cholangitis - Infection of biliary tract
Secondary biliary cirrhosis if obstruction is prolonged
What happens in liver failure in terms of hepatocytes?
Effectively you run out of functioning hepatocytes and you have to rely on the liver to regenerate itslef
Acute or Chronic causes
What are acute causes of LF?
Hepatitis (A, B, C, E & Others) from Viruses
Alcohol or Drugs
Bile duct obstruction
What is a chronic cause of LF?
Cirrhosis
What does hepatitis cause?
Liver cell damage and death of individual liver cells
What are the three possible outcome from Hepatitis?
Resolution - Hep A & E
Liver failure if severe - Hep A, B & E
Progression to chronic hepatitis and cirrhosis - Hep B & C
What is hepatic cirrhosis?
End stage chronic liver disease in response of liver to chronic injury
What are the causes of Cirrhosis? (6)
Alcohol
Hepatitis B & C
PBC & Auto-immune hepatitis
Metabolic disorders - Haemachromatosis & Wilson’s disease
Obesity
Cryptogenic - Unknown cause and most common
What structural come about from cirrhosis?
Loss of normal structure which is replaced by nodules of hepatocytes and fibrous tissue
How large is a cerotic liver compared to that of a healthy liver?
Much smaller
What are the complications of cirrhosis?
Altered liver function
Abnormal blood flow
Increased risk of hepatocellular carcinoma
What is the abnormal blood flow like in cirrhosis?
Portosystemic anastomoses dilate in portal hypertension giving large dilated distended vascular structures, aka varices
What are the five stages in the development of gastric cancer?
Normal and H. pylori infection Atrophic gastritis Intestinal metaplasia Dysplasia Gastic cancer - Adenocarcinoma
