Hepato-biliary Pathology

Question 1

What are the functions of the liver?

Answer 1

Protein synthesis
Fat and carbohydrate metabolism
Detoxification of drugs and toxins

Question 2

What are the causes of acute liver failure ?

Answer 2

Hepatitis 
Viruses 
Alcohol 
Drugs 
Bile duct obstruction

Question 3

What is the pathology of viral hepatitis?

Answer 3

Inflammation of the liver

Liver cell damage and cell death

Question 4

What are the outcomes of viral hepatitis?

Answer 4

Resolution (hep A, E)
Liver failure (hep A, B, E)
Progression to chronic hepatitis and cirrhosis (hep B, C)

Question 5

What is the pathology of alcoholic liver disease?

Answer 5

Fatty change 
Acute inflammation 
Liver cell death 
Liver failure 
Progression to cirrhosis

Question 6

What is the pathway of pre hepatic bilirubin metabolism?

Answer 6

Breakdown of haemoglobin in spleen
Haem converted to bilirubin
Release of bilirubin into circulation

Question 7

What is the pathway of hepatic bilirubin metabolism?

Answer 7

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

Question 8

What is the pathway of post hepatic bilirubin metabolism?

Answer 8

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re absorption of bilirubin

Question 9

What are the hepatic causes of jaundice?

Answer 9

Cholestasis

Intra hepatic bile duct obstruction

Question 10

What is the pathology of cholestasis jaundice?

Answer 10

Bile accumulates within hepatocytes or bile canaliculi

Question 11

What are the cause of cholestasis?

Answer 11

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

Question 12

What are the causes of intra hepatic bile obstruction?

Answer 12

Primary biliary cholngitis
Primary sclerosing cholangitis
Liver tumours

Question 13

What are the pathological features of primary biliary cholangitis?

Answer 13

Granulomatous inflammation
Loss of intra hepatic bile ducts
Raised serum alkaline phosphatase

Question 14

What are the patholigal features of primary sclerosing cholangitis?

Answer 14

Chronic inflammation and fibrous obliteration of bile ducts

Loss of intra hepatic bile ducts

Question 15

What are the causes of cirrhosis?

Answer 15

Alcohol 
Hepatitis B and C 
Immune mediated liver disease 
Metabolic disorders (excess iron or copper) 
Obesity (diabetes) 
Cryptogenic

Question 16

What is the pathology of cirrhosis?

Answer 16

Loss of normal liver structure

Replaced by nodules of hepatocytes and fibrous tissue

Question 17

What are the complications of cirrhosis?

Answer 17

Altered liver function
Abnormal blood flow
Increased risk of hepatocellular carcinoma
More susceptible to bleeding (portal venous supply at low pressure)

Question 18

What are the different types of liver tumours?

Answer 18

Hepatocellular carcinoma
Cholangiocarcinoma
Metatatic tumours

Question 19

What are the risk factors for gallstones?

Answer 19

Obesity

Diabetes

Question 20

What is acute cholecystitis?

Answer 20

Acute inflammation of the gallbladder which may lead to perforation of the gall bladder or biliary peritonitis

Question 21

What is chronic cholecystitis?

Answer 21

Chronic inflammation and fibrosis go the gall bladder

Question 22

What are the cause of common bile duct obstruction?

Answer 22

Gallstones
Bile duct tumours
Benign strictures
External compression

Question 23

What are the effects of a common bile duct obstruction?

Answer 23

Jaundice
No bile excreted into the duodenum
Infection of bile proximal to obstruction
Secondary biliary obstruction