Hepato-Biliary Pathology

Question 1

What is the structure of a normal liver?

Answer 1

• Dual blood supply
• Hepatic artery
• Portal vein

Question 2

What is the function of a normal liver?

Answer 2

• Protein synthesis
• Metabolism of fat and carbohydrate
• Detoxification of drugs and toxins

Question 3

Give examples of liver pathology.

Answer 3

• Liver failure
• Jaundice
• Intrahepatic bile duct obstruction
• Cirrhosis
• Tumours

Question 4

Give an example of pathology in the gall bladder.

Answer 4

Inflammation

Question 5

Give an example of pathology in the extrahepatic bile ducts

Answer 5

Obstruction

Question 6

What is liver failure a complication of?

Answer 6

• Acute liver injury

- Chronic liver injury

Question 7

What can cause acute liver injury?

Answer 7

• Hepatitis

- Bile duct obstruction

Question 8

What can cause hepatitis?

Answer 8

• Viruses
• Alcohol
• Drugs

Question 9

Give examples of viral hepatitis.

Answer 9

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis E
• Other viruses

Question 10

What is the pathology of viral hepatitis?

Answer 10

• Inflammation of the liver
• Liver cell damage and death of individual liver cells
• Outcome of acute inflammation

Question 11

When can resolution occur after viral hepatitis?

Answer 11

• A

- E

Question 12

When can liver failure occur after severe damage to the liver in the case of hepatitis?

Answer 12

• A
• B
• E

Question 13

When can there be progression to chronic hepatitis and cirrhosis?

Answer 13

• B

- C

Question 14

What is alcoholic liver disease?

Answer 14

A response of the liver to excess alcohol

Question 15

What occurs in alcoholic liver disease?

Answer 15

• Fatty change
• Alcoholic hepatitis
• Progression to cirrhosis

Question 16

What happens in alcoholic hepatitis?

Answer 16

• Acute inflammation
• Liver cell death
• Liver failure

Question 17

What is the physiology behind jaundice?

Answer 17

• Increased circulating bilirubin

- Cause by altered metabolism of bilirubin

Question 18

What is the pathway of bilirubin metabolism?

Answer 18

• Pre-hepatic
• Hepatic
• Post-hepatic

Question 19

What does the pre-hepatic part of the metabolism of bilirubin involve?

Answer 19

• Breakdown of haemoglobin in spleen to form haem and globin
• Haem converted to bilirubin
• Release of bilirubin into circulation

Question 20

What does the hepatic part of the metabolism of bilirubin involve?

Answer 20

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

Question 21

What does the post-hepatic part of the metabolism of bilirubin involve?

Answer 21

• Transport of conjugated bilirubin in biliary system
• Breakdown of bilirubin conjugate in intestine
• Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)

Question 22

How can jaundice be classified?

Answer 22

• Pre-hepatic
• Hepatic
• Post-hepatic

Question 23

What causes pre-hepatic jaundice?

Answer 23

Increased release of haemoglobin from red cells (haemolysis)

Question 24

What are the hepatic causes of jaundice?

Answer 24

• Cholestasis

- Intra-hepatic bile duct obstruction

Question 25

Cholestasis

Answer 25

Accumulation of bile within hepatocytes or bile canaliculi

Question 26

What are some causes of cholestasis?

Answer 26

- Viral hepatitis - Alcoholic hepatitis - Liver failure - Drugs (therapeutic/recreational)

Question 27

What is meant by predictable and unpredictable drug-induced cholestasis?

Answer 27

- Predictable: dose related | - Unpredictable: Not dose related

Question 28

What can cause intra-hepatic bile duct obstruction?

Answer 28

- Primary biliary cholangitis - Primary sclerosing cholangitis - Tumours of the liver

Question 29

What tumours of the liver can cause intra-hepatic bile duct obstruction?

Answer 29

- Hepatocellular carcinoma - Tumours of intra-hepatic bile ducts - Metastatic tumours

Question 30

What is primary biliary cholangitis?

Answer 30

- An organ specific auto-immune disease that mainly affects female - Anti-mitochondrial auto-antibodies - Raised serum alkaline phosphatase

Question 31

What is the pathology of primary biliary cholangitis?

Answer 31

- Granulomatous inflammation involving bile ducts - Loss of intra-hepatic bile ducts - Progression to cirrhosis

Question 32

What is primary sclerosing cholangitis?

Answer 32

- Chronic inflammation and fibrous obliteration of bile ducts - Loss of intra0hepatic bile ducts

Question 33

What is primary sclerosing cholangitis associated with?

Answer 33

Inflammatory bowel disease

Question 34

What can primary sclerosing cholangitis progress to?

Answer 34

Cirrhosis

Question 35

What does primary sclerosing cholangitis put you at increased risk of developing?

Answer 35

Cholangiocarcinoma

Question 36

Hepatic cirrhosis

Answer 36

End stage chronic liver disease as a response to chronic injury

Question 37

What can cause cirrhosis?

Answer 37

- Alcohol - Hepatitis B, C - Immune mediated liver disease - Metabolic disorders - Obesity - Cryptogenic

Question 38

What immune mediated liver diseases can cause cirrhosis?

Answer 38

- Auto-immune hepatitis | - Primary biliary cholangitis

Question 39

What metabolic disorders can cause cirrhosis?

Answer 39

- Excess iron: primary haemochromatosis | - Excess copper: Wilsons' disease

Question 40

What is the pathology of liver cirrhosis?

Answer 40

- Diffuse process involving whole liver - Loss of normal liver structure - Replaced by nodules of hepatocytes and fibrous tissue

Question 41

What are the complications of cirrhosis?

Answer 41

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

Question 42

Give examples of liver tumours.

Answer 42

- Hepatocellular carcinoma: malignant tumour of hepatocytes - Cholangiocarcinoma: malignant tumour of bile duct epithelium - Metastatic tumours

Question 43

What are post-hepatic causes of jaundice?

Answer 43

- Cholelithiasis (gallstones) - Diseases of gall bladder - Extra-hepatic duct obstruction

Question 44

What are 2 risk factors for gallstones?

Answer 44

- Obesity | - Diabetes

Question 45

What is the pathology of gallstones?

Answer 45

Inflammation - Acute cholecystitis - Chronic cholecystitis

Question 46

Describe acute cholecystitis.

Answer 46

- Acute inflammation of gall bladder: empyema (perforation of gall bladder/ biliary peritonitis) - Progression to chronic inflammation

Question 47

What are the causes of common bile duct obstruction?

Answer 47

- Gallstones - Bile duct tumours - Benign stricture - External compression (tumours)

Question 48

What are the effects of common bile duct obstruction?

Answer 48

- Jaundice - No bile excreted into duodenum - Infection of bile proximal to obstruction (ascending cholangitis) - Secondary biliary cirrhosis if obstruction prolonged