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Systems: Alimentary AB > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

1
Q

What is the structure of a normal liver?

A
  • Dual blood supply
  • Hepatic artery
  • Portal vein
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2
Q

What is the function of a normal liver?

A
  • Protein synthesis
  • Metabolism of fat and carbohydrate
  • Detoxification of drugs and toxins
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3
Q

Give examples of liver pathology.

A
  • Liver failure
  • Jaundice
  • Intrahepatic bile duct obstruction
  • Cirrhosis
  • Tumours
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4
Q

Give an example of pathology in the gall bladder.

A

Inflammation

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5
Q

Give an example of pathology in the extrahepatic bile ducts

A

Obstruction

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6
Q

What is liver failure a complication of?

A
  • Acute liver injury

- Chronic liver injury

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7
Q

What can cause acute liver injury?

A
  • Hepatitis

- Bile duct obstruction

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8
Q

What can cause hepatitis?

A
  • Viruses
  • Alcohol
  • Drugs
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9
Q

Give examples of viral hepatitis.

A
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis E
  • Other viruses
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10
Q

What is the pathology of viral hepatitis?

A
  • Inflammation of the liver
  • Liver cell damage and death of individual liver cells
  • Outcome of acute inflammation
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11
Q

When can resolution occur after viral hepatitis?

A
  • A

- E

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12
Q

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

A
  • A
  • B
  • E
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13
Q

When can there be progression to chronic hepatitis and cirrhosis?

A
  • B

- C

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14
Q

What is alcoholic liver disease?

A

A response of the liver to excess alcohol

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15
Q

What occurs in alcoholic liver disease?

A
  • Fatty change
  • Alcoholic hepatitis
  • Progression to cirrhosis
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16
Q

What happens in alcoholic hepatitis?

A
  • Acute inflammation
  • Liver cell death
  • Liver failure
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17
Q

What is the physiology behind jaundice?

A
  • Increased circulating bilirubin

- Cause by altered metabolism of bilirubin

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18
Q

What is the pathway of bilirubin metabolism?

A
  • Pre-hepatic
  • Hepatic
  • Post-hepatic
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19
Q

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

A
  • Breakdown of haemoglobin in spleen to form haem and globin
  • Haem converted to bilirubin
  • Release of bilirubin into circulation
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20
Q

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

A
  • Uptake of bilirubin by hepatocytes
  • Conjugation of bilirubin in hepatocytes
  • Excretion of conjugated bilirubin into biliary system
21
Q

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

A
  • Transport of conjugated bilirubin in biliary system
  • Breakdown of bilirubin conjugate in intestine
  • Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)
22
Q

How can jaundice be classified?

A
  • Pre-hepatic
  • Hepatic
  • Post-hepatic
23
Q

What causes pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells (haemolysis)

24
Q

What are the hepatic causes of jaundice?

A
  • Cholestasis

- Intra-hepatic bile duct obstruction

25
Q

Cholestasis

A

Accumulation of bile within hepatocytes or bile canaliculi

26
Q

What are some causes of cholestasis?

A
  • Viral hepatitis
  • Alcoholic hepatitis
  • Liver failure
  • Drugs (therapeutic/recreational)
27
Q

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

A
  • Predictable: dose related

- Unpredictable: Not dose related

28
Q

What can cause intra-hepatic bile duct obstruction?

A
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
  • Tumours of the liver
29
Q

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

A
  • Hepatocellular carcinoma
  • Tumours of intra-hepatic bile ducts
  • Metastatic tumours
30
Q

What is primary biliary cholangitis?

A
  • An organ specific auto-immune disease that mainly affects female
  • Anti-mitochondrial auto-antibodies
  • Raised serum alkaline phosphatase
31
Q

What is the pathology of primary biliary cholangitis?

A
  • Granulomatous inflammation involving bile ducts
  • Loss of intra-hepatic bile ducts
  • Progression to cirrhosis
32
Q

What is primary sclerosing cholangitis?

A
  • Chronic inflammation and fibrous obliteration of bile ducts
  • Loss of intra0hepatic bile ducts
33
Q

What is primary sclerosing cholangitis associated with?

A

Inflammatory bowel disease

34
Q

What can primary sclerosing cholangitis progress to?

A

Cirrhosis

35
Q

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

A

Cholangiocarcinoma

36
Q

Hepatic cirrhosis

A

End stage chronic liver disease as a response to chronic injury

37
Q

What can cause cirrhosis?

A
  • Alcohol
  • Hepatitis B, C
  • Immune mediated liver disease
  • Metabolic disorders
  • Obesity
  • Cryptogenic
38
Q

What immune mediated liver diseases can cause cirrhosis?

A
  • Auto-immune hepatitis

- Primary biliary cholangitis

39
Q

What metabolic disorders can cause cirrhosis?

A
  • Excess iron: primary haemochromatosis

- Excess copper: Wilsons’ disease

40
Q

What is the pathology of liver cirrhosis?

A
  • Diffuse process involving whole liver
  • Loss of normal liver structure
  • Replaced by nodules of hepatocytes and fibrous tissue
41
Q

What are the complications of cirrhosis?

A
  • Altered liver function (liver failure)
  • Abnormal blood flow (portal hypertension)
  • Increased risk of hepatocellular carcinoma
42
Q

Give examples of liver tumours.

A
  • Hepatocellular carcinoma: malignant tumour of hepatocytes
  • Cholangiocarcinoma: malignant tumour of bile duct epithelium
  • Metastatic tumours
43
Q

What are post-hepatic causes of jaundice?

A
  • Cholelithiasis (gallstones)
  • Diseases of gall bladder
  • Extra-hepatic duct obstruction
44
Q

What are 2 risk factors for gallstones?

A
  • Obesity

- Diabetes

45
Q

What is the pathology of gallstones?

A

Inflammation

  • Acute cholecystitis
  • Chronic cholecystitis
46
Q

Describe acute cholecystitis.

A
  • Acute inflammation of gall bladder: empyema (perforation of gall bladder/ biliary peritonitis)
  • Progression to chronic inflammation
47
Q

What are the causes of common bile duct obstruction?

A
  • Gallstones
  • Bile duct tumours
  • Benign stricture
  • External compression (tumours)
48
Q

What are the effects of common bile duct obstruction?

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

Systems: Alimentary AB (37 decks)

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