Hepato-Biliary Pathology Flashcards
What is the structure of a normal liver?
- Dual blood supply
- Hepatic artery
- Portal vein
What is the function of a normal liver?
- Protein synthesis
- Metabolism of fat and carbohydrate
- Detoxification of drugs and toxins
Give examples of liver pathology.
- Liver failure
- Jaundice
- Intrahepatic bile duct obstruction
- Cirrhosis
- Tumours
Give an example of pathology in the gall bladder.
Inflammation
Give an example of pathology in the extrahepatic bile ducts
Obstruction
What is liver failure a complication of?
- Acute liver injury
- Chronic liver injury
What can cause acute liver injury?
- Hepatitis
- Bile duct obstruction
What can cause hepatitis?
- Viruses
- Alcohol
- Drugs
Give examples of viral hepatitis.
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis E
- Other viruses
What is the pathology of viral hepatitis?
- Inflammation of the liver
- Liver cell damage and death of individual liver cells
- Outcome of acute inflammation
When can resolution occur after viral hepatitis?
- A
- E
When can liver failure occur after severe damage to the liver in the case of hepatitis?
- A
- B
- E
When can there be progression to chronic hepatitis and cirrhosis?
- B
- C
What is alcoholic liver disease?
A response of the liver to excess alcohol
What occurs in alcoholic liver disease?
- Fatty change
- Alcoholic hepatitis
- Progression to cirrhosis
What happens in alcoholic hepatitis?
- Acute inflammation
- Liver cell death
- Liver failure
What is the physiology behind jaundice?
- Increased circulating bilirubin
- Cause by altered metabolism of bilirubin
What is the pathway of bilirubin metabolism?
- Pre-hepatic
- Hepatic
- Post-hepatic
What does the pre-hepatic part of the metabolism of bilirubin involve?
- Breakdown of haemoglobin in spleen to form haem and globin
- Haem converted to bilirubin
- Release of bilirubin into circulation
What does the hepatic part of the metabolism of bilirubin involve?
- Uptake of bilirubin by hepatocytes
- Conjugation of bilirubin in hepatocytes
- Excretion of conjugated bilirubin into biliary system
What does the post-hepatic part of the metabolism of bilirubin involve?
- Transport of conjugated bilirubin in biliary system
- Breakdown of bilirubin conjugate in intestine
- Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)
How can jaundice be classified?
- Pre-hepatic
- Hepatic
- Post-hepatic
What causes pre-hepatic jaundice?
Increased release of haemoglobin from red cells (haemolysis)
What are the hepatic causes of jaundice?
- Cholestasis
- Intra-hepatic bile duct obstruction
Cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
What are some causes of cholestasis?
- Viral hepatitis
- Alcoholic hepatitis
- Liver failure
- Drugs (therapeutic/recreational)
What is meant by predictable and unpredictable drug-induced cholestasis?
- Predictable: dose related
- Unpredictable: Not dose related
What can cause intra-hepatic bile duct obstruction?
- Primary biliary cholangitis
- Primary sclerosing cholangitis
- Tumours of the liver
What tumours of the liver can cause intra-hepatic bile duct obstruction?
- Hepatocellular carcinoma
- Tumours of intra-hepatic bile ducts
- Metastatic tumours
What is primary biliary cholangitis?
- An organ specific auto-immune disease that mainly affects female
- Anti-mitochondrial auto-antibodies
- Raised serum alkaline phosphatase
What is the pathology of primary biliary cholangitis?
- Granulomatous inflammation involving bile ducts
- Loss of intra-hepatic bile ducts
- Progression to cirrhosis
What is primary sclerosing cholangitis?
- Chronic inflammation and fibrous obliteration of bile ducts
- Loss of intra0hepatic bile ducts
What is primary sclerosing cholangitis associated with?
Inflammatory bowel disease
What can primary sclerosing cholangitis progress to?
Cirrhosis
What does primary sclerosing cholangitis put you at increased risk of developing?
Cholangiocarcinoma
Hepatic cirrhosis
End stage chronic liver disease as a response to chronic injury
What can cause cirrhosis?
- Alcohol
- Hepatitis B, C
- Immune mediated liver disease
- Metabolic disorders
- Obesity
- Cryptogenic
What immune mediated liver diseases can cause cirrhosis?
- Auto-immune hepatitis
- Primary biliary cholangitis
What metabolic disorders can cause cirrhosis?
- Excess iron: primary haemochromatosis
- Excess copper: Wilsons’ disease
What is the pathology of liver cirrhosis?
- Diffuse process involving whole liver
- Loss of normal liver structure
- Replaced by nodules of hepatocytes and fibrous tissue
What are the complications of cirrhosis?
- Altered liver function (liver failure)
- Abnormal blood flow (portal hypertension)
- Increased risk of hepatocellular carcinoma
Give examples of liver tumours.
- Hepatocellular carcinoma: malignant tumour of hepatocytes
- Cholangiocarcinoma: malignant tumour of bile duct epithelium
- Metastatic tumours
What are post-hepatic causes of jaundice?
- Cholelithiasis (gallstones)
- Diseases of gall bladder
- Extra-hepatic duct obstruction
What are 2 risk factors for gallstones?
- Obesity
- Diabetes
What is the pathology of gallstones?
Inflammation
- Acute cholecystitis
- Chronic cholecystitis
Describe acute cholecystitis.
- Acute inflammation of gall bladder: empyema (perforation of gall bladder/ biliary peritonitis)
- Progression to chronic inflammation
What are the causes of common bile duct obstruction?
- Gallstones
- Bile duct tumours
- Benign stricture
- External compression (tumours)
What are the effects of common bile duct obstruction?
- Jaundice
- No bile excreted into duodenum
- Infection of bile proximal to obstruction (ascending cholangitis)
- Secondary biliary cirrhosis if obstruction prolonged
