Hepato-Biliary Pathology Flashcards
What is the inflammatory pathology of the gallbladder?
Acute cholecystitis:
1) Acute inflammation of gall bladder:
- Empyema (perforation of gallbladder and biliary peritonitis)
2) Progression to chronic inflammation
Chronic cholecystitis:
1) Chronic inflammation and fibrosis of gall bladder
What is the pathology of bile duct obstruction?
Caused by:
1) Gall stones
2) Bile duct tumours
3) Benign stricture
4) External compression (tumours)
Effects of bile duct obstruction:
1) Jaundice
2) No bile excreted into duodenum
3) Bile infected proximal to obstruction
4) Secondary biliary cirrhosis if obstruction prolonged
What different pathologies can occur within the Liver?
Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours
What is liver failure?
It is a complication of either:
1) Acute Liver Injury
2) Chronic Liver Injury (cirrhosis)
What are the causes of acute liver injury and what is it?
Acute Liver Injury - Damage or death of liver cells
1) Heaptitis - Virus, alcohol, drugs
2) Bile duct obstruction
What are the different types of Viral Hepatitis?
A
B
C
E
Others
What is the pathology of viral hepatitis?
1) Inflammation of Liver
2) Liver cell damage and death of individual liver cells
3) Outcome of acute inflammation:
- Resolution = return to normal (A,E)
- Liver failure if severe damage to liver (A,B,E)
- Progression to chronic hepatitis and cirrhosis (B,C)
What is alcoholic liver disease?
- The response of the liver to exccess alcohol
- There is a change in the liver making it more fatty
- Alcoholic hepatitis can be acquired as a result
- Alcoholic liver disease can progress to cirrhosis
What is the cause of jaundice?
Increased circulating bilirubin, caused by altered metabolism of bilirubin
What are the different ways in which bilirubin metabolism can be altered?
1) Pre-hepatic
2) Hepatic
3) Post-hepatic
What is the metabolic pathway of bilirubin in the pre-hepatic stage?
1) Haemoglobin is broken down in spleen to form haem and globin
2) Haem converted to bilirubin
3) Release of bilirubin into circulation
What is the metabolic pathway of bilirubin in the hepatic phase?
1) Uptake of bilirubin by hepatocytes
2) Bilirubin is conjugated in hepatocytes
3) Excretion of conjugated bilirubin into biliary system
What is the post-hepatic pathway of metabolism of bilirubin?
1) Conjugated bilirubin is transported in the biliary system
2) Breakdown of bolirubin conjugate in intestine
3) Re-absorption of bilirubin (entero-hepatic circulation)
What are the causes of pre-hepatic jaundice?
Increased release of haemoglobin from red blood cells
What are the hepatic causes of jaundice?
1) Viral hepatitis
2) Alcoholic hepatitis
3) Liver failure
4) Drugs
5) Bilary/sclerosing cholangitis
6) Tumours of liver
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
What are the causes of cholestasis?
1) Viral hepatitis
2) Alcoholic hepatitis
3) Liver failure
4) Drugs (therapeutic or recreational)
What can cause intra-hepatic bile duct obstruction?
1) Primary biliary cholangitis
2) Primary sclerosing cholangitis
3) Tumours of liver
What is primary biliary cholangitis?
1) Organ specific auto-immune disease
2) Mainly affects females
3) Raised Anti-mitochondrial and alkaline phosphotase in serum good indicators
What is the pathology of primary biliary cholangitis?
1) Granulomatous inflammation involving bile ducts
2) Loss of intra hepatic bile ducts
3) Progression to cirrhosis
What is primary sclerosing cholangitis
1) Chronic inflammation and fibrous obliteration of bile ducts
2) Loss of intra-hepatic bile ducts
3) Associated with IBD
4) Progression to cirrhosis
What is hepatic cirrhosis?
End-stage chronic liver disease - a response to a chronic liver injury
What are the causes of liver cirrhosis?
1) Alcohol
2) Hepatitis B&C
3) Immune mediated liver disease (auto-immune hepatitis)
4) Metabolic disorders (excess iron or excess copper (wilsons disease)
5) Obesity -DM
6) Cryptogenic (unknown cause - most common)
What is the pathology of cirrhosis?
1) Diffuse process involving whole liver
2) Loss or normal liver structure
3) Replaced by nodules of hepatocytes and fibrous tissue
