Hepato-Biliary Pathology

Question 1

What is the inflammatory pathology of the gallbladder?

Answer 1

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

Question 2

What is the pathology of bile duct obstruction?

Answer 2

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

Question 3

What different pathologies can occur within the Liver?

Answer 3

Liver failure

Jaundice

Intrahepatic bile duct obstruction

Cirrhosis

Tumours

Question 4

What is liver failure?

Answer 4

It is a complication of either:

1) Acute Liver Injury
2) Chronic Liver Injury (cirrhosis)

Question 5

What are the causes of acute liver injury and what is it?

Answer 5

Acute Liver Injury - Damage or death of liver cells

1) Heaptitis - Virus, alcohol, drugs
2) Bile duct obstruction

Question 6

What are the different types of Viral Hepatitis?

Answer 6

A

B

C

E

Others

Question 7

What is the pathology of viral hepatitis?

Answer 7

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)

Question 8

What is alcoholic liver disease?

Answer 8

• 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

Question 9

What is the cause of jaundice?

Answer 9

Increased circulating bilirubin, caused by altered metabolism of bilirubin

Question 10

What are the different ways in which bilirubin metabolism can be altered?

Answer 10

1) Pre-hepatic
2) Hepatic
3) Post-hepatic

Question 11

What is the metabolic pathway of bilirubin in the pre-hepatic stage?

Answer 11

1) Haemoglobin is broken down in spleen to form haem and globin
2) Haem converted to bilirubin
3) Release of bilirubin into circulation

Question 12

What is the metabolic pathway of bilirubin in the hepatic phase?

Answer 12

1) Uptake of bilirubin by hepatocytes
2) Bilirubin is conjugated in hepatocytes
3) Excretion of conjugated bilirubin into biliary system

Question 13

What is the post-hepatic pathway of metabolism of bilirubin?

Answer 13

1) Conjugated bilirubin is transported in the biliary system
2) Breakdown of bolirubin conjugate in intestine
3) Re-absorption of bilirubin (entero-hepatic circulation)

Question 14

What are the causes of pre-hepatic jaundice?

Answer 14

Increased release of haemoglobin from red blood cells

Question 15

What are the hepatic causes of jaundice?

Answer 15

1) Viral hepatitis
2) Alcoholic hepatitis
3) Liver failure
4) Drugs
5) Bilary/sclerosing cholangitis
6) Tumours of liver

Question 16

What is cholestasis?

Answer 16

Accumulation of bile within hepatocytes or bile canaliculi

Question 17

What are the causes of cholestasis?

Answer 17

1) Viral hepatitis
2) Alcoholic hepatitis
3) Liver failure
4) Drugs (therapeutic or recreational)

Question 18

What can cause intra-hepatic bile duct obstruction?

Answer 18

1) Primary biliary cholangitis
2) Primary sclerosing cholangitis
3) Tumours of liver

Question 19

What is primary biliary cholangitis?

Answer 19

1) Organ specific auto-immune disease
2) Mainly affects females
3) Raised Anti-mitochondrial and alkaline phosphotase in serum good indicators

Question 20

What is the pathology of primary biliary cholangitis?

Answer 20

1) Granulomatous inflammation involving bile ducts
2) Loss of intra hepatic bile ducts
3) Progression to cirrhosis

Question 21

What is primary sclerosing cholangitis

Answer 21

1) Chronic inflammation and fibrous obliteration of bile ducts
2) Loss of intra-hepatic bile ducts
3) Associated with IBD
4) Progression to cirrhosis

Question 22

What is hepatic cirrhosis?

Answer 22

End-stage chronic liver disease - a response to a chronic liver injury

Question 23

What are the causes of liver cirrhosis?

Answer 23

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)

Question 24

What is the pathology of cirrhosis?

Answer 24

1) Diffuse process involving whole liver
2) Loss or normal liver structure
3) Replaced by nodules of hepatocytes and fibrous tissue

Question 25

What are some of the complications of cirrhosis?

Answer 25

1) Liver failure
2) Abnormal blood flow (portal hypertension - proximal end of oesophagus most affected)
3) Increased risk of hepatocellular carcinoma

Question 26

What are some common tumours of the liver?

Answer 26

1) Hepatocellular carcinoma
2) Cholangiocarcinoma
3) Metastatic tumours (most common - common site of metastasis)

Question 27

What are the risk factors for gallstones?

Answer 27

1) Obesity
2) Diabetes