Hepato-biliary Pathology Flashcards
Liver failure is a complication of what?
Acute or Chronic liver injury
Acute causes of liver injury?
Hepatitis
Bile duct obstruction
What are the main types of hepatitis?
Viral
Autoimmune
Drug
Alcohol
What viruses cause Hepatitis?
Hep A, B, C, E
Epstein Barr
How does viral hepatitis cause damage?
Inflammation
Damage/death of individual liver cells
Possible outcomes of acute Hepatitis A, E?
Resolution - return to normal
Possible outcomes of acute Hep A, B, E?
Liver failure in severe damage
Possible outcomes of acute Hep B, C?
Progression to chronic hepatitis - cirrhosis
Which forms of hepatitis are blood borne?
Hep B, C
What is the process to cirrhosis in alcoholic liver disease
Fatty change in liver
Alcoholic hepatitis
(acute inflam, liver cell death)
Cirrhosis
What is the cause of jaundice?
Increased circulating bilirubin
What is the pre-hepatic metabolism of bilirubin?
Haemoglobin broken down in spleen -> haem and globin
Haem -> bilirubin
Bilirubin released
What is the hepatic metabolism of bilirubin?
Bilirubin -> hepatocytes
Conjugation of bilirubin
Excretion into biliary system
Why is bilirubin conjugated in the hepatocytes?
Increase solubility
What is the post-hepatic metabolism of bilirubin?
Biliary system –> intestine
Broken down and re-absorbed
What is the cause of pre-hepatic jaundice?
Increased haemolysis, not related to the liver
What are the hepatic causes of jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
Accumulation of bile within the hepatocytes or canaliculi
What causes Cholestasis?
Viral, Alcoholic Hep
Liver failure
Drugs (must be excluded)
Causes of Intra-hepatic bile duct obstruction
Primary biliary Cholangitis
Primary sclerosing cholangitis
Liver tumours
What is Primary Biliary Cholangitis?
Autoimmune disease, causing granulomatous inflammation in bile ducts
Progresses to cirrhosis
What are the tests for primary biliary cholangitis?
Anti-mitochondrial auto-antibodies in serum
Raised serum alkaline phosphatase
What is primary sclerosing cholangitis?
Chronic inflammation leading to fibrotic obliteration of bile ducts
Primary sclerosing cholangitis is associated with what?
Chronic Inflammatory Bowel disease
Primary sclerosing cholangitis can progress to what?
Cirrhosis
Cholangiocarcinoma
What is hepatic cirrhosis?
End stage liver disease
What are the causes of cirrhosis?
Alcohol Hep B, C Immune mediated liver diseases Excess iron, copper Obesity Cryptogenic (most common)
What are the complications of cirrhosis?
Liver failure
Portal hypertension
Hepatocellular carcinoma
Hepatocellular carcinoma are tumours of what?
Malignant tumour of hepatocyte
Cholangiocarcinoma are tumours of what?
Malignant tumours of bile ducts
What are the post-hepatic causes of jaundice?
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
Risk factors for Gallstones
Obesity
Diabetes
What are the outcomes of acute cholecystitis
Empyema leading to perforation - peritonitis
Progression to chronic disease
Chronic cholecystitis leads to what?
Fibrosis of the gallbladder wall leading to impairment of gallbladder contraction (pain)
Causes of common bile duct obstruction?
Gallstones
Bile duct tumours
Stricture
Compression (tumours)
Effects of common bile duct obstruction
Jaundice
Infection of proximal bile duct
Seconday biliary cirrhosis
