Hepato-Biliary Pathology

Question 1

Function of the liver

Answer 1

Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol

Question 2

Pathologies of the liver

Answer 2

Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours

Question 3

Pathology of the gallbladder

Answer 3

Inflammation

Question 4

Pathology of the extrahepatic bile ducts

Answer 4

Obstruction

Question 5

Liver failure as a complication of

Answer 5

Acute liver injury

Chronic liver injury

Question 6

Acute liver injury

Answer 6

Hepatitis from viruses, drugs or alcohol

Bile duct obstruction

Question 7

Pathology of viral hepatitis

Answer 7

Inflammation of liver

Liver cell damage and death of individual liver cells

Question 8

Outcome of acute inflammation to the liver

Answer 8

Resolution
Liver failure if severe damage to liver
Progression to chronic hepatitis and cirrhosis

Question 9

Alcoholic liver disease

Answer 9

Response of liver to excess alcohol
Fatty change
Alcoholic hepatitis
Progress to cirrhosis

Question 10

Jaundice caused by

Answer 10

Altered metabolism of bilirubin => increased circulating bilirubin

Question 11

Pre-hepatic pathway of bilirubin metabolism

Answer 11

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

Question 12

Pre-hepatic jaundice

Answer 12

Increased release of haemoglobin from RBCs (haemolysis)

Question 13

Hepatic pathway of bilirubin metabolism

Answer 13

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system

Question 14

Hepatic jaundice

Answer 14

Cholestasis

Intra-hepatic bile duct obstruction

Question 15

Post-hepatic pathway of bilirubin metabolism

Answer 15

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin

Question 16

Post-hepatic jaundice

Answer 16

Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction

Question 17

Intra-hepatic bile duct obstruction

Answer 17

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver

Question 18

Tumours of the liver

Answer 18

Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours

Question 19

Primary biliary cholangitis

Answer 19

Granulomatous inflammation involving bile ducts - loss of hepatic ducts leads to cirrhosis
Increased risk of cholangiocarcinoma

Question 20

What is hepatic cirrhosis?

Answer 20

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

Question 21

Causes of hepatic cirrhosis

Answer 21

Alcohol
Hepatitis B, C
Immune mediated liver disease (auto-immune hepatitis, primary biliary cholangitis)
Metabolic disorders (excess iron/copper)
Obesity (diabetes mellitus)
Cryptogenic

Question 22

Cryptogenic

Answer 22

Unknown cause

Question 23

Pathology of cirrhosis

Answer 23

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

Question 24

Complications of cirrhosis

Answer 24

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

Question 25

Hepatocellular carcinoma

Answer 25

Malignant tumour of hepatocytes

Question 26

Cholangiocarcinoma

Answer 26

Malignant tumour of bile duct epithelium

Question 27

Cholestasis

Answer 27

Accumulation of bile within hepatocytes or bile canaliculi

Question 28

Risk factors for gallstones

Answer 28

Obesity

Diabetes

Question 29

Acute cholecystitis

Answer 29

Acute inflammation of gall bladder

Empyema (perforation of gall bladder, biliary peritonitis)

Question 30

Chronic cholecystitis

Answer 30

Chronic inflammation and fibrosis of gall bladder

Question 31

Causes of common bile duct obstruction

Answer 31

Gallstones
Bile duct tumours
Benign stricture
External compression (tumours)

Question 32

Effects of common bile duct obstruction

Answer 32

Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction - ascending cholangitis
Secondary biliary cirrhosis if obstruction prolonged