Hepato-Biliary Pathology Flashcards
Function of the liver
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
Pathologies of the liver
Liver failure Jaundice Intrahepatic bile duct obstruction Cirrhosis Tumours
Pathology of the gallbladder
Inflammation
Pathology of the extrahepatic bile ducts
Obstruction
Liver failure as a complication of
Acute liver injury
Chronic liver injury
Acute liver injury
Hepatitis from viruses, drugs or alcohol
Bile duct obstruction
Pathology of viral hepatitis
Inflammation of liver
Liver cell damage and death of individual liver cells
Outcome of acute inflammation to the liver
Resolution
Liver failure if severe damage to liver
Progression to chronic hepatitis and cirrhosis
Alcoholic liver disease
Response of liver to excess alcohol
Fatty change
Alcoholic hepatitis
Progress to cirrhosis
Jaundice caused by
Altered metabolism of bilirubin => increased circulating bilirubin
Pre-hepatic pathway of bilirubin metabolism
Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation
Pre-hepatic jaundice
Increased release of haemoglobin from RBCs (haemolysis)
Hepatic pathway of bilirubin metabolism
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system
Hepatic jaundice
Cholestasis
Intra-hepatic bile duct obstruction
Post-hepatic pathway of bilirubin metabolism
Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin
Post-hepatic jaundice
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
Intra-hepatic bile duct obstruction
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver
Tumours of the liver
Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours
Primary biliary cholangitis
Granulomatous inflammation involving bile ducts - loss of hepatic ducts leads to cirrhosis
Increased risk of cholangiocarcinoma
What is hepatic cirrhosis?
End stage chronic liver disease - response of liver to chronic injury
Causes of hepatic cirrhosis
Alcohol Hepatitis B, C Immune mediated liver disease (auto-immune hepatitis, primary biliary cholangitis) Metabolic disorders (excess iron/copper) Obesity (diabetes mellitus) Cryptogenic
Cryptogenic
Unknown cause
Pathology of cirrhosis
Diffuse process involving whole liver
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue
Complications of cirrhosis
Altered liver function (liver failure)
Abnormal blood flow (portal hypertension)
Increased risk of hepatocellular carcinoma
Hepatocellular carcinoma
Malignant tumour of hepatocytes
Cholangiocarcinoma
Malignant tumour of bile duct epithelium
Cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
Risk factors for gallstones
Obesity
Diabetes
Acute cholecystitis
Acute inflammation of gall bladder
Empyema (perforation of gall bladder, biliary peritonitis)
Chronic cholecystitis
Chronic inflammation and fibrosis of gall bladder
Causes of common bile duct obstruction
Gallstones
Bile duct tumours
Benign stricture
External compression (tumours)
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
