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GI System > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

1
Q

What is the blood supply of the liver?

A

Receives dual blood supply from the hepatic artery and portal vein

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2
Q

Name three function of the liver

A
  • Protein synthesis
  • Metabolism of fat and carbohydrate
  • Detoxification of drugs and toxins including alcohol
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3
Q

Name five different pathologies of the liver

A
  • Liver failure
  • Jaundice
  • Intrahepatic bile duct obstruction
  • Cirrhosis
  • Tumours
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4
Q

Name a pathology of the gall bladder

A

Inflammation

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5
Q

Name a pathology of the extrahepatic bile ducts

A

Obstruction

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6
Q

What is liver failure

A

A complication of acute liver injury or chronic end-stage liver injury (i.e. cirrhosis)

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7
Q

Name two types of acute liver injury

A

Hepatitis and bile duct obstruction

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8
Q

Name three causes of hepatitis

A

Viruses, alcohol, drugs

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9
Q

How does bile duct obstruction cause acute liver injury?

A

Bile backs up into the liver which is damaging as it is toxic to it

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10
Q

Name different types of viral hepatitis and its pathology

A

A, B, C, E (D is closely related) and other viruses

Inflammation of liver cells -> liver cell damage and death of individual hepatocytes

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11
Q

What are the three possible outcomes for an acute liver injury?

A

Resolution = returns to normal (Hepatitis A & E)

Liver failure if severe damage to liver (Hepatitis A, B & E)

Progression to chronic hepatitis and cirrhosis (Hepatitis B & C)

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12
Q

What is the progression of alcoholic liver disease?

A
  1. Response of liver to excess alcohol
  2. Causes a fatty change – liver becomes fatty and fat accumulates in hepatocytes
  3. Alcoholic hepatitis
    • Acute inflammation
    • Liver cell death
    • Liver failure
  4. Progress to cirrhosis (with recurrent episodes of alcohol excess)
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13
Q

What is jaundice?

A

Cardinal sign of liver disease caused by increased circulating bilirubin caused by altered metabolism of bilirubin

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14
Q

What are the three stages of bilirubin metabolism?

A
  1. Pre-hepatic
  2. Hepatic
  3. Post-hepatic
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15
Q

What occurs in the pre-hepatic phase of bilirubin metabolism?

A
  1. Formed from breakdown of haemoglobin in spleen to form haem and globin
  2. Haem -> bilirubin
  3. Release of bilirubin into circulation
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16
Q

What occurs in the hepatic phase of bilirubin metabolism?

A
  1. Uptake of bilirubin by hepatocytes
  2. Conjugation of bilirubin in hepatocytes (making it more soluble to allow diffusion)
  3. Excretion of conjugated bilirubin into biliary system
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17
Q

What occurs in the post-hepatic phase of bilirubin metabolism?

A
  1. Transport of conjugated bilirubin in biliary system
  2. Breakdown of bilirubin conjugate in intestine
  3. Re-absorption of bilirubin ( entero-hepatic circulation of bilirubin)
18
Q

What are three different types of causes of jaundice?

A

Pre-hepatic, hepatic and post-hepatic

19
Q

Name a pre-hepatic cause of jaundice

A

Increased release of haemoglobin from red cells (haemolysis)

20
Q

Name hepatic causes of jaundice

A
  • Cholestasis (reduction in bile flow)

* Intra-hepatic bile duct obstruction

21
Q

Name post-hepatic causes of jaundice

A
  • Cholelithiasis (gallstones)
  • Diseases of gall bladder
  • Extra-hepatic duct obstruction
22
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi causing reduce bile flow

23
Q

What are four causes of cholestasis?

A
  • Viral hepatitis
  • Alcoholic hepatitis
  • Liver failure
  • Drugs: therapeutic or recreational
24
Q

Name three causes of intra-hepatic bile duct obstruction

A
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
  • Tumours of liver
25
Q

What is primary biliary cholangitis?

A

Organ specific auto-immune disease damaging the biliary ducts

  • Mainly affects females
  • Anti-mitochondrial auto-antibodies in serum
  • Raised serum alkaline phosphatase
26
Q

Describe the pathology of primary biliary cholangitis

A
  1. Granulomatous inflammation involving bile ducts
  2. Loss of intra-hepatic bile ducts
  3. Progression to cirrhosis
27
Q

What is primary sclerosing cholangitis?

A
  • Chronic inflammation and fibrous obliteration of bile ducts
  • Loss of intra-hepatic bile ducts
  • Progression to cirrhosis
  • Increased risk of development of cholangiocarcinoma
28
Q

What is hepatic cirrhosis?

A

End-stage chronic liver disease that occurs in response of liver to chronic injury

29
Q

Name six different causes of hepatic cirrhosis

A 
• Alcohol 
• Hepatitis B, C
• Immune mediated liver disease 
  - Autoimmune hepatitis 
  - Primary biliary cholangitis 
• Metabolic disorders 
  - Excess iron (primary haemochromatosis)
  - Excess copper (Wilson’s disease)
• Obesity - Diabetes 
• Cryptogenic (unknown)
30
Q

Describe the pathology of hepatic cirrhosis

A
  1. Diffuse process involving whole liver
  2. Loss of normal liver structure
  3. Replaced by nodules of hepatocytes and fibrous tissue
31
Q

Name three possible complications of hepatic cirrhosis

A

• Altered liver function (liver failure)
• Abnormal blood flow (portal hypertension)
o Spleen enlarges
o Dilatation of porto-systemic venous anastomosis
• Increased risk of hepatocellular carcinoma

32
Q

Name three different types of liver tumours

A
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Metastatic tumours
33
Q

What is Hepatocellular carcinoma?

A

Malignant tumour of hepatocytes

• Main risk factor: cirrhosis

34
Q

What is cholangiocarcinoma?

A

Malignant tumour of bile duct epithelium

35
Q

What are the two types of inflammation of the gall bladder?

A

Acute and chronic cholecystitis

36
Q

What is acute cholecystitis?

A

Acute inflammation of gall bladder

37
Q

What is a complication of acute cholecystitis?

A

Empyema – causes:
• Perforation of gall bladder
• Biliary peritonitis

Progression to chronic cholecystitis

38
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of gall bladder

39
Q

Why is there RUQ pain in chronic cholecystitis?

A

Gallbladder is a muscular structure which contracts to release bile into the bile duct, so fibrosis impairs muscle and therefore abnormal function causing RUQ pain

40
Q

Name four causes of bile duct obstruction

A
  • Gall stones
  • Bile duct tumour
  • Benign stricture
  • External compression (tumour i.e. tumour of pancreas can press on duct)
41
Q

Name four effects of common bile duct obstruction

A
  • Jaundice
  • No bile excreted in duodenum
  • Infection of bile proximal to obstruction (ascending cholangitis)
  • Secondary bilary cirrhosis if obstruction prolonged

GI System (28 decks)

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