Hepato-biliary Pathology

Question 1

What are the causes of acute liver injury?

Answer 1

Hepatitis (can be caused by viruses, alcohol or drugs)

Bile duct obstruction

Question 2

Describe the pathology of viral hepatitis

Answer 2

Inflammation of the liver causes liver cell damage and death of individual liver cells

Question 3

What are the potential outcomes of acute inflammation caused by hepatitis, and what kinds of hepatitis can cause each?

Answer 3

Resolution/returns to normal- can result from hepatitis A and E
Liver failure if severe damage to liver- can result from hepatitis A, B and E
Progression to chronic hepatitis and cirrhosis- can result from hepatitis B and C

Question 4

Describe the pathology of alcoholic liver disease

Answer 4

Excess alcohol upsets metabolism of fat and causes fatty change in the liver. This causes alcoholic hepatitis, resulting in acute inflammation, liver cell death and liver failure. It can progress to cirrhosis.

Question 5

What causes jaundice?

Answer 5

Altered metabolism of bilirubin causes an increase in circulating bilirubin

Question 6

Describe the pre-hepatic part of bilirubin metabolism

Answer 6

Haemoglobin is broken down in the spleen to form haem and globin
Haem converted to bilirubin
Bilirubin released into circulation

Question 7

Describe the hepatic part of bilirubin metabolism

Answer 7

Bilirubin is taken up by hepatocytes
Bilirubin is conjugated in hepatocytes
Conjugated bilirubin is excreted into the biliary system

Question 8

Describe the post hepatic part of bilirubin metabolism

Answer 8

Conjugated bilirubin is transported in the biliary system
Bilirubin conjugate is broken down in the intestine
Bilirubin is then reabsorbed

Question 9

What is the cause of pre-hepatic jaundice

Answer 9

Increased release of haemoglobin from red cells

Question 10

What are the hepatic causes of jaundice?

Answer 10

Cholestasis

Intra-hepatic bile duct obstruction

Question 11

What is cholestasis?

Answer 11

An accumulation of bile within hepatocytes or bile canaliculi

Question 12

What are the causes of cholestasis?

Answer 12

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drug use (recreational or therapeutic)

Question 13

What are the two kinds of drug-induced cholestasis?

Answer 13

Predictable- dose related

Unpredictable- not dose related

Question 14

What are the common causes of intra-hepatic bile duct obstruction?

Answer 14

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver

Question 15

What is primary biliary cholangitis and who does it affect?

Answer 15

An organ specific auto-immune disease affected mainly females (9:1)

Question 16

What changes appear in the serum in cases of primary biliary cholangitis?

Answer 16

Anti-mitochondrial auto-antibodies In serum

Raised serum alkaline phosphatase

Question 17

Describe the pathology of primary biliary cholangitis

Answer 17

Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis

Question 18

With what disease is primary sclerosing cholangitis associated?

Answer 18

Inflammatory bowel disease

Question 19

Describe the pathology of primary sclerosing cholangitis

Answer 19

Chronic inflammation and fibrous obliteration of bile ducts causes loss of intra-hepatic bile ducts
Can progress to cirrhosis

Question 20

What disease does primary sclerosing cholangitis increase the risk of?

Answer 20

Cholangiocarcinoma

Question 21

What are the causes of heptic cirrhosis?

Answer 21

Alcohol
Hepatitis B and C
Immune  mediated liver disease 
Metabolic disorders (excess iron or copper)
Obesity 
Cryptogenic (commonest cause)

Question 22

Describe the pathology of hepatic cirrhosis

Answer 22

Diffuse process involving the whole liver

Loss of normal liver structure- replaced by nodules of hepatocytes and fibrous tissue

Question 23

What are the possible complications of cirrhosis?

Answer 23

Altered liver function- can cause liver failure
Abnormal blood flow- can cause portal hypertension
Increased risk of hepatocellular carcinoma

Question 24

What are the three most common liver tumours and what does each affect?

Answer 24

Hepatocellular carcinoma- malignant tumour of hepatocytes
Cholangiocarcinoma- malignant tumour of bile duct epithelium
Metastatic tumours (liver is common site of metastases)

Question 25

What are the causes of post-hepatic jaundice

Answer 25

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

Question 26

What are the risk factors for gallstones?

Answer 26

Obesity and diabetes

Question 27

What can gallstones cause in the gallbladder?

Answer 27

Acute or chronic cholecystitis

Question 28

What is acute cholecystitis and what are it’s complications?

Answer 28

Acute inflammation of gall bladder
Can cause empyema, perforation of gall bladder and biliary peritonitis
Can progress to chronic inflammation

Question 29

What is chronic cholecystitis?

Answer 29

Chronic inflammation and fibrosis of gall bladder

Question 30

What are the common causes of common bile duct obstruction?

Answer 30

Gallstones
Bile duct tumours
Benign stricture
External compression (tumours)

Question 31

What are the effects of common bile duct obstruction?

Answer 31

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

Question 32

What are the risk factors for cholangiocarcinoma?

Answer 32

Age
Primary sclerosing cholangitis (strong association)
Congenital cystic disease 
Biliary-enteric drainage 
Thorotrast (contrast)
Hepatolithiasis

Question 33

How does cholangiocarcinoma present?

Answer 33

Obstructive jaundice
Itching
Non-specific symptoms