Hepato-biliary Pathology Flashcards
What are the causes of acute liver injury?
Hepatitis (can be caused by viruses, alcohol or drugs)
Bile duct obstruction
Describe the pathology of viral hepatitis
Inflammation of the liver causes liver cell damage and death of individual liver cells
What are the potential outcomes of acute inflammation caused by hepatitis, and what kinds of hepatitis can cause each?
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
Describe the pathology of alcoholic liver disease
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.
What causes jaundice?
Altered metabolism of bilirubin causes an increase in circulating bilirubin
Describe the pre-hepatic part of bilirubin metabolism
Haemoglobin is broken down in the spleen to form haem and globin
Haem converted to bilirubin
Bilirubin released into circulation
Describe the hepatic part of bilirubin metabolism
Bilirubin is taken up by hepatocytes
Bilirubin is conjugated in hepatocytes
Conjugated bilirubin is excreted into the biliary system
Describe the post hepatic part of bilirubin metabolism
Conjugated bilirubin is transported in the biliary system
Bilirubin conjugate is broken down in the intestine
Bilirubin is then reabsorbed
What is the cause of pre-hepatic jaundice
Increased release of haemoglobin from red cells
What are the hepatic causes of jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
An accumulation of bile within hepatocytes or bile canaliculi
What are the causes of cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drug use (recreational or therapeutic)
What are the two kinds of drug-induced cholestasis?
Predictable- dose related
Unpredictable- not dose related
What are the common causes of intra-hepatic bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver
What is primary biliary cholangitis and who does it affect?
An organ specific auto-immune disease affected mainly females (9:1)
What changes appear in the serum in cases of primary biliary cholangitis?
Anti-mitochondrial auto-antibodies In serum
Raised serum alkaline phosphatase
Describe the pathology of primary biliary cholangitis
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
With what disease is primary sclerosing cholangitis associated?
Inflammatory bowel disease
Describe the pathology of primary sclerosing cholangitis
Chronic inflammation and fibrous obliteration of bile ducts causes loss of intra-hepatic bile ducts
Can progress to cirrhosis
What disease does primary sclerosing cholangitis increase the risk of?
Cholangiocarcinoma
What are the causes of heptic cirrhosis?
Alcohol Hepatitis B and C Immune mediated liver disease Metabolic disorders (excess iron or copper) Obesity Cryptogenic (commonest cause)
Describe the pathology of hepatic cirrhosis
Diffuse process involving the whole liver
Loss of normal liver structure- replaced by nodules of hepatocytes and fibrous tissue
What are the possible complications of cirrhosis?
Altered liver function- can cause liver failure
Abnormal blood flow- can cause portal hypertension
Increased risk of hepatocellular carcinoma
What are the three most common liver tumours and what does each affect?
Hepatocellular carcinoma- malignant tumour of hepatocytes
Cholangiocarcinoma- malignant tumour of bile duct epithelium
Metastatic tumours (liver is common site of metastases)
What are the causes of post-hepatic jaundice
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
What are the risk factors for gallstones?
Obesity and diabetes
What can gallstones cause in the gallbladder?
Acute or chronic cholecystitis
What is acute cholecystitis and what are it’s complications?
Acute inflammation of gall bladder
Can cause empyema, perforation of gall bladder and biliary peritonitis
Can progress to chronic inflammation
What is chronic cholecystitis?
Chronic inflammation and fibrosis of gall bladder
What are the common causes of common bile duct obstruction?
Gallstones
Bile duct tumours
Benign stricture
External compression (tumours)
What are the effects of common bile duct obstruction?
Jaundice
No bile excreted into duodenum
Infection of bile duct proximal to obstruction (ascending cholangitis)
Secondary biliary cirrhosis if obstruction prolonged
What are the risk factors for cholangiocarcinoma?
Age Primary sclerosing cholangitis (strong association) Congenital cystic disease Biliary-enteric drainage Thorotrast (contrast) Hepatolithiasis
How does cholangiocarcinoma present?
Obstructive jaundice
Itching
Non-specific symptoms
