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*GI System - Pathology > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

1
Q

Describe the blood that the hepatic artery supplies the liver

A

Oxygen rich

Nutrient depleted

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2
Q

Describe the blood that the hepatic portal vein supplies the liver

A

Oxygen depleted

Nutrient rich

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3
Q

What are the functions of the liver (3)?

A

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

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4
Q

Give 5 pathologies which can occur in the liver

A 
Liver failure
Jaundice
Intrahepatic bile duct obstruction 
Cirrhosis
Tumours
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5
Q

What pathology can occur in the gall bladder?

A

Inflammation

?gall stones

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6
Q

What can go wrong with the extrahepatic bile ducts?

A

Obstruction

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7
Q

What is a complication of acute/chronic liver injury?

A

Liver failure

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8
Q

What 2 pathologies can cause acute liver injury?

A

Hepatitis (inflammation of liver)

Bile duct obstruction

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9
Q

What are 3 general causes of hepatitis?

A

Virus
Alcohol
Drugs (almost any drug)

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10
Q

What viruses cause viral hepatitis?

A 
Hep A
Hep B
Hep C
Hep E
Others inc megalovirus, EB virus
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11
Q

What are the 2 general steps of viral hepatitis?

A

Inflammation of liver

Liver cell damage and death of individual liver cells

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12
Q

What hep viruses normally have a resolution?

A

Hep A + E

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13
Q

What hep viruses can cause liver failure if serious damage to liver? (if supported through acute phase, can return to normal)

A

Hep A, B, E

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14
Q

What hep viruses progress to chronic hepatitis and cirrhosis?

A

Hep B + C (blood borne viruses)

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15
Q

What can alcoholic liver disease progress to?

A

Cirrhosis

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16
Q

What change occurs in hepatocytes in alcoholic liver disease?

A

Fat accumulates; leads to acute inflammation, liver cell death and liver failure

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17
Q

What is jaundice caused by?

A

Increased circulating bilirubin (altered metabolism of it)

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18
Q

What are the 3 pathways of bilirubin metabolism (also 3 types of jaundice)?

A
  • pre-hepatic
  • hepatic
  • post-hepatic
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19
Q

Describe the pre-hepatic metabolism of bilirubin

A
  1. Breakdown of haemoglobin in spleen to haem and globin
  2. Haem to bilirubin
  3. Release of bilirubin into circulation
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20
Q

Describe the hepatic metabolism of bilirubin

A
  1. Uptake of bilirubin by hepatocytes
  2. Conjugation of bilirubin in hepatocytes
  3. Excretion of conjugated bilirubin into biliary system
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21
Q

Describe the post-hepatic metabolism of bilirubin

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)
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22
Q

What are the 3 classifications of jaundice?

A
  • pre-hepatic
  • hepatic
  • post-hepatic
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23
Q

Describe the pathology associated with pre-hepatic jaundice

A

Increased release of haemoglobin from red cells (haemolysis)

24
Q

Name 2 hepatic causes of jaundice

A

CHOLESTASIS

INTRA-HEPATIC BILE DUCT OBSTRUCTION

25
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

26
Q

Name 4 causes of cholestasis

A
  • viral hepatitis
  • alcoholic hepatitis
  • liver failure
  • drugs (therapeutic or recreational)
27
Q

What are the 2 types of drug-induced cholestasis?

A

Predictable (dose-related)

Unpredictable (not dose related)

28
Q

Name 3 conditions associated with intra-hepatic bile duct obstruction

A

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver

29
Q

What are 3 types of tumour in the liver?

A

Hepatocellular carcinoma
Tumour of intra-hepatic bile ducts
Metastatic tumours

30
Q

What type of disease is primary biliary cholangitis?

A

Organ-specific auto-immune disease

31
Q

Which gender is more affected by PBC?

A

Females (9:1)

32
Q

What 2 tests are done in PBC?

A

Anti-mitochondrial auto-antibodies in serum (positive)

Serum alkaline phosphatase (raised)

33
Q

What type of inflammation is found in PBC?

A

Granulomatous inflammation involving bile ducts

34
Q

What is lost in PBC?

A

Intra-hepatic bile ducts

35
Q

What can PBC progress to?

A

Cirrhosis

36
Q

Describe primary SCLEROSING cholangitis

A

Chronic inflammation and fibrous obliteration of bile ducts

37
Q

What is lost in PSC?

A

Intra-hepatic bile ducts

38
Q

What is PSC commonly associated with?

A

Inflammatory bowel disease

39
Q

What can PSC progress to?

A

Cirrhosis

Increased risk of development of cholangiocarcinoma

40
Q

What is the main difference between PBC and PSC in terms of site of disease?

A 
PBC = small bile ducts inside liver only 
PSC = Bile ducts inside and outside the liver; however in small duct PSC (10-15% of patients) only the small ducts inside the liver are affected
41
Q

What is hepatic cirrhosis a response to?

A

Chronic liver injury (end stage chronic liver disease)

42
Q

Name 6 general causes of cirrhosis

A
  • Alcohol
  • Hep B + C
  • Immune mediated liver disease
  • Metabolic disorders
  • Obesity
  • Cryptogenic (unknown cause) - commonest
43
Q

Name the 2 types of immune mediated liver disease associated with cirrhosis

A

Auto-immune hepatitis

Primary biliary cholangitis

44
Q

Name the 2 metabolic disorders associated with cirrhosis

A 
Excess iron (primary haemochromatosis)
Excess copper (Wilson's disease)
45
Q

What disease linked to obesity leads to cirrhosis?

A

Diabetes mellitus

46
Q

How is the structure of the liver affected in cirrhosis?

A

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

47
Q

Name 3 possible complications of cirrhosis

A
  • Altered liver function (liver failure)
  • Abnormal blood flow (portal hypertension)
  • Increased risk of hepatocellular carcinoma
48
Q

Three liver tumours as previously mentioned are hepatocellular carcinoma, cholangiocarcinoma and metastatic tumours - describe each

A 
HC = malignant tumour of hepatocytes 
C = malignant tumour of bile duct epithelium
MT = common site of metastases
49
Q

Name 3 causes of post-hepatic jaundice

A

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

50
Q

Name 2 risk factors for gallstones

A

obesity + diabetes

51
Q

Gallstones can lead to inflammation - name the 2 types of inflammation

A

ACUTE cholecystitis

CHRONIC cholecystitis

52
Q

What complication is associated with acute cholecystitis?

A

Empyema (bladder fills with purulent material; perforation of gallbladder = biliary peritonitis)

53
Q

What can acute cholecystitis progress to?

A

Chronic inflammation

54
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of gall bladder

55
Q

Name 4 causes of common bile duct obstruction

A

Gallstones
Bile duct tumours
Benign structure
External compression - tumours

56
Q

Name 4 effects of common bile duct obstruction

A

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

*GI System - Pathology (8 decks)

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