Hepato-Biliary Pathology Flashcards
Describe the blood that the hepatic artery supplies the liver
Oxygen rich
Nutrient depleted
Describe the blood that the hepatic portal vein supplies the liver
Oxygen depleted
Nutrient rich
What are the functions of the liver (3)?
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
Give 5 pathologies which can occur in the liver
Liver failure Jaundice Intrahepatic bile duct obstruction Cirrhosis Tumours
What pathology can occur in the gall bladder?
Inflammation
?gall stones
What can go wrong with the extrahepatic bile ducts?
Obstruction
What is a complication of acute/chronic liver injury?
Liver failure
What 2 pathologies can cause acute liver injury?
Hepatitis (inflammation of liver)
Bile duct obstruction
What are 3 general causes of hepatitis?
Virus
Alcohol
Drugs (almost any drug)
What viruses cause viral hepatitis?
Hep A Hep B Hep C Hep E Others inc megalovirus, EB virus
What are the 2 general steps of viral hepatitis?
Inflammation of liver
Liver cell damage and death of individual liver cells
What hep viruses normally have a resolution?
Hep A + E
What hep viruses can cause liver failure if serious damage to liver? (if supported through acute phase, can return to normal)
Hep A, B, E
What hep viruses progress to chronic hepatitis and cirrhosis?
Hep B + C (blood borne viruses)
What can alcoholic liver disease progress to?
Cirrhosis
What change occurs in hepatocytes in alcoholic liver disease?
Fat accumulates; leads to acute inflammation, liver cell death and liver failure
What is jaundice caused by?
Increased circulating bilirubin (altered metabolism of it)
What are the 3 pathways of bilirubin metabolism (also 3 types of jaundice)?
- pre-hepatic
- hepatic
- post-hepatic
Describe the pre-hepatic metabolism of bilirubin
- Breakdown of haemoglobin in spleen to haem and globin
- Haem to bilirubin
- Release of bilirubin into circulation
Describe the hepatic metabolism of bilirubin
- Uptake of bilirubin by hepatocytes
- Conjugation of bilirubin in hepatocytes
- Excretion of conjugated bilirubin into biliary system
Describe the post-hepatic metabolism of bilirubin
- Transport of conjugated bilirubin in biliary system
- Breakdown of bilirubin conjugate in intestine
- Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)
What are the 3 classifications of jaundice?
- pre-hepatic
- hepatic
- post-hepatic
Describe the pathology associated with pre-hepatic jaundice
Increased release of haemoglobin from red cells (haemolysis)
Name 2 hepatic causes of jaundice
CHOLESTASIS
INTRA-HEPATIC BILE DUCT OBSTRUCTION
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
Name 4 causes of cholestasis
- viral hepatitis
- alcoholic hepatitis
- liver failure
- drugs (therapeutic or recreational)
What are the 2 types of drug-induced cholestasis?
Predictable (dose-related)
Unpredictable (not dose related)
Name 3 conditions associated with intra-hepatic bile duct obstruction
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver
What are 3 types of tumour in the liver?
Hepatocellular carcinoma
Tumour of intra-hepatic bile ducts
Metastatic tumours
What type of disease is primary biliary cholangitis?
Organ-specific auto-immune disease
Which gender is more affected by PBC?
Females (9:1)
What 2 tests are done in PBC?
Anti-mitochondrial auto-antibodies in serum (positive)
Serum alkaline phosphatase (raised)
What type of inflammation is found in PBC?
Granulomatous inflammation involving bile ducts
What is lost in PBC?
Intra-hepatic bile ducts
What can PBC progress to?
Cirrhosis
Describe primary SCLEROSING cholangitis
Chronic inflammation and fibrous obliteration of bile ducts
What is lost in PSC?
Intra-hepatic bile ducts
What is PSC commonly associated with?
Inflammatory bowel disease
What can PSC progress to?
Cirrhosis
Increased risk of development of cholangiocarcinoma
What is the main difference between PBC and PSC in terms of site of disease?
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
What is hepatic cirrhosis a response to?
Chronic liver injury (end stage chronic liver disease)
Name 6 general causes of cirrhosis
- Alcohol
- Hep B + C
- Immune mediated liver disease
- Metabolic disorders
- Obesity
- Cryptogenic (unknown cause) - commonest
Name the 2 types of immune mediated liver disease associated with cirrhosis
Auto-immune hepatitis
Primary biliary cholangitis
Name the 2 metabolic disorders associated with cirrhosis
Excess iron (primary haemochromatosis) Excess copper (Wilson's disease)
What disease linked to obesity leads to cirrhosis?
Diabetes mellitus
How is the structure of the liver affected in cirrhosis?
Loss of normal liver structure; replaced by nodules of hepatocytes and fibrous tissue
Name 3 possible complications of cirrhosis
- Altered liver function (liver failure)
- Abnormal blood flow (portal hypertension)
- Increased risk of hepatocellular carcinoma
Three liver tumours as previously mentioned are hepatocellular carcinoma, cholangiocarcinoma and metastatic tumours - describe each
HC = malignant tumour of hepatocytes C = malignant tumour of bile duct epithelium MT = common site of metastases
Name 3 causes of post-hepatic jaundice
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
Name 2 risk factors for gallstones
obesity + diabetes
Gallstones can lead to inflammation - name the 2 types of inflammation
ACUTE cholecystitis
CHRONIC cholecystitis
What complication is associated with acute cholecystitis?
Empyema (bladder fills with purulent material; perforation of gallbladder = biliary peritonitis)
What can acute cholecystitis progress to?
Chronic inflammation
What is chronic cholecystitis?
Chronic inflammation and fibrosis of gall bladder
Name 4 causes of common bile duct obstruction
Gallstones
Bile duct tumours
Benign structure
External compression - tumours
Name 4 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
