Hepato-Biliary Pathology

Question 1

Function of liver

Answer 1

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

Question 2

Pathology of jaundice

Answer 2

Increasing circulating bilirubin

Caused by altering the metabolism of bilirubin

Question 3

Types of jaundice

Answer 3

Pre hepatic
Hepatic
Post hepatic

Question 4

Journey of pre hepatic bilirubin

Answer 4

Haemoglobin in RBCS
Broken down in spleen
Haemoglobin broken down forms haem and globin
Haem converted to bilirubin
Release of bilirubin into the circulation

Question 5

Journey of hepatic bilirubin

Answer 5

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes.
Excretion of conjugated bilirubin into biliary system

Question 6

Where is bilirubin processed?

Answer 6

Hepatocytes

Question 7

Features of conjugated bilirubin

Answer 7

Water soluble

More excretable

Question 8

Journey of post hepatic bilirubin

Answer 8

Transport of conjugated bilirubin in the biliary system
Passes down the bile duct through the gall bladder and into the small intestine
Breakdown of bilirubin conjugate in the intestine
Reabsorption of bilirubin
- entero-hepatic circulation of bilirubin

Question 9

Where is bilirubin conjugate broken down?

Answer 9

Small intestine

Question 10

Pathology of pre hepatic jaundice

Answer 10

Increased release of haemoglobin from RBCs (haemolysis)

Question 11

Causes of hepatic jaundice

Answer 11

Cholestasis
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver

Question 12

What is cholestasis?

Answer 12

Accumulation of bile within hepatocytes or bile canniculi

Question 13

Causes of cholestasis

Answer 13

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

Question 14

What is primary biliary cholangitis?

Answer 14

Organ specific autoimmune disease

Question 15

Who gets primary biliary cholangitis?

Answer 15

F > M 9:1

Question 16

Pathology of primary biliary cholangitis

Answer 16

Granulomatous infection involving the bile ducts
Loss of intra hepatic bile ducts
Progression to cirrhosis

Question 17

What blood results would be found in primary biliary cholangitis?

Answer 17

Raised serum alkaline phosphatase

Anti-microbial auto-antibodies in the serum

Question 18

What is primary sclerosing cholangitis? (pathology)

Answer 18

Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra hepatic bile ducts
Progression to cirrhosis

Question 19

What is primary sclerosing cholangitis associated with?

Answer 19

IBD

Question 20

In primary sclerosing cholangitis, what is there an increased risk of developing?

Answer 20

Cholangiocarcinoma

Question 21

What tumours can be found in the liver?

Answer 21

Hepatocellular carcinoma
Tumours of the intra hepatic bile ducts
Metastatic tumours

Question 22

What is hepatic cirrhosis end stage of?

Answer 22

Chronic liver disease

Question 23

Causes of hepatic cirrhosis

Answer 23

Alcohol 
Hepatitis B, C
Immune mediated liver disease
- auto immune hepatitis
- primary biliary cholangitis 
Hemochromatosis
Wilsons disease
DM / obesity
Cryptogenic

Question 24

What is wilsons disease?

Answer 24

Excess copper

Question 25

What does cryptogenic mean?

Answer 25

Unknown cause

Question 26

What is the most common cause of hepatic cirrhosis?

Answer 26

Cryptogenic

Question 27

Pathology of hepatic cirrhosis

Answer 27

Diffuse process involving whole liver Loss of normal liver structure Replaced by nodules of hepatocytes and fibrous tissue

Question 28

Complications of liver cirrhosis

Answer 28

Liver failure | Portal HTN

Question 29

Why does the spleen get enlarged in portal HTN?

Answer 29

The splenic vein feeds into the portal vein

Question 30

What is there an increased risk of in hepatic cirrhosis?

Answer 30

Hepatocellular carcinoma

Question 31

Definition of hepatocellular carcinoma

Answer 31

Malignant tumour of hepatocytes

Question 32

Definition of cholangiocarcinoma

Answer 32

Malignant tumour of the bile duct epithelium

Question 33

What is the liver a common site for?

Answer 33

Metastases

Question 34

Causes of post hepatic jaundice

Answer 34

Cholelithiasis Acute cholecystitis Chronic cholecystitis Extra hepatic duct obstruction

Question 35

What is cholelithiasis?

Answer 35

Gallstones

Question 36

Risk factors for cholelithiasis

Answer 36

Obesity | DM

Question 37

What is cholecystitis?

Answer 37

Inflammation of the gallbladder

Question 38

Complications of acute cholecystitis

Answer 38

Perforation of gall bladder Biliary peritonitis Progress to chronic cholecystitis

Question 39

Pathology of chronic cholecystitis

Answer 39

Chronic inflammation and fibrosis of the gall bladder Muscle wall of gallbladder replaced by fibrous tissue Wall becomes very thick

Question 40

Examples of pathologies of the liver

Answer 40

``` Liver failure Jaundice Intrahepatic bile duct obstruction Cirrhosis Tumours ```

Question 41

To get liver failure, what % of liver cells would have to be knocked out?

Answer 41

75%

Question 42

Causes of viral hepatitis

Answer 42

``` Hep A Hep B Hep C Hep D Hep E ```

Question 43

Pathology of viral hepatitis

Answer 43

Inflammation of liver Liver damage Death of individual cells

Question 44

Possible outcomes of acute liver inflammation - and what viruses would cause these?

Answer 44

Resolution - hep A, E Liver failure - Hep A, B, E Progression to chronic hepatitis and cirrhosis - Hep B, C

Question 45

What is cirrhosis?

Answer 45

Scarring

Question 46

How is Hep A transferred?

Answer 46

Faecal oral route

Question 47

How is Hep B and C transferred?

Answer 47

Blood borne route

Question 48

How is Hep E transferred?

Answer 48

Zoological means e.g. undercooked pork

Question 49

Pathology of alcoholic liver disease

Answer 49

``` Response of liver to excess alcohol Fatty change Alcohol disrupts fatty acid metabolism in the liver and so fats accumulate in liver 1. Acute inflammation 2. Liver cell death 3. Liver failure Progression to cirrhosis ```

Question 50

Causes of bile duct obstruction

Answer 50

Gallstones Bile duct tumours Benign stricture External compression e.g. tumours at head of pancreas

Question 51

Resulting pathology of bile duct obstruction

Answer 51

Jaundice No bile excreted into duodenum Infection of bile proximal to obstruction - ascending cholangitis Secondary biliary cirrhosis is obstruction is prolonged

Question 52

What is cholangitis?

Answer 52

Inflammation of bile duct

Question 53

Are gallstones reversible?

Answer 53

Yes

Question 54

Gold standard investigation for PSC

Answer 54

MRCP