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Gastrointestinal Pathology > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

1
Q

Function of liver

A

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

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2
Q

Pathology of jaundice

A

Increasing circulating bilirubin

Caused by altering the metabolism of bilirubin

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3
Q

Types of jaundice

A

Pre hepatic
Hepatic
Post hepatic

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4
Q

Journey of pre hepatic bilirubin

A

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

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5
Q

Journey of hepatic bilirubin

A

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

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6
Q

Where is bilirubin processed?

A

Hepatocytes

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7
Q

Features of conjugated bilirubin

A

Water soluble

More excretable

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8
Q

Journey of post hepatic bilirubin

A

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

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9
Q

Where is bilirubin conjugate broken down?

A

Small intestine

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10
Q

Pathology of pre hepatic jaundice

A

Increased release of haemoglobin from RBCs (haemolysis)

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11
Q

Causes of hepatic jaundice

A

Cholestasis
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver

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12
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canniculi

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13
Q

Causes of cholestasis

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

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14
Q

What is primary biliary cholangitis?

A

Organ specific autoimmune disease

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15
Q

Who gets primary biliary cholangitis?

A

F > M 9:1

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16
Q

Pathology of primary biliary cholangitis

A

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

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17
Q

What blood results would be found in primary biliary cholangitis?

A

Raised serum alkaline phosphatase

Anti-microbial auto-antibodies in the serum

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18
Q

What is primary sclerosing cholangitis? (pathology)

A

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

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19
Q

What is primary sclerosing cholangitis associated with?

A

IBD

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20
Q

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

A

Cholangiocarcinoma

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21
Q

What tumours can be found in the liver?

A

Hepatocellular carcinoma
Tumours of the intra hepatic bile ducts
Metastatic tumours

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22
Q

What is hepatic cirrhosis end stage of?

A

Chronic liver disease

23
Q

Causes of hepatic cirrhosis

A 
Alcohol 
Hepatitis B, C
Immune mediated liver disease
- auto immune hepatitis
- primary biliary cholangitis 
Hemochromatosis
Wilsons disease
DM / obesity
Cryptogenic
24
Q

What is wilsons disease?

A

Excess copper

25
Q

What does cryptogenic mean?

A

Unknown cause

26
Q

What is the most common cause of hepatic cirrhosis?

A

Cryptogenic

27
Q

Pathology of hepatic cirrhosis

A

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

28
Q

Complications of liver cirrhosis

A

Liver failure

Portal HTN

29
Q

Why does the spleen get enlarged in portal HTN?

A

The splenic vein feeds into the portal vein

30
Q

What is there an increased risk of in hepatic cirrhosis?

A

Hepatocellular carcinoma

31
Q

Definition of hepatocellular carcinoma

A

Malignant tumour of hepatocytes

32
Q

Definition of cholangiocarcinoma

A

Malignant tumour of the bile duct epithelium

33
Q

What is the liver a common site for?

A

Metastases

34
Q

Causes of post hepatic jaundice

A

Cholelithiasis
Acute cholecystitis
Chronic cholecystitis
Extra hepatic duct obstruction

35
Q

What is cholelithiasis?

A

Gallstones

36
Q

Risk factors for cholelithiasis

A

Obesity

DM

37
Q

What is cholecystitis?

A

Inflammation of the gallbladder

38
Q

Complications of acute cholecystitis

A

Perforation of gall bladder
Biliary peritonitis
Progress to chronic cholecystitis

39
Q

Pathology of chronic cholecystitis

A

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

40
Q

Examples of pathologies of the liver

A 
Liver failure
Jaundice
Intrahepatic bile duct obstruction 
Cirrhosis
Tumours
41
Q

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

A

75%

42
Q

Causes of viral hepatitis

A 
Hep A
Hep B
Hep C
Hep D
Hep E
43
Q

Pathology of viral hepatitis

A

Inflammation of liver
Liver damage
Death of individual cells

44
Q

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

A

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

45
Q

What is cirrhosis?

A

Scarring

46
Q

How is Hep A transferred?

A

Faecal oral route

47
Q

How is Hep B and C transferred?

A

Blood borne route

48
Q

How is Hep E transferred?

A

Zoological means e.g. undercooked pork

49
Q

Pathology of alcoholic liver disease

A 
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
50
Q

Causes of bile duct obstruction

A

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

51
Q

Resulting pathology of bile duct obstruction

A

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

52
Q

What is cholangitis?

A

Inflammation of bile duct

53
Q

Are gallstones reversible?

A

Yes

54
Q

Gold standard investigation for PSC

A

MRCP

Gastrointestinal Pathology (26 decks)

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