Hepato-Biliary Pathology Flashcards
structure of liver
Dual blood supply
Hepatic artery, portal vein
fuunction of liver
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
liver diseases
Liver failure Jaundice Intrahepatic bile duct obstruction Cirrhosis Tumours
gallbladder diseases
inflammation
what is liver failure a complication of?
acute liver injury
chronic liver injury
wht causes acute liver injuries
Hepatitis Viruses Alcohol Drugs Bile duct obstruction
viral hepatitis
Hepatitis A Hepatitis B Hepatitis C Hepatitis E Other viruses
pathology of viral hepatitis
Inflammation of liver
Liver cell damage and death of individual liver cells
Outcome of acute inflammation Resolution-liver returns to normal Hepatitis A, E Liver failure if severe damage to liver Hepatitis A, B, E Progression to chronic hepatitis and cirrhosis Hepatitis B, C
what is the response of liver to excess alcohol
Fatty change Alcoholic hepatitis Acute inflammation Liver cell death Liver failure Progress to cirrhosis
what is jaundice and how is it caused
Increased circulating bilirubin
Caused by altered metabolism of bilirubin
what are the pathways of bilirubin metabolism
Pre-hepatic
Hepatic
Post-hepatic
what happens in pre-hepatic pathway?
Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation
what happens in the hepatic pathway?
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system
what happens in the post-hepatic pathway
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 classifications of causes of jaundice
Pre-hepatic
Hepatic
Post-hepatic
what is the cause of pre hepatic
Increased release of haemoglobin from red cells (haemolysis)
what are the hepatic caauses of jaundice
Cholestasis
Intra-hepatic bile duct obstruction
what is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
causes of cholestasis
Viral hepatitis Alcoholic hepatitis Liver failure Drugs Therapeutic Recreational
what is Primary biliary cholangitis
is a chronic disease in which the bile ducts in your liver are slowly destroyed. Bile is a fluid made in your liver. It aids with digestion and helps your body get rid of cholesterol, toxins and worn-out red blood cells
who is more likely to get Primary sclerosing cholangitis
female
pathology of Primary sclerosing cholangitis
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
what is pathology of Primary Sclerosing Cholangitis ?
Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Associated with inflammatory bowel disease
Progression to cirrhosis
Increased risk of development of cholangiocarcinoma
what is hepatic cirrhosis?
End stage chronic liver disease
causes of cirrhosis
Alcohol Hepatitis B, C Immune mediated liver disease Auto-immune hepatitis Primary biliary cholangitis Metabolic disorders Excess iron Primary haemochromatosis Excess copper Wilson’s disease Obesity Diabetes mellitus
pathology of cirrhosis
Diffuse process involving whole liver
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue
complications of cirrhosis
Altered liver function Liver failure Abnormal blood flow Portal hypertension Increased risk of hepatocellular carcinoma
what are the different liver tumours
Hepatocellular carcinoma Malignant tumour of hepatocytes Cholangiocarcinoma Malignant tumour of bile duct epithelium Metastatic tumours Common site of metastases
what are the post-hepatic jaundice causes
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
risk factors of gallstones
Obesity
Diabetes
pathology of gallstones in gallbladder
Inflammation
Acute cholecystitis
Chronic cholecystitis
what is Acute Cholecystitis
Acute inflammation of gall bladder Empyema Perforation of gall bladder Biliary peritonitis Progression to chronic inflammation
causes of common bile duct obstruction
Gallstones Bile duct tumours Benign stricture External compression Tumours
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
