Hepato-Biliary Pathology

Question 1

structure of liver

Answer 1

Dual blood supply

Hepatic artery, portal vein

Question 2

fuunction of liver

Answer 2

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

Question 3

liver diseases

Answer 3

Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours

Question 4

gallbladder diseases

Answer 4

inflammation

Question 5

what is liver failure a complication of?

Answer 5

acute liver injury

chronic liver injury

Question 6

wht causes acute liver injuries

Answer 6

Hepatitis
Viruses
Alcohol
Drugs
Bile duct obstruction

Question 7

viral hepatitis

Answer 7

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Other viruses

Question 8

pathology of viral hepatitis

Answer 8

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

Question 9

what is the response of liver to excess alcohol

Answer 9

Fatty change
Alcoholic hepatitis
Acute inflammation 
Liver cell death
Liver failure
Progress to cirrhosis

Question 10

what is jaundice and how is it caused

Answer 10

Increased circulating bilirubin

Caused by altered metabolism of bilirubin

Question 11

what are the pathways of bilirubin metabolism

Answer 11

Pre-hepatic
Hepatic
Post-hepatic

Question 12

what happens in pre-hepatic pathway?

Answer 12

Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation

Question 13

what happens in the hepatic pathway?

Answer 13

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

Question 14

what happens in the post-hepatic pathway

Answer 14

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin
Entero-hepatic circulation of bilirubin

Question 15

what are the classifications of causes of jaundice

Answer 15

Pre-hepatic
Hepatic
Post-hepatic

Question 16

what is the cause of pre hepatic

Answer 16

Increased release of haemoglobin from red cells (haemolysis)

Question 17

what are the hepatic caauses of jaundice

Answer 17

Cholestasis

Intra-hepatic bile duct obstruction

Question 18

what is cholestasis?

Answer 18

Accumulation of bile within hepatocytes or bile canaliculi

Question 19

causes of cholestasis

Answer 19

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs
Therapeutic
Recreational

Question 20

what is Primary biliary cholangitis

Answer 20

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

Question 21

who is more likely to get Primary sclerosing cholangitis

Answer 21

female

Question 22

pathology of Primary sclerosing cholangitis

Answer 22

Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis

Question 23

what is pathology of Primary Sclerosing Cholangitis ?

Answer 23

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

Question 24

what is hepatic cirrhosis?

Answer 24

End stage chronic liver disease

Question 25

causes of cirrhosis

Answer 25

``` 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 ```

Question 26

pathology of cirrhosis

Answer 26

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

Question 27

complications of cirrhosis

Answer 27

``` Altered liver function Liver failure Abnormal blood flow Portal hypertension Increased risk of hepatocellular carcinoma ```

Question 28

what are the different liver tumours

Answer 28

``` Hepatocellular carcinoma Malignant tumour of hepatocytes Cholangiocarcinoma Malignant tumour of bile duct epithelium Metastatic tumours Common site of metastases ```

Question 29

what are the post-hepatic jaundice causes

Answer 29

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

Question 30

risk factors of gallstones

Answer 30

Obesity | Diabetes

Question 31

pathology of gallstones in gallbladder

Answer 31

Inflammation Acute cholecystitis Chronic cholecystitis

Question 32

what is Acute Cholecystitis

Answer 32

``` Acute inflammation of gall bladder Empyema Perforation of gall bladder Biliary peritonitis Progression to chronic inflammation ```

Question 33

causes of common bile duct obstruction

Answer 33

``` Gallstones Bile duct tumours Benign stricture External compression Tumours ```

Question 34

effects of common bile duct obstruction

Answer 34

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