Hepato-biliary pathology

Question 1

Describe the blood supply to the liver

Answer 1

dual blood supply 
hepatic artery (high pressure) and portal vein (low pressure)

Question 2

functions of the liver? (3)

Answer 2

Protein synthesis

Metabolism of fat and carbohydrate

Detoxification of drugs and toxins esp. alcohol

Question 3

Name some pathologies linked with the liver, gallbladder and extraheptaic bile ducts

Answer 3

liver - failure, jaundice, intrahepatic bile duct obstruction, cirrhosis, tumours

gallbladder - inflammation

extrahepatic bile ducts - obstruction

Question 4

what can cause hepatitis? (3)

Answer 4

viruses
alcohol
drugs - OTC, prescribed or recreational

Question 5

which types of hepatitis infection are blood borne?

Answer 5

hepatitis B and C

Question 6

what are three different outcomes that could come about from acute inflammation due to viral hepatitis? and what types of hepatitis cause each

Answer 6

1. resolution - liver returns to normal - hep A, E
2. liver failure if severe damage to liver - HEP A, B, E
3. progression to chronic hepatitis and cirrhosis - hep B, C

Question 7

how does alcohol affect the liver?

Answer 7

liver cells accumulate fat cells as the alcohol disrupts normal metabolism of fats within the hepatocytes

progresses to cirrhosis

Question 8

What is Jaundice and what causes it?

Answer 8

yellowing of the skin - major symptom of liver disease

caused by increased circulating bilirubin

Question 9

Name the 3 main pathways of bilirubin metabolism ie the 3 classes of jaundice

Answer 9

pre hepatic
hepatic
post hepatic

Question 10

describe the pre hepatic stage of bilirubin metabolism (3 steps)

Answer 10

Breakdown of haemoglobin in spleen to form haem and globin

Haem converted to bilirubin

Release of bilirubin into circulation

Question 11

describe the hepatic stage of bilirubin metabolism (3 steps)

Answer 11

Uptake of bilirubin by hepatocytes

Conjugation of bilirubin in hepatocytes (makes it more soluble)

Excretion of conjugated bilirubin into biliary system through bile duct

Question 12

describe the post-hepatic stage of bilirubin metabolism

Answer 12

Transport of conjugated bilirubin in biliary system

Breakdown of bilirubin conjugate in intestine

Re-absorption of bilirubin

Question 13

main cause of pre hepatic jaundice

Answer 13

Impaired transport/haemolysis

Question 14

Main causes of hepatic jaundice? (2)

Answer 14

Cholestasis - decrease in bile flow due to impaired secretion by hepatocytes

Intra-hepatic bile duct obstruction ie the branches off of the left and right hepatic ducts

ie defective uptake, conjugation, excretion

Question 15

causes of cholestasis (4)

Answer 15

Viral hepatitis
Alcoholic hepatitis
Liver failure – acute/chronic
Drugs - Therapeutic and Recreational

Question 16

what is cholestasis

Answer 16

accumulation of bile within hepatocytes or bile canaliculi (duct like structures that later form the larger hepatic ducts) which causes obstruction

Question 17

How can the intra-hepatic bile duct become obstructed

Answer 17

tumour - hepatocellular carcinoma, tumours of intra-hep bile duct, metastatic tumours that compress bile duct (pancreas etc)

primary sclerosing cholangitis

primary biliary cholangitis

Question 18

what is primary biliary cholangitis?

Answer 18

Organ specific auto-immune disease

Mainly affects females (9:1)

Anti-mitochondrial auto-antibodies in serum

Raised serum alkaline phosphatase

Question 19

Describe the pathology of primary biliary cholangitis?

Answer 19

Granulomatous inflammation involving bile ducts

Loss of intra-hepatic bile ducts - fibrosis

Progression to cirrhosis - increased risk of developing cholangiocarcinoma

Question 20

which other disease is primary sclerosing Cholangitis strongly associated with?

Answer 20

inflammatory bowel disease

Question 21

what is cholangiocarcinoma

Answer 21

cancer of the bile duct

Question 22

what is the 1 response that all pathologies of the liver result in

Answer 22

hepatic Cirrhosis - response to chronic injury

Question 23

Causes of cirrhosis (5)

Answer 23

Alcohol

Hepatitis B, C

Immune mediated liver disease eg Auto-immune hepatitis or Primary biliary cholangitis

metabolic disorders - excess iron or copper which are toxic to the liver

obesity - diabetes

Question 24

Name the disease where there is a real excess of copper in the circulation?

Answer 24

Wilson’s disease

Question 25

Cirrhosis pathology

Answer 25

loss of normal liver structure as liver tissue is replaced by nodules of hepatocytes and fibrous tissue

a cirrhotic liver is often smaller and much lighter

Question 26

What are some complications of cirrhosis? (3)

Answer 26

altered liver function - failure

abnormal blood flow - portal hypertension - mucks up the dual blood supply

increased risk of hepatocellular carcinoma

Question 27

Name 3 liver tumours

Answer 27

hepatocelllular carcinoma - malignant tumour of hepatocytes

cholangiocarcinoma - malignant tumour of bile duct epithelium

metastatic tumours - common site esp tumours of the GI tract

Question 28

Risk factors for gallstones?

Answer 28

obesity

diabetes - high pain threshold - don’t detect early

Question 29

acute inflammation of the gallbladder can lead to what within it?

Answer 29

Empyema - pus filled cavity. If the gallbladder then perforates, pus can spill into peritoneal cavity

bile is very toxic outwith the bile duct

Question 30

what happens if you have chronic cholecystitis

Answer 30

chronic inflammation and fibrosis of the gallbladder

wall thickens and the usual muscular structure is replaced with fibrotic tissue - makes it less mobile

Question 31

what is the name of the duct that supplies the gallbladder

Answer 31

cystic duct

It connects the top of the gallbladder’s neck to the common hepatic duct.

Question 32

causes of common bile duct obstruction (5)

Answer 32

Gallstones
Bile duct tumours
Benign stricture
External compression
Tumours eg in the pancreas

Question 33

effects of common bile duct obstruction (4)

Answer 33

Jaundice

No bile excreted into duodenum

Infection of bile proximal to obstruction eg Ascending cholangitis

Secondary biliary cirrhosis if obstruction prolonged