Hepato-Biliary Pathology Flashcards
Functions of the Liver
Protein Synthesis
Metabolism of Fat and Carbohydrate
Detox of drugs and toxins
Pathologies of the Liver
Liver Failure Jaundice Intrahepatic Bile Duct obstruction Cirrhosis Tumours
Define Liver Failure. What causes it?
Large parts of the liver are damaged and cannot function.
Caused by acute liver injury or chronic injury (cirrhosis)
Causes of acute liver injury
Drug Overdose. Hep A, B & E. Epstein Barr. (viruses), alcohol, or bile duct obstruction
Outcome of Acute Hepatitis (A,B & E)
These variations of hepatitis cause inflammation and liver cell damage and death.
This will either resolve, result in liver failure or progress to chronic hepatitis and cirrhosis
What is alcoholic liver disease and the effects on the liver
ALD is damage to the liver caused by excess alcohol.
Alcohol abuse can impact the liver’s ability to regenerate. Over short periods of time, large amounts of alcohol can lead to a build-up of fats.
What are the three stages of ALD
- Fatty Liver (reversible in two weeks)
- Alcoholic Hepatitis (usually reversible, acute inflammation, cell death and liver failure)
- Cirrhosis (point of significant scarring, irreversible damage)
Treatment of ALD
No specific treatment. Stop drinking for life :(.
Define Cirrhosis
Loss of hepatocytes and permanent scarring leading to loss of function.
Define Jaundice and it’s cause
Defintition: Increased circulating bilirubin.
Cause: Altered metabolism of biliruibin (pre-hepatic, hepatic or post hepatic)
Pathway of Bilirubin in three steps
- haemoglobin is broken down into haem and globin in the spleen. haem is converted to bilirubin and released into circulation
- Bilirubin is brought up by hepatocytes and conjugated before being released to the biliary tree.
- Bilirubin conjugate in intesine is broken down and reabsorbed.
Causes of Pre-Hepatic Jaundice
Increased release of haemoglobin from red blood cells -haemolytic anaemia
Cause of hepatic jaundice
Cholestais
Intra-hepatic bile duct obstruction
Define Cholestasis
Reduction/Obstruction of Bile flow leading to accumulation of bile within the hepatocytes or bile canaliculi.
Causes of cholestasis
Viral Hepatitis
Alcoholic hepatitis
Liver Failure
Drugs
Cause of intra-hepatic bile duct obstruction
Primary Biliary cholangitis (cirrhosis)(destruction of the bile ducts- autoimmune).
Primary sclerosing cholangitis (chronic inflammation and fibrous obliteration of bile ducts) associated with IBD, progressing to cirrhosis. Increased risk of cholangiocarcinoma
Tumours of the liver - Hepatocelluar carcinoma
Intra-hepatic bile ducts
Metastatic tumours
What is Primary Biliary Cholangitis?
Cirrhosis of the bile ducts. It is an organ specific autoimmune disease affecting woman.
Anti-mitochondrial auto-antibodies can be found in serum and will have elevated ALP
Pathology of primary biliary cholangitis
Granulomatous inflammation of the bile ducts.
Loss of intra-hepatic bile ducts
Progressing cirrhosis.
Define Hepatic Cirrhosis
End stage chronic liver disease in response to chronic injury
Causes of Cirrhosis
- Alcohol
- Hepatitis B & C
- Autoimmune disease (autoimmune hepatitis or primary biliary cholangitis)
- Metabolic Disorders - excess iron (primary haemochromatosis), Excess copper (wilsons disease)
- Obesity - Diabtes mellitus
Pathology of Cirrhosis
Loss of Liver structure throughout the liver. Replaced by nodules of hepatocytes and fibrous tissue
Complication of Cirrhosis
Altered Liver Function - Liver Failure.
Abnormal Blood flow - portal hypertension
Increased risk of hepatocelluar carcinoma
What is hepatocellular hepatocytes
Malignant Tumour of Hepatocytes
What is cholangiocarcinoma
Malignant tumour of the bile duct epithelia
Risk Factors of Gallstones
Obesity
Diabetes
What is Cholelithiasis
Formation of gallstones
Causes of common bile duct obstruction
Gallstones
Bile duct tumours
Benign Stricture
Extrenal compression of tumours
Effects of common bile duct obstruction
Jaundice
No Bile excretion into the duodenum.
Infection of bile proximal to the obstruction. Cholangitis.(inflammation of the bile duct.)
