Hepato-Biliary Pathology

Question 1

Causes of acute liver damage?

Answer 1

Hepatitis

Bile duct obstruction

Question 2

How does hepatitis cause liver failure?

Answer 2

Causes inflammation of the liver

Damage and death of individual liver cells

Question 3

Possible outcomes of viral hepatitis A infection?

Answer 3

1. Resolution, liver back to normal

2. Liver failure if serious damage done to liver cells

Question 4

Possible outcomes of viral hepatitis B infection?

Answer 4

1. Resolution
2. Liver failure if serious damage done to liver cells
3. Progression to chronic hepatitis and cirrhosis

Question 5

Possible outcomes of viral hepatitis C infection?

Answer 5

> 80% Progress to chronic hepatitis

30% get cirrhosis

Increased risk of HCC

Question 6

What is alcoholic liver disease? How does it progress?

Answer 6

Liver disease due to excess alcohol consumption

Starts as buildup of fats in liver
Then alcoholic hepatitis (inflammation, cell death)
End stage is liver cirrhosis (significant scarring)

Question 7

What is jaundice a sign of?

Answer 7

Increased circulating bilirubin

Due to improper bilirubin metabolism

Question 8

3 stages of bilirubin metabolism? What happens in each?

Answer 8

1. Pre-hepatic - haemoglobin breakdown in spleen, bilirubin released to circulation
2. Hepatic - uptake of bilirubin by hepatocytes, conjugation and release into biliary system
3. Post-hepatic - breakdown of conjugated bilirubin in intestine, reabsorption of bilirubin

Question 9

What is a pre-hepatic cause of jaundice?

Answer 9

Increased haemoglobin being released from red blood cells (haemolysis)

Question 10

What are some hepatic causes of jaundice?

Answer 10

Cholestasis

Intra-hepatic bile duct obstruction

Question 11

What is cholestasis?

Answer 11

Decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts

Question 12

Causes of cholestasis?

Answer 12

Viral hepatitis
Alcoholic hepatitis
Liver failure 
Drugs (therapeutic/recreational)
Bile duct obstruction (cholangiocarcinoma, gallstones, pancreatic cancer)

Question 13

Causes of intra-hepatic bile duct obstruction?

Answer 13

Primary biliary cholangitis
Primary sclerosing cholangitis
Liver tumours

Question 14

What is primary biliary cholangitis? Who is it most likely to effect?

Answer 14

It is an organ specific autoimmune disease causing granulomatous inflammation of the bile ducts - leads to loss of intra-hepatic bile ducts. Progresses to cirrhosis

Affects mainly women 9:1

Question 15

What is primary sclerosing cholangitis? What is the difference between type 1 and type 2?

Answer 15

Chronic inflammation and fibrous obliteration of intra-hepatic bile ducts.

Type 1 associated with inflammatory bowel disease
Type 2 - higher chance of cholangiocarcinoma

Question 16

Causes of hepatic cirrhosis?

Answer 16

Alcohol
Hepatitis B, C & D
Immune mediated liver disease 
Metabolic disorders (excess Fe/Cu) (haemochromatosis & wilsons)
Obesity (diabetes mellitus)
PBC

Question 17

What is cirrhosis?

Answer 17

End stage liver disease affecting the whole liver.

Loss of normal liver structure - replaced by nodules of hepatocytes and fibrous tissue

Question 18

Complications of cirrhosis?

Answer 18

Hepatic encephalopathy 
Renal Failure 
Portal hypertension
Impaired coagulation & immunity
Increased risk of hepatocellular carcinoma

Question 19

Types of liver tumour? Describe

Answer 19

Hepatocellular carcinoma - malignant tumour of hepatocytes

Cholangiocarcinoma - malignant tumour of bile duct epithelium

Metastatic tumours - common place to spread

Hepatic Adenoma

Question 20

Causes of post hepatic jaundice?

Answer 20

Cholelithiasis (gallstones)
Gall bladder disease
Extra-hepatic duct obstruction

Question 21

Diseases of the gallbladder itself that can cause post hepatic jaundice?

Answer 21

Acute/chronic cholecystitis

Gallstones

Question 22

Causes of common bile duct (extra-hepatic) obstruction?

Answer 22

Gallstones
Bile duct tumours
Benign stricture
External compression from tumours

Question 23

Effects of common bile duct obstruction?

Answer 23

Ascending Cholangitis

Stop release of bile into duodenal papilla
Jaundice
Infection of bile proximal to obstruction
Secondary biliary cirrhosis if obstruction is prolonged