Hepato-Biliary Pathology Flashcards
Causes of acute liver damage?
Hepatitis
Bile duct obstruction
How does hepatitis cause liver failure?
Causes inflammation of the liver
Damage and death of individual liver cells
Possible outcomes of viral hepatitis A infection?
- Resolution, liver back to normal
2. Liver failure if serious damage done to liver cells
Possible outcomes of viral hepatitis B infection?
- Resolution
- Liver failure if serious damage done to liver cells
- Progression to chronic hepatitis and cirrhosis
Possible outcomes of viral hepatitis C infection?
> 80% Progress to chronic hepatitis
30% get cirrhosis
Increased risk of HCC
What is alcoholic liver disease? How does it progress?
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)
What is jaundice a sign of?
Increased circulating bilirubin
Due to improper bilirubin metabolism
3 stages of bilirubin metabolism? What happens in each?
- Pre-hepatic - haemoglobin breakdown in spleen, bilirubin released to circulation
- Hepatic - uptake of bilirubin by hepatocytes, conjugation and release into biliary system
- Post-hepatic - breakdown of conjugated bilirubin in intestine, reabsorption of bilirubin
What is a pre-hepatic cause of jaundice?
Increased haemoglobin being released from red blood cells (haemolysis)
What are some hepatic causes of jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
Decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts
Causes of cholestasis?
Viral hepatitis Alcoholic hepatitis Liver failure Drugs (therapeutic/recreational) Bile duct obstruction (cholangiocarcinoma, gallstones, pancreatic cancer)
Causes of intra-hepatic bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
Liver tumours
What is primary biliary cholangitis? Who is it most likely to effect?
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
What is primary sclerosing cholangitis? What is the difference between type 1 and type 2?
Chronic inflammation and fibrous obliteration of intra-hepatic bile ducts.
Type 1 associated with inflammatory bowel disease
Type 2 - higher chance of cholangiocarcinoma
Causes of hepatic cirrhosis?
Alcohol Hepatitis B, C & D Immune mediated liver disease Metabolic disorders (excess Fe/Cu) (haemochromatosis & wilsons) Obesity (diabetes mellitus) PBC
What is cirrhosis?
End stage liver disease affecting the whole liver.
Loss of normal liver structure - replaced by nodules of hepatocytes and fibrous tissue
Complications of cirrhosis?
Hepatic encephalopathy Renal Failure Portal hypertension Impaired coagulation & immunity Increased risk of hepatocellular carcinoma
Types of liver tumour? Describe
Hepatocellular carcinoma - malignant tumour of hepatocytes
Cholangiocarcinoma - malignant tumour of bile duct epithelium
Metastatic tumours - common place to spread
Hepatic Adenoma
Causes of post hepatic jaundice?
Cholelithiasis (gallstones)
Gall bladder disease
Extra-hepatic duct obstruction
Diseases of the gallbladder itself that can cause post hepatic jaundice?
Acute/chronic cholecystitis
Gallstones
Causes of common bile duct (extra-hepatic) obstruction?
Gallstones
Bile duct tumours
Benign stricture
External compression from tumours
Effects of common bile duct obstruction?
Ascending Cholangitis
Stop release of bile into duodenal papilla
Jaundice
Infection of bile proximal to obstruction
Secondary biliary cirrhosis if obstruction is prolonged
