Hepato-Biliary Pathology

Question 1

What can liver failure be a complication of?

Answer 1

Acute liver injury

Chronic liver injury (e.g. cirrhosis)

Question 2

What can cause acute liver injury?

Answer 2

Hepatitis (viruses, alcohol, drugs)

Bile duct obstruction

Question 3

What is viral hepatitis?

Answer 3

Inflammation of the liver

Liver cell damage and death of individual liver cells

Question 4

What is the outcome of acute inflammation in viral hepatitis?

Answer 4

Resolution - back to normal (hep A, E)
Liver failure - severe damage (hep A, B, E)
Progression to chronic hepatitis and cirrhosis (hep B, C)

Question 5

What is alcoholic liver disease?

Answer 5

Response of liver to excess alcohol causing acute inflammation, liver cell death, liver failure
Can progress to cirrhosis

Question 6

What is jaundice?

Answer 6

Increased circulation bilirubin caused by altered metabolism

Question 7

What happens in the pre-hepatic pathway of bilirubin?

Answer 7

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

Question 8

What happens in the hepatic pathway of bilirubin?

Answer 8

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

Question 9

What happens in the post-hepatic pathway of bilirubin?

Answer 9

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

Question 10

What is pre-hepatic jaundice?

Answer 10

Increased release of haemoglobin from red cells (haemolysis)

Question 11

What are the hepatic causes of jaundice?

Answer 11

Cholestasis

Intra-hepatic bile duct obstruction

Question 12

What is cholestasis?

Answer 12

Accumulation of bile within hepatocytes or bile canaliculi

Question 13

What are the causes of cholestasis?

Answer 13

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs (therapeutic/recreational)

Question 14

What are the causes of intra-hepatic bile duct obstruction?

Answer 14

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver (hepatocellular carcinoma, intra-hepatic bile duct tumours, metastatic tumours)

Question 15

What is primary biliary cholangitis?

Answer 15

Organ-specific auto-immune disease
Anti-mitochondrial auto-antibodies in serum
Raised serum alkaline phosphatase

Question 16

What happens in primary biliary cholangitis?

Answer 16

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

Question 17

What is primary sclerosing cholangitis?

Answer 17

Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Associated with IBD
Progression to cirrhosis 
Increased risk of cholangiocarcinoma

Question 18

What is hepatic cirrhosis?

Answer 18

End-stage chronic liver disease - response of liver to chronic injury

Question 19

What are the causes of cirrhosis?

Answer 19

Alcohol
Hepatitis B, C
Immune mediated liver disease (autoimmune hepatitis, primary biliary cholangitis)
Metabolic disorders (excess iron - primary haemochromatosis, excess copper - Wilson’s disease)
Obesity (diabetes mellitus)

Question 20

What happens to the liver with cirrhosis?

Answer 20

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

Question 21

What are the complications of cirrhosis?

Answer 21

Altered liver function - liver failure
Abnormal blood flow - portal hypertension
Increased risk of hepatocellular carcinoma

Question 22

What are the types of liver tumours?

Answer 22

Hepatocellular carcinoma - malignant tumour of hepatocytes
Cholangiocarcinoma - malignant tumour of bile duct epithelium
Metastatic tumours - liver is common site

Question 23

What causes post-hepatic jaundice?

Answer 23

Cholelithiasis (gallstones)
Diseases of gallbladder
Extra-hepatic duct obstruction

Question 24

What are risk factors for gallstones?

Answer 24

Obesity

Diabetes

Question 25

What is acute cholecystitis?

Answer 25

Acute inflammation of the gallbladder - empyema (perforation of gallbladder, biliary peritonitis)
May progress to chronic

Question 26

What is chronic cholecystitis?

Answer 26

Chronic inflammation and fibrosis of the gallbladder

Question 27

What are the causes of common bile duct obstruction?

Answer 27

Gallstones
Bile duct tumours
Benign stricture
External compression - tumours

Question 28

What are the effects of common bile duct obstruction?

Answer 28

Jaundice
No bile excreted to duodenum
Infection of bile proximal to obstruction (ascending cholangitis)
Secondary biliary cirrhosis if prolonged obstruction