Hepato-Biliary Pathology Flashcards
What can liver failure be a complication of?
Acute liver injury
Chronic liver injury (e.g. cirrhosis)
What can cause acute liver injury?
Hepatitis (viruses, alcohol, drugs)
Bile duct obstruction
What is viral hepatitis?
Inflammation of the liver
Liver cell damage and death of individual liver cells
What is the outcome of acute inflammation in viral hepatitis?
Resolution - back to normal (hep A, E)
Liver failure - severe damage (hep A, B, E)
Progression to chronic hepatitis and cirrhosis (hep B, C)
What is alcoholic liver disease?
Response of liver to excess alcohol causing acute inflammation, liver cell death, liver failure
Can progress to cirrhosis
What is jaundice?
Increased circulation bilirubin caused by altered metabolism
What happens in the pre-hepatic pathway of bilirubin?
Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Bilirubin released into circulation
What happens in the hepatic pathway of bilirubin?
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system
What happens in the post-hepatic pathway of bilirubin?
Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin
What is pre-hepatic jaundice?
Increased release of haemoglobin from red cells (haemolysis)
What are the hepatic causes of jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
What are the causes of cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs (therapeutic/recreational)
What are the causes of intra-hepatic bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver (hepatocellular carcinoma, intra-hepatic bile duct tumours, metastatic tumours)
What is primary biliary cholangitis?
Organ-specific auto-immune disease
Anti-mitochondrial auto-antibodies in serum
Raised serum alkaline phosphatase
What happens in primary biliary cholangitis?
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
What is primary sclerosing cholangitis?
Chronic inflammation and fibrous obliteration of bile ducts Loss of intra-hepatic bile ducts Associated with IBD Progression to cirrhosis Increased risk of cholangiocarcinoma
What is hepatic cirrhosis?
End-stage chronic liver disease - response of liver to chronic injury
What are the causes of cirrhosis?
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)
What happens to the liver with cirrhosis?
Loss of liver structure replaced by nodules of hepatocytes and fibrous tissue
What are the complications of cirrhosis?
Altered liver function - liver failure
Abnormal blood flow - portal hypertension
Increased risk of hepatocellular carcinoma
What are the types of liver tumours?
Hepatocellular carcinoma - malignant tumour of hepatocytes
Cholangiocarcinoma - malignant tumour of bile duct epithelium
Metastatic tumours - liver is common site
What causes post-hepatic jaundice?
Cholelithiasis (gallstones)
Diseases of gallbladder
Extra-hepatic duct obstruction
What are risk factors for gallstones?
Obesity
Diabetes
What is acute cholecystitis?
Acute inflammation of the gallbladder - empyema (perforation of gallbladder, biliary peritonitis)
May progress to chronic
What is chronic cholecystitis?
Chronic inflammation and fibrosis of the gallbladder
What are the causes of common bile duct obstruction?
Gallstones
Bile duct tumours
Benign stricture
External compression - tumours
What are the effects of common bile duct obstruction?
Jaundice
No bile excreted to duodenum
Infection of bile proximal to obstruction (ascending cholangitis)
Secondary biliary cirrhosis if prolonged obstruction
