Hepato-biliary Pathology Flashcards
What is the structure and function of normal liver?
Functions:
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins (including alcohol)
What are the possible pathologies of the liver?
Liver failure
Jaundice
Intrahepatic bile obstruction
Cirrhosis
Tumours
What pathologies are associated with the gall bladder?
Inflammation
What pathologies are associated with extrahepatic bile ducts?
Obstruction
What results in liver failure?
•Complication of
–Acute liver injury
–Chronic liver injury i.e. cirrhosis
What causes acute liver injury?
•Hepatitis
–Viruses
–Alcohol
–Drugs
•Bile duct obstruction (bile is toxic to the liver and can damage the liver)
What happens as a result of inflamamtion of the liver?
Liver cell damage and damage to individual cancer cells
Which strains of viral hepatitis will likely have a resolution and return to normal?
Hepatitis A and E
Which strains of viral hepatits can cause chronic hepatitis?
Hepatitis B and C
Which strains of viral hepatitis can cause progression to chronic hepatitis and cirrhosis?
Hepatits B and C
What is the disease progression of alcoholic liver disease?
Fatty change
Alcoholic hepatitis
- Acute inflammation
- Liver cell death
- Liver failure
Progress to cirrhosis
What is the cause of jaundice?
Increased circulating bilirubin
What is pre-hepatic metabolism of bilirubin?
–Breakdown of haemoglobin in spleen to form haem and globin
–Haem converted to bilirubin
–Release of bilirubin into circulation
What is the hepatic section of the bilirubin metabolism?
–Uptake of bilirubin by hepatocytes
–Conjugation of bilirubin in hepatocytes
–Excretion of conjugated bilirubin into biliary system
What is the post hepatic metabolism of bilirubin?
–Transport of conjugated bilirubin in biliary system
–Breakdown of bilirubin conjugate in intestine
–Re-absorption of bilirubin
•Entero-hepatic circulation of bilirubin
What are the three classifications of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
What is the cause of 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 defined as?
•Accumulation of bile within hepatocytes or bile canaliculi
What are causes of cholestasis?
Viral hepatitis
Alcoholic hepatits
Liver failure
Drugs
What are the different types of drug induced cholestasis?
Predictable vs unpredictable
Predicatable = dose related
Unpredicatable = not dose related
What are the different causes of bile duct obstruction?
- Primary biliary cholangitis
- Primary sclerosing cholangitis
- Tumours of liver
–Hepatocellular carcinoma
–Tumours of intra-hepatic bile ducts
–Metastatic tumours
What cancer risk does sclerosing cholangitis have?
Development of cholangiocarcinoma
What are the causes of cirrhosis?
Alcohol
Hepatitis B and C
Immune mediated liver disease
(–Auto-immune hepatitis
–Primary biliary cholangitis)
•Metabolic disorders
–Excess iron
•Primary haemochromatosis
–Excess copper
•Wilson’s disease
•Obesity
–Diabetes mellitus
•Cryptogenic (unknown cause)
–Commonest cause
How does primary sclerosing cholangitis result in cirrhosis?
Chronic inflammation and fibrous alteration of bile ducts
What is normal liver structure replaced by in fibrosis?
•Replaced by nodules of hepatocytes and fibrous tissue
What are complications of cirrhosis?
•Altered liver function
–Liver failure
•Abnormal blood flow
–Portal hypertension
•Increased risk of hepatocellular carcinoma
What are the different tumours of the liver?
•Hepatocellular carcinoma
–Malignant tumour of hepatocytes
•Cholangiocarcinoma
–Malignant tumour of bile duct epithelium
•Metastatic tumours
–Common site of metastases
What are post hepatic causes of jaundice?
- Cholelithiasis (gallstones)
- Diseases of gall bladder
- Extra-hepatic duct obstruction
What are risk factors for gallstones?
Obesity
Diabetes
What results from acute inflammation of the gallbladder?
- Empyema
(Perforation of gall bladder)
Biliary Peritonitis
Progression to chronic inflammation
What happens as a resut of chronic cholecystitis?
Fibrosis
What causes common bile duct obstruction?
Gallstones
Bile duct tumours
Benign strictures
External compression (tumours)
What are the effects of common bile duct obstruction?
- Jaundice
- No bile excreted into duodenum
- Infection of bile proximal to obstruction
–Ascending cholangitis
•Secondary biliary cirrhosis if obstruction prolonged
