Hepato-billary pathology Flashcards
Liver functions
Metabolism of fats and carbs
Detoxify drugs, toxins inc. alcohol
produce proteins (protein synthesis)
What causes liver failure?
Chirrosis (scarring) - Chronic liver injury
Too much toxins - damage to cells (acute liver injury)
Why do you get fluid i n abdomen wiht liver failure?
Becuase loss of protein production - therefore loss of oncotic pressure and more fluid pushed outside of vessles
What can cause acute liver injury?
Hepatitis: (alcohol, drugs,Viruses)
Bile duct obstruction
What can be the causes of viral hepiatitis?
Hep A, B C , E and other virus’s
What does viral hepatitis cause?
inflammation and fluid -> cell death and damage
Outcomes for the viral hepatitiess
C (unt) - C (hronic hepatitis) and C (irrhosis)
B (astard) - Failure if severe and Chirrosis
A, E - can resolve or if severe progress to severe liver damage and liver failure
What is alcoholic liver disease?
“Fatty liver disease” - “Steatohepatitis”
Damages liver cells so that they take on more fat and have areas of inflmmmation. Leads to cell death and liver failure -> cirrhosis
What is jaundice?
Excess bilirubin (part of remnants of dead blood cells) floatin round - gets taken up by (areas of high collagen?) eg eyes and skin - look yellow.
3 phases if bilirubin metabolism
Prehepatic, hepatic, post hepatic
Metabolism of bilirubin in pre-hepatic
Spleen - breaks up dead rbc into haem and globin:
Haem - iron ion and bilirubin
Globin - protein just recycled
What i shepatic pathway of bilirubin?
Bilirubin arrives in liver (Uncongugated even though travels though blood with albumin as bilirubin is insoluble). And is turned into congugated bilirubin (bilirubin diglucuronide) through the enzyme glucuronyl transferase
What is the post-hepatic pathway of bilirubin?
transport of bilirubin through the bile duct and through the small intstine where bacteria modify it and some is reabsorbed as urobilinogen and excreted in the urine (via kidneys) and some is excreted in the poo (stercobilinogen)
What are the causes of jaundice?
Basically if something has gone wring in the pre hepatic, hepatic or post hepatic phases of bilirubin metabolism which causes there to be more bilirubin in crculation than there should be.
Eg pre-hepatic = internal bleed or ineffective erythropoiesis (red blood cell production). causing too many dead rbc being broken down
hepatic = damage of liver cells/biliary tree eg viral infection
Post-hepatic = something wrong with passage through bile duct eg gallstones
What is cholestasis?
Chole - gallbladder/bile related
Stasis - stillness
Bile stillness, so accumulation of bile within hepatocytes or bile canaliculi
Caused by:
-Viral hepatitis
-Alcoholic hepatitis
-Liver failure
-Drugs
-Therapeutic
-Recreational
What is primary bilary cholangitis? WHoi does it affect more?
Affects females more, granulomatous inflammation involving bile ducts, autoimmune disease, loss of hepatic bile ducts -> Cirrhosis
Whta is primary sclerosinhg Cholangitis?
Chronic inflamm and fibrous obliteration of bile ducts. affects men more. associated with IBD (inflamm. bowl disease). Can lead to Cirrhosis and risk of cholangiocarcinoma
What is hepatic cirrhosis?
fibrotic scarring of the liver making it unable to function effectivly dependant on the extent of the scarring.
(End stage chronic liver disease
Response of liver to chronic injury)
Causes of Cirrhosis?
Alcohol
Hepatitis B, C
Immune mediated liver disease
Auto-immune hepatitis
Primary biliary cholangitis
Metabolic disorders (Excess iron, Excess copper (Wilson’s disease))
Obesity
Diabetes mellitus
Complicaitons of cirrhosis
liver failure
Abnormal blood flow
Portal hypertension
Increased risk of hepatocellular carcinoma
3 tyoes of liver tumours
Hepatocellular carcinoma (Malignant tumour of hepatocytes)
Cholangiocarcinoma (Malignant tumour of bile duct epithelium)
Metastatic tumours
What are the post-hepatic causes of jaundice
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
Pathology of gallstones
Inflammation in gall bladder (cholecycstitis)
What ar ethe causes of common bile duct obstrucoitn
gall stones, cancers, benign strictures
What are the effect of common bile duct obstructoin?
Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction
Ascending cholangitis
Secondary biliary cirrhosis if obstruction prolonged