Hepato-billary pathology

Question 1

Liver functions

Answer 1

Metabolism of fats and carbs
Detoxify drugs, toxins inc. alcohol
produce proteins (protein synthesis)

Question 2

What causes liver failure?

Answer 2

Chirrosis (scarring) - Chronic liver injury
Too much toxins - damage to cells (acute liver injury)

Question 3

Why do you get fluid i n abdomen wiht liver failure?

Answer 3

Becuase loss of protein production - therefore loss of oncotic pressure and more fluid pushed outside of vessles

Question 4

What can cause acute liver injury?

Answer 4

Hepatitis: (alcohol, drugs,Viruses)

Bile duct obstruction

Question 5

What can be the causes of viral hepiatitis?

Answer 5

Hep A, B C , E and other virus’s

Question 6

What does viral hepatitis cause?

Answer 6

inflammation and fluid -> cell death and damage

Question 7

Outcomes for the viral hepatitiess

Answer 7

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

Question 8

What is alcoholic liver disease?

Answer 8

“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

Question 9

What is jaundice?

Answer 9

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.

Question 10

3 phases if bilirubin metabolism

Answer 10

Prehepatic, hepatic, post hepatic

Question 11

Metabolism of bilirubin in pre-hepatic

Answer 11

Spleen - breaks up dead rbc into haem and globin:

Haem - iron ion and bilirubin
Globin - protein just recycled

Question 12

What i shepatic pathway of bilirubin?

Answer 12

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

Question 13

What is the post-hepatic pathway of bilirubin?

Answer 13

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)

Question 14

What are the causes of jaundice?

Answer 14

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

Question 15

What is cholestasis?

Answer 15

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

Question 16

What is primary bilary cholangitis? WHoi does it affect more?

Answer 16

Affects females more, granulomatous inflammation involving bile ducts, autoimmune disease, loss of hepatic bile ducts -> Cirrhosis

Question 17

Whta is primary sclerosinhg Cholangitis?

Answer 17

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

Question 18

What is hepatic cirrhosis?

Answer 18

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)

Question 19

Causes of Cirrhosis?

Answer 19

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

Question 20

Complicaitons of cirrhosis

Answer 20

liver failure
Abnormal blood flow
Portal hypertension
Increased risk of hepatocellular carcinoma

Question 21

3 tyoes of liver tumours

Answer 21

Hepatocellular carcinoma (Malignant tumour of hepatocytes)

Cholangiocarcinoma (Malignant tumour of bile duct epithelium)

Metastatic tumours

Question 22

What are the post-hepatic causes of jaundice

Answer 22

Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction

Question 23

Pathology of gallstones

Answer 23

Inflammation in gall bladder (cholecycstitis)

Question 24

What ar ethe causes of common bile duct obstrucoitn

Answer 24

gall stones, cancers, benign strictures

Question 25

What are the effect of common bile duct obstructoin?

Answer 25

Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction
Ascending cholangitis
Secondary biliary cirrhosis if obstruction prolonged