Hepatobiliary Pathology

Question 1

How man lobes are in the liver?

Answer 1

2 lobes

Question 2

The liver is involved in carbohydrate metabolism, and with the storage of?

Answer 2

Glycogen

Question 3

Jaundice is the yellowing of the skin and the conjunctivae and is seen with raised bilirubin to above which levels?

Answer 3

> 40mmol/L

Question 4

Bilirubin is a breakdown product of?

Answer 4

Haemoglobin

Question 5

What are the two forms of bilirubin?

Answer 5

Unconjugated water insoluble form
Conjugated in the liver to glucuronic acid

Question 6

What does bilirubin conjugate to?

Answer 6

Glucuronic acid

Question 7

Unconjugated bilirubin binds to which trnasport protein?

Answer 7

Albumin, becoming fat soluble and potentially toxic.

Question 8

Conjugated bilirubin is soluble in what and is normally excreted as?

Answer 8

Water soluble
Excreted in the bile

Question 9

What are the three main pathologies that cause jaundice?

Answer 9

• hepatitis
• alcoholic liver disease
• hemochromatosis

Question 10

What are some possible causes of hepatisis?

Answer 10

• noninfectious causes
• viral
• bacterial

Question 11

What are the two types of hepatitis?

Answer 11

chronic and acute

Question 12

HepA (acute) virus is normally spread through which route?

Answer 12

The Faeco-oral route

Question 13

HepB Virus is usually spread through which route and account for how much of the chronic infections of the liver?

Answer 13

Parenteral
Around 4% progress to chronic infection –> cirrhosis and possible hepatocellular carcinoma

Question 14

HepC virus is usually spread through which route and accounts for how much of the chronic liver infections?

Answer 14

Parenteral
around 85% of chronic liver infections

Question 15

What type of morphology is seen of the hepatocytes with acute viral hepatitis?

Answer 15

Hepatocytes appear swollen and vacuolated, ballooning degeneration’ with hepatomegaly.
Focal necrosis of hepatocytes
Apoptosis
Eosinophilic councilman bodies.

Question 16

What type of hepatocytes are seen with chronic viral hepatitis?

Answer 16

Ground glass hepatocytes, possible viral inclusion bodies.

Question 17

What can cirrhosis lead to?

Answer 17

Liver dysfunction and increasing the risk for hepatocellular carcinoma

Question 18

What type of changes are seen in alcoholic liver disease?

Answer 18

Fatty change - steatosis, hepatitis, fibrosis or cirrhosis

Question 19

In a liver biopsy of someone with alcoholic liver disease what is evident?

Answer 19

• hepatocyte necrosis
• fatty change
• Mallory’s hyaline

Question 20

ATP is diverted from which type of metabolism to alcohol metabolism leading to the accumulation of? In Alcoholic liver disease.

Answer 20

Diverted from fat metabolism to alcohol metabolism, fat accumulation.

Question 21

Alcohol stimulates which type of synthesis

Answer 21

Collagen synthesis leading to fibrosis

Question 22

What can lead to inflammation and hepatocyte damage?

Answer 22

Acetaldehyde

Question 23

Primary haemochromatosis is caused by the autosomal recessive mutation of which protein on chromosome 6?

Answer 23

C282Y

Question 24

In haemochromatosis, excessive absorption of iron is absorbed which deposits in the organs of the body as?

Answer 24

Hemosiderin leading to cirrhosis developing over time

Question 25

Cirrhosis is due to an extended period of liver damage, what are some common causes?

Answer 25

toxins (alcohol)
drugs
infections (HCV)
gallstones

Question 26

What is the stain used to demonstrate the dense connective tissue of a cirrhotic liver?

Answer 26

Masson Trichrome stain in which connective tissue stains green

Question 27

What are the three consequences of a cirrhotic liver?

Answer 27

• failure of synthesis (decreased albumin and clotting factors)
• failure of catabolism (persistence of hormones)
• failure of flow

Question 28

Liver failure leads to the reduced synthesis of which factors and hormones?

Answer 28

Decreased albumin and clotting factors, failure of catabolism of hormones and nitrogenous wastes.

Question 29

What is the most common tumor of the liver?

Answer 29

Hepatocellular carcinoma

Question 30

Hepatocellular carcinoma can arise from which types of hepatitis?

Answer 30

Hep B and Hep C

Question 31

Hepatocellular carcinoma often secretes which protein into the blood?

Answer 31

Alpha fetoprotein

Question 32

Elevated GGT is indicative of which type of liver damage?

Answer 32

Alcohol induced liver damage

Question 33

What are the 4 liver enzymes?

Answer 33

AST
ALT
GGT
Alkaline Phosphatase
Bilirubin
Albumin
Clotting Factors

Question 34

What is the function of the gall bladder?

Answer 34

Bile Storage - Consists of lipids, cholesterol, bile salts and bilirubin

Question 35

When do gallstones occur?

Answer 35

When there is excess cholesterol in the bile.

Question 36

What are the three types of gallstones?

Answer 36

• pigment stones
• cholesterol stones
• mixed stones (mostly)

Question 37

What is cholecystitis?

Answer 37

This is where there is an inflammation of the gall bladder - pain, tenderness may become infected. May need GB removal.

Question 38

What is cholangitis?

Answer 38

Inflammation of the bile duct radiating back to the liver - obstruction of the common bile duct.

Question 39

Reticulin illustrates what? What colour does it stain?

Answer 39

Reticulin
Silver

Question 40

What stain illustrates glycogen?

Answer 40

PAS; illustrating hepatocytes entrapped in fibrosis/inflammation

Question 41

What is the stain for Perl’s ?

Answer 41

Haemachromatosis

Question 42

Shikata/Orcein stains which two components?

Answer 42

HBV and elastin