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The Alimentary Canal > Hepatobiliary Pathology > Flashcards

Hepatobiliary Pathology Flashcards

1
Q

Describe blood supply of the liver

A

Dual blood supply
Hepatic artery
Portal vein

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2
Q

What are the functions of the liver?

A

Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol

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3
Q

What does the hepatobiliary system include?

A

Liver
Gallbladder
Extrahepatic bile ducts

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4
Q

What is liver failure a complication of?

A

Acute liver injury
Chronic liver injury - cirrhosis

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5
Q

What can cause acute liver injury?

A

Hepatitis - viruses, alcohol and drugs
Bile duct obstruction

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6
Q

What are the different viral types of hepatitis?

A

A, B, C, E and other viruses

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7
Q

Describe the pathology of viral hepatitis

A

Inflammation of the liver
Liver cell damage and death of individual liver cells

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8
Q

What is the outcome of acute inflammation?

A

Resolution
Liver failure
Progression to chronic hepatitis and cirrhosis

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9
Q

What types of hepatitis can lead to resolution of liver to normal?

A

A and E

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10
Q

What types of hepatitis can cause liver failure?

A

A, B and E

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11
Q

What types of hepatitis can lead to chronic hepatitis or cirrhosis?

A

B and C

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12
Q

Describe alcoholic liver disease

A

Response of liver to excess alcohol
Fatty change
Progress to cirrhosis
Alcoholic hepatitis

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13
Q

Explain alcoholic hepatitis

A

Acute inflammation
Liver cell death
Liver failure

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14
Q

What is steatohepatitis?

A

Fatty change which can be seen in alcoholic liver disease
Hepatocytes packed with lipid vesicles

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15
Q

What is jaundice?

A

Increased circulating bilirubin

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16
Q

What is jaundice caused by?

A

Altered metabolism of bilirubin

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17
Q

What are the pathways of bilirubin metabolism?

A

Pre-hepatic
Hepatic
Post-hepatic

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18
Q

Explain the pre-hepatic breakdown of bilirubin

A

Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation

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19
Q

Explain the hepatic pathway of bilirubin

A

Uptake of bilirubin into hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system

20
Q

Explain the post-hepatic pathway of bilirubin

A

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin in enterohepatic circulation

21
Q

What is pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells - haemolysis
E.coli, drugs and chemo can do this

22
Q

What are hepatic causes of jaundice?

A

Cholestasis
Intrahepatic bile duct obstruction

23
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

24
Q

What are some causes of cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs - therapeutic or recreational

25
Q

What is the difference between predictable vs unpredictable cholestasis?

A

Predictable - dose related
Unpredictable - not dose related

26
Q

What are the 2 types of intrahepatic bile obstruction?

A

Primary biliary cholangitis
Primary sclerosing cholangitis

27
Q

What are some tumours of the liver?

A

Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours

28
Q

Explain primary biliary cholangitis

A

Organ specific autoimmune disease
Mainly affects females
There is antimicrobial auto-antibodies in serum
Raised serum alkaline phosphate

29
Q

Describe the pathology of primary biliary cholangitis

A

Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis

30
Q

Explain sclerosing cholangitis

A

Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Associated with inflammatory bowel disease

31
Q

What does primary sclerosing cholangitis lead to?

A

Progression to cirrhosis
Increased risk of development of cholangiocarcinoma

32
Q

What is cholangiocarcinoma?

A

Cancer in the bile duct

33
Q

What is hepatic cirrhosis?

A

End stage chronic liver disease in response to chronic injury
Cirrhosis is healed by fibrosis

34
Q

What are some causes of cirrhosis?

A

Alcohol
Hepatitis B and C
Immune mediated liver damage - autoimmune hepatitis and PBC
Metabolic disorders
Obesity

35
Q

What are the metabolic disorders which can cause cirrhosis?

A

Excess iron - primary haemochromatosis
Excess copper - Wilson’s disease

36
Q

Describe the pathology of cirrhosis

A

Diffuse process involving whole organ
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue

37
Q

What are some complications of cirrhosis?

A

Altered liver function - liver failure
Abnormal blood flow - portal hypertension
Increased risk of hepatocellular carcinoma

38
Q

What are some types of liver tumours?

A

Hepatocellular carcinoma - malignant tumour of hepatocytes
Cholangiocarcinoma - malignant
Metastatic tumour

39
Q

What can cause post-hepatic jaundice?

A

Cholelithiasis (gallstones)
Diseases of gallbladder
Extra-hepatic duct obstruction

40
Q

What are the risk factors of gallstones?

A

Obesity
Diabetes

41
Q

What can cause gallstones in the gallbladder?

A

Inflammation
Acute cholecystitis
Chronic cholecystitis

42
Q

What can acute cholecystitis lead to?

A

Empyema if perforation of gallbladder or biliary peritonitis
Progression to chronic inflammation

43
Q

Explain chronic cholecystitis

A

Chronic inflammation and fibrosis of gallbladder
Walls are thick
Stones have rubbed off epithelium so can cause blood in gallbladder

44
Q

What are some causes of common bile duct obstruction?

A

Gallstones
Bile duct tumours
Benign stricture
External compression - tumours

45
Q

What are the effects of common bile duct obstruction?

A

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

The Alimentary Canal (33 decks)

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