Hepatobiliary Pathology Flashcards by Sophie Pitcairn

Describe blood supply of the liver

Dual blood supply
Hepatic artery
Portal vein

How well did you know this?

Not at all

Perfectly

What are the functions of the liver?

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

How well did you know this?

Not at all

Perfectly

What does the hepatobiliary system include?

Liver
Gallbladder
Extrahepatic bile ducts

How well did you know this?

Not at all

Perfectly

What is liver failure a complication of?

Acute liver injury
Chronic liver injury - cirrhosis

How well did you know this?

Not at all

Perfectly

What can cause acute liver injury?

Hepatitis - viruses, alcohol and drugs
Bile duct obstruction

How well did you know this?

Not at all

Perfectly

What are the different viral types of hepatitis?

A, B, C, E and other viruses

How well did you know this?

Not at all

Perfectly

Describe the pathology of viral hepatitis

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

How well did you know this?

Not at all

Perfectly

What is the outcome of acute inflammation?

Resolution
Liver failure
Progression to chronic hepatitis and cirrhosis

How well did you know this?

Not at all

Perfectly

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

A and E

How well did you know this?

Not at all

Perfectly

What types of hepatitis can cause liver failure?

A, B and E

How well did you know this?

Not at all

Perfectly

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

B and C

How well did you know this?

Not at all

Perfectly

Describe alcoholic liver disease

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

How well did you know this?

Not at all

Perfectly

Explain alcoholic hepatitis

Acute inflammation
Liver cell death
Liver failure

How well did you know this?

Not at all

Perfectly

What is steatohepatitis?

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

How well did you know this?

Not at all

Perfectly

What is jaundice?

Increased circulating bilirubin

How well did you know this?

Not at all

Perfectly

What is jaundice caused by?

Altered metabolism of bilirubin

How well did you know this?

Not at all

Perfectly

What are the pathways of bilirubin metabolism?

Pre-hepatic
Hepatic
Post-hepatic

How well did you know this?

Not at all

Perfectly

Explain the pre-hepatic breakdown of bilirubin

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

How well did you know this?

Not at all

Perfectly

Explain the hepatic pathway of bilirubin

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

Explain the post-hepatic pathway of bilirubin

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

What is pre-hepatic jaundice?

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

What are hepatic causes of jaundice?

Cholestasis
Intrahepatic bile duct obstruction

What is cholestasis?

Accumulation of bile within hepatocytes or bile canaliculi

What are some causes of cholestasis?

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs - therapeutic or recreational

What is the difference between predictable vs unpredictable cholestasis?

Predictable - dose related Unpredictable - not dose related

What are the 2 types of intrahepatic bile obstruction?

Primary biliary cholangitis Primary sclerosing cholangitis

What are some tumours of the liver?

Hepatocellular carcinoma Tumours of intra-hepatic bile ducts Metastatic tumours

Explain primary biliary cholangitis

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

Describe the pathology of primary biliary cholangitis

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

Explain sclerosing cholangitis

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

What does primary sclerosing cholangitis lead to?

Progression to cirrhosis Increased risk of development of cholangiocarcinoma

What is cholangiocarcinoma?

Cancer in the bile duct

What is hepatic cirrhosis?

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

What are some causes of cirrhosis?

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

What are the metabolic disorders which can cause cirrhosis?

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

Describe the pathology of cirrhosis

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

What are some complications of cirrhosis?

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

What are some types of liver tumours?

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

What can cause post-hepatic jaundice?

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

What are the risk factors of gallstones?

Obesity Diabetes

What can cause gallstones in the gallbladder?

Inflammation Acute cholecystitis Chronic cholecystitis

What can acute cholecystitis lead to?

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

Explain chronic cholecystitis

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

What are some causes of common bile duct obstruction?

Gallstones Bile duct tumours Benign stricture 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 prolonged