Hepatobiliary Pathology Flashcards
Describe blood supply of the liver
Dual blood supply
Hepatic artery
Portal vein
What are the functions of the liver?
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
What does the hepatobiliary system include?
Liver
Gallbladder
Extrahepatic bile ducts
What is liver failure a complication of?
Acute liver injury
Chronic liver injury - cirrhosis
What can cause acute liver injury?
Hepatitis - viruses, alcohol and drugs
Bile duct obstruction
What are the different viral types of hepatitis?
A, B, C, E and other viruses
Describe the pathology of viral hepatitis
Inflammation of the liver
Liver cell damage and death of individual liver cells
What is the outcome of acute inflammation?
Resolution
Liver failure
Progression to chronic hepatitis and cirrhosis
What types of hepatitis can lead to resolution of liver to normal?
A and E
What types of hepatitis can cause liver failure?
A, B and E
What types of hepatitis can lead to chronic hepatitis or cirrhosis?
B and C
Describe alcoholic liver disease
Response of liver to excess alcohol
Fatty change
Progress to cirrhosis
Alcoholic hepatitis
Explain alcoholic hepatitis
Acute inflammation
Liver cell death
Liver failure
What is steatohepatitis?
Fatty change which can be seen in alcoholic liver disease
Hepatocytes packed with lipid vesicles
What is jaundice?
Increased circulating bilirubin
What is jaundice caused by?
Altered metabolism of bilirubin
What are the pathways of bilirubin metabolism?
Pre-hepatic
Hepatic
Post-hepatic
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
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
