Hepatobiliary Pathology Flashcards

1
Q

what is liver failure a complication of?

A

acute or chronic liver injury

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2
Q

what can cause acute liver injury?

A

> hepatitis

> bile duct obstruction

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3
Q

describe the pathology of viral hepatitis

A

there is inflammation of the liver that causes cell damage and death of individual liver cells

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4
Q

what may be the outcome of acute inflammation of the liver caused by viral hepatitis?

A

> resolution
liver failure if damage is severe
progression to chronic hepatitis or cirrhosis

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5
Q

what is the response of the liver to excess alcohol?

A

alcoholic liver disease, there is a fatty change and acute inflammation leading to liver cell death and liver failure.

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6
Q

what can alcoholic hepatitis progress to?

A

cirrhosis

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7
Q

what causes jaundice?

A

increased circulating bilirubin from altered metabolism of bilirubin

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8
Q

describe the pre-hepatic metabolism of bilirubin

A

> haemoglobin is split in the spleen into haem and globin

> haem is converted to bilirubin and released into the circulation

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9
Q

in the hepatic stage of bilirubin metabolism what happens to the bilirubin in hepatocytes?

A

it is conjugated then excreted into the biliary system

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10
Q

describe the post hepatic pathway of bilirubin metabolism

A

> transport through the biliary system
bilirubin conjugate is broken down in the intestine
bilirubin is then reabsorbed

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11
Q

what is the cause of pre-hepatic jaundice?

A

increased release of haemoglobin form red blood cells

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12
Q

what are causes of hepatic jaundice?

A

> cholestasis

> intra-hepatic bile duct obstruction

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13
Q

what is cholestasis?

A

accumulation of bile within hepatocytes or bile canaliculi

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14
Q

what can cause cholestasis?

A

> viral hepatitis
alcoholic hepatitis
liver failure
drugs

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15
Q

what is the difference between predictable and non-predictable drug induced cholestasis?

A

predictable is dose related and unpredictable is not dose related

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16
Q

what can cause intra-hepatic bile duct obstruction?

A

> primary biliary cholangitis
primary sclerosing cholangitis
tumours of the liver

17
Q

what is primary biliary cholangitis?

A

> organ specific autoimmune disease

18
Q

describe serum changes in primary biliary cholangitis

A

> anti-microbial autoantibodies present

> raised serum alkaline phosphatase

19
Q

describe the inflammation in primary biliary cholangitis

A

granulomatous inflammation involving the bile ducts (can progress to cirrhosis)

20
Q

describe the pathology of primary sclerosing cholangitis

A

> chronic inflammation
fibrous obliteration of bile ducts
= loss of intra-hepatic bile ducts

21
Q

what condition is primary sclerosing cholangitis associated with?

A

inflammatory bowel disease

22
Q

what may progress form primary sclerosing cholangitis?

A

> cirrhosis

> cholangiocarcinoma

23
Q

what is hepatic cirrhosis?

A

end stage chronic liver disease that is a response of the liver to chronic injury

24
Q

what is the aetiology of cirrhosis?

A
> alcohol
> hep. b, c
> immune mediated liver disease
> metabolic disorders
> obesity
> idiopathic
25
Q

what metabolic disorders can cause cirrhosis?

A

> primary haemochromatosis (excess iron)

> wilson’s disease (excess copper)

26
Q

describe the pathology of cirrhosis

A

> diffuse process involving the whole liver
loss of normal liver structure
replaced by nodules of hepatocytes and fibrous tissue

27
Q

what are the complications of cirrhosis?

A

> altered liver function-failure
abnormal blood flow-portal hypertension
increased risk of hepatocellular carcinoma

28
Q

what tumours can develop in the liver?

A

> hepatocellular carcinoma
cholangiocarcinoma
metastatic tumours

29
Q

what is a hepatocellular carcinoma?

A

a malignant tumour of hepatocytes

30
Q

what is a cholangiocarcinoma?

A

malignant tumour of bile duct wpithelium

31
Q

what can cause post-hepatic jaundice?

A

> cholelithiasis (gallstones)
diseases of gall bladder
extra-hepatic duct obstruction

32
Q

what are the risk factors for gall stones?

A

> obesity

> diabetes

33
Q

what is cholecystitis?

A

inflammation of the gall bladder, can be acute or chronic

34
Q

how may acute cholecystitis progress?

A

empyema:
> perforation of gall bladder
> biliary peritonitis

> can progress to chronic inflammation

35
Q

what can cause obstruction of the common bile duct?

A

> gallstones
bile duct tumours
benign stricture
external compression (tumour)

36
Q

what are the effects of common bile duct obstruction?

A

> jaundice
no bile excreted into duodenum
infection of bile proximal to obstruction
secondary biliary cirrhosis if obstruction is prolonged

37
Q

what is ascending cholangitis?

A

infection of the bile proximal to the obstruction in common bile duct obstruction