Hepatobiliary Pathology Flashcards
what is liver failure a complication of?
acute or chronic liver injury
what can cause acute liver injury?
> hepatitis
> bile duct obstruction
describe the pathology of viral hepatitis
there is inflammation of the liver that causes cell damage and death of individual liver cells
what may be the outcome of acute inflammation of the liver caused by viral hepatitis?
> resolution
liver failure if damage is severe
progression to chronic hepatitis or cirrhosis
what is the response of the liver to excess alcohol?
alcoholic liver disease, there is a fatty change and acute inflammation leading to liver cell death and liver failure.
what can alcoholic hepatitis progress to?
cirrhosis
what causes jaundice?
increased circulating bilirubin from altered metabolism of bilirubin
describe the pre-hepatic metabolism of bilirubin
> haemoglobin is split in the spleen into haem and globin
> haem is converted to bilirubin and released into the circulation
in the hepatic stage of bilirubin metabolism what happens to the bilirubin in hepatocytes?
it is conjugated then excreted into the biliary system
describe the post hepatic pathway of bilirubin metabolism
> transport through the biliary system
bilirubin conjugate is broken down in the intestine
bilirubin is then reabsorbed
what is the cause of pre-hepatic jaundice?
increased release of haemoglobin form red blood cells
what are causes of hepatic jaundice?
> cholestasis
> intra-hepatic bile duct obstruction
what is cholestasis?
accumulation of bile within hepatocytes or bile canaliculi
what can cause cholestasis?
> viral hepatitis
alcoholic hepatitis
liver failure
drugs
what is the difference between predictable and non-predictable drug induced cholestasis?
predictable is dose related and unpredictable is not dose related
what can cause intra-hepatic bile duct obstruction?
> primary biliary cholangitis
primary sclerosing cholangitis
tumours of the liver
what is primary biliary cholangitis?
> organ specific autoimmune disease
describe serum changes in primary biliary cholangitis
> anti-microbial autoantibodies present
> raised serum alkaline phosphatase
describe the inflammation in primary biliary cholangitis
granulomatous inflammation involving the bile ducts (can progress to cirrhosis)
describe the pathology of primary sclerosing cholangitis
> chronic inflammation
fibrous obliteration of bile ducts
= loss of intra-hepatic bile ducts
what condition is primary sclerosing cholangitis associated with?
inflammatory bowel disease
what may progress form primary sclerosing cholangitis?
> cirrhosis
> cholangiocarcinoma
what is hepatic cirrhosis?
end stage chronic liver disease that is a response of the liver to chronic injury
what is the aetiology of cirrhosis?
> alcohol > hep. b, c > immune mediated liver disease > metabolic disorders > obesity > idiopathic
what metabolic disorders can cause cirrhosis?
> primary haemochromatosis (excess iron)
> wilson’s disease (excess copper)
describe the pathology of cirrhosis
> diffuse process involving the whole liver
loss of normal liver structure
replaced by nodules of hepatocytes and fibrous tissue
what are the complications of cirrhosis?
> altered liver function-failure
abnormal blood flow-portal hypertension
increased risk of hepatocellular carcinoma
what tumours can develop in the liver?
> hepatocellular carcinoma
cholangiocarcinoma
metastatic tumours
what is a hepatocellular carcinoma?
a malignant tumour of hepatocytes
what is a cholangiocarcinoma?
malignant tumour of bile duct wpithelium
what can cause post-hepatic jaundice?
> cholelithiasis (gallstones)
diseases of gall bladder
extra-hepatic duct obstruction
what are the risk factors for gall stones?
> obesity
> diabetes
what is cholecystitis?
inflammation of the gall bladder, can be acute or chronic
how may acute cholecystitis progress?
empyema:
> perforation of gall bladder
> biliary peritonitis
> can progress to chronic inflammation
what can cause obstruction of the common bile duct?
> gallstones
bile duct tumours
benign stricture
external compression (tumour)
what are the effects of common bile duct obstruction?
> jaundice
no bile excreted into duodenum
infection of bile proximal to obstruction
secondary biliary cirrhosis if obstruction is prolonged
what is ascending cholangitis?
infection of the bile proximal to the obstruction in common bile duct obstruction
