Hepatobiliary pathology Flashcards
What are the two vessels making up the dual blood supply of the liver?
portal vein and hepatic artery
List some functions of the liver
metabolise carbohydrates and fat, bile synthesis, protein synthesis and detoxification
What is liver failure a complication of?
acute liver injury eg hepatitis, bile duct obstruction
chronic liver injury eg cirrhosis
What is alcoholic liver disease?
Fatty change to the liver in response to excess alcohol which disrupts fatty acid metabolism
What is jaundice?
Increased circulating bilirubin caused by altered bilirubin metabolism
What are the 3 stages of bilirubin metabolism?
pre-hepatic
hepatic
post-hepatic
Where does bilirubin come from?
haemoglobin split to give haem and globin and the haem goes on to make bilirubin which enters the circulation
What happens within the hepatic stage of bilirubin metabolism?
taken up by hepatocytes and conjugated to make more water soluble and then exported to the biliary system
What happens within the post hepatic stage of the bilirubin metabolism?
conjugated bilirubin broken down in intestine and bilirubin is reabsorbed
What happens within the pre-hepatic jaundice stage?
excess haemolysis - increased release of haemoglobin
What are the 2 causes of hepatic jaundice?
cholestasis
intra hepatic bile duct obstruction
What is cholestasis?
The inability of bile to enter the duodenum leading to an accumulation within the hepatocytes or bile canaliculi
List some causes of cholestasis
alcoholic hepatitis, drugs, hepatitis virus, liver failure
What is the difference between predictable and non predictable drug cholestasis?
predictable is dose related
List 3 causes of intrahepatic bile duct obstruction
PBC
PSC
tumours
What is primary biliary cholangitis - brief summary
An organ specific autoimmune disease which leads to granulomatous inflammation involving bile ducts, the loss of intra-hepatic bile ducts and leading to cirrhosis
PBC - who it effects and the diagnostic measurements
females 9:1
anti mitochondrial auto antibodies in serum
raised serum alkaline phosphatase
What is primary sclerosing cholangitis?
chronic inflammation and fibrous obliteration of ducts losing the ducts
What is PSC linked to?
IBD
What can PSC progress to?
cirrhosis
cholangiocarcinoma
What is cholangiocarcinoma?
Malignant tumour effecting the bile duct epithelium
What are some causes of hepatic cirrhosis?
alcohol, hepatitis B,C, autoimmune hepatitis, PBC, metabolic disorders, obesity, diabetes and unknown
Describe the appearance of a cirrhosed liver
small, shrunken, vast amounts of nodules and fibrous tissue and encompasses the whole liver
List the 3 main complications of cirrhosis
hepatocellular carcinoma, altered liver function leading to liver failure and abnormal blood flow leading to portal hypertension
What precaution is put in place with people with cirrhosis?
screening programmes for cancer
List the 3 potential causes of post-hepatic jaundice
cholelithiasis - gallstones
diseases of the gallbladder
extra hepatic duct obstruction
What are 2 main risk factors for gallstones?
obesity and diabetes
What is the pathology of acute cholecystitis?
empyema, perforation and peritonitis which can lead to chronic cholecystitis
What happens during chronic cholystitis?
inflammation and chronic fibrosis
What are the causes of common bile duct obstruction?
tumours, gallstones, strictures, pancreatic tumours
What are the effects of common bile duct obstruction?
jaundice!
secondary biliary cirrhosis, infection of bile
