Hepatobiliary pathology

Question 1

What are the two vessels making up the dual blood supply of the liver?

Answer 1

portal vein and hepatic artery

Question 2

List some functions of the liver

Answer 2

metabolise carbohydrates and fat, bile synthesis, protein synthesis and detoxification

Question 3

What is liver failure a complication of?

Answer 3

acute liver injury eg hepatitis, bile duct obstruction

chronic liver injury eg cirrhosis

Question 4

What is alcoholic liver disease?

Answer 4

Fatty change to the liver in response to excess alcohol which disrupts fatty acid metabolism

Question 5

What is jaundice?

Answer 5

Increased circulating bilirubin caused by altered bilirubin metabolism

Question 6

What are the 3 stages of bilirubin metabolism?

Answer 6

pre-hepatic
hepatic
post-hepatic

Question 7

Where does bilirubin come from?

Answer 7

haemoglobin split to give haem and globin and the haem goes on to make bilirubin which enters the circulation

Question 8

What happens within the hepatic stage of bilirubin metabolism?

Answer 8

taken up by hepatocytes and conjugated to make more water soluble and then exported to the biliary system

Question 9

What happens within the post hepatic stage of the bilirubin metabolism?

Answer 9

conjugated bilirubin broken down in intestine and bilirubin is reabsorbed

Question 10

What happens within the pre-hepatic jaundice stage?

Answer 10

excess haemolysis - increased release of haemoglobin

Question 11

What are the 2 causes of hepatic jaundice?

Answer 11

cholestasis

intra hepatic bile duct obstruction

Question 12

What is cholestasis?

Answer 12

The inability of bile to enter the duodenum leading to an accumulation within the hepatocytes or bile canaliculi

Question 13

List some causes of cholestasis

Answer 13

alcoholic hepatitis, drugs, hepatitis virus, liver failure

Question 14

What is the difference between predictable and non predictable drug cholestasis?

Answer 14

predictable is dose related

Question 15

List 3 causes of intrahepatic bile duct obstruction

Answer 15

PBC
PSC
tumours

Question 16

What is primary biliary cholangitis - brief summary

Answer 16

An organ specific autoimmune disease which leads to granulomatous inflammation involving bile ducts, the loss of intra-hepatic bile ducts and leading to cirrhosis

Question 17

PBC - who it effects and the diagnostic measurements

Answer 17

females 9:1
anti mitochondrial auto antibodies in serum
raised serum alkaline phosphatase

Question 18

What is primary sclerosing cholangitis?

Answer 18

chronic inflammation and fibrous obliteration of ducts losing the ducts

Question 19

What is PSC linked to?

Answer 19

IBD

Question 20

What can PSC progress to?

Answer 20

cirrhosis

cholangiocarcinoma

Question 21

What is cholangiocarcinoma?

Answer 21

Malignant tumour effecting the bile duct epithelium

Question 22

What are some causes of hepatic cirrhosis?

Answer 22

alcohol, hepatitis B,C, autoimmune hepatitis, PBC, metabolic disorders, obesity, diabetes and unknown

Question 23

Describe the appearance of a cirrhosed liver

Answer 23

small, shrunken, vast amounts of nodules and fibrous tissue and encompasses the whole liver

Question 24

List the 3 main complications of cirrhosis

Answer 24

hepatocellular carcinoma, altered liver function leading to liver failure and abnormal blood flow leading to portal hypertension

Question 25

What precaution is put in place with people with cirrhosis?

Answer 25

screening programmes for cancer

Question 26

List the 3 potential causes of post-hepatic jaundice

Answer 26

cholelithiasis - gallstones
diseases of the gallbladder
extra hepatic duct obstruction

Question 27

What are 2 main risk factors for gallstones?

Answer 27

obesity and diabetes

Question 28

What is the pathology of acute cholecystitis?

Answer 28

empyema, perforation and peritonitis which can lead to chronic cholecystitis

Question 29

What happens during chronic cholystitis?

Answer 29

inflammation and chronic fibrosis

Question 30

What are the causes of common bile duct obstruction?

Answer 30

tumours, gallstones, strictures, pancreatic tumours

Question 31

What are the effects of common bile duct obstruction?

Answer 31

jaundice!

secondary biliary cirrhosis, infection of bile