Hepatobiliary Pathology Flashcards
Describe the blood that the hepatic artery supplies to the liver
Oxygen rich
Nutrient depleted
Describe the blood that the hepatic portal vein supplies to the liver
Oxygen depleted
Nutrient rich
What are the functions of the liver?
Protein synthesis
Metabolism of fat and carbohydrate
Metabolism of alcohol
Biliary metabolism
Where is bile stored?
In the gall bladder
What is liver failure a complication of?
Acute liver injury
Chronic livery injury
What is hepatits?
Liver inflammation
What can cause hepatitis?
Viruses
Alcohol
Drugs
What viruses target the liver?
Hep A
Hep B
Hep C
Hep E
Which virus is Hep D associated with?
Hep B
Which hepatitis viruses normally resolute?
A and E
What is jaundice caused by?
Increased circulating bilirubin
What are the 3 classifications of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
Where are RBC processed?
Spleen
Describe the pre-hepatic metabolism of bilirubin
- Breakdown of haemoglobin in spleen (as this is where RBC are processed) to form haem and globin
- Haem converted to bilirubin
- Release of bilirubin into circulation
- There is a normal low circulating level of bilirubin
Describe the hepatic metabolism of bilirubin
- Uptake of bilirubin by hepatocytes
- Conjugation of bilirubin in hepatocytes (make it go water soluble)
- Excretion of conjugated bilirubin into biliary system
Describe the Post-hepatic metabolism of bilirubin
- Transport of conjugated bilirubin in biliary system
- Breakdown of bilirubin conjugate in intestine
- Re-absorption of bilirubin
- Entero-hepatic circulation of bilirubin
What are the 3 classifications of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
What are some causes for cholestasis?
o Viral hepatitis o Alcoholic hepatitis o Liver Failure o Drugs - Therapeutic - Recreational o Any drug can potentially cause liver harm
What 2 conditions cause intra-hepatic bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
Does PBC mainly affect males or females?
Females
What is hepatic cirrhosis?
End stage liver disease
Response of liver to chronic injury
Scarring of the liver
What are some causes of cirrhosis?
Alcohol Hepatitis B and C Immune mediated liver disease (auto-immune hepatitis, primary biliary cholangitis) Excess iron Wilson's disease (excess copper) Obesity Fatty liver disease Cryptogenic
What is the pathology of liver cirrhosis like?
o Diffuse process involving whole liver o Loss of normal liver structure o Replaced by nodules of hepatocytes separated by large bands of fibrous tissue o Smaller than normal o Fibrosed o Nodules of various size
What are the complications of cirrhosis?
Altered liver function
Abnormal blood flow
Increased risk of hepatocellular carcinoma
What tumours can occur in the liver?
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours
What is hepatocellular carcinoma?
Malignant tumour of hepatocytes
What is cholangiocarcinoma?
Malignant tumour of bile duct epithelium
Is the liver a common site for metastases?
Yes
What are the risk factors for cholelithiasis?
Obesity Diabetes Fat Female Forty Fertile
What is cholelithiasis?
Gallstones
What is cholecystitis?
Inflammation of the gall bladder
What is empyema in the gall bladder?
Accumulation of pus in the hollow organ
What is chronic cholecystitis?
Chronic inflammation and fibrosis of the gall bladder
What are causes of common bile duct obstruction?
Gallstones Bile duct tumours in the duct Compression from external tumours Benign tumours Benign strictures
What are the consequences of common bile duct obstruction?
Jaundice as no bile is excreted into the duodenum
Infection of bile proximal to obstruction
Secondary biliary cirrhosis
What causes biliary colic?
When the GB contracts after a fatty meal to try release bile
but gallstones get pushed in to the cystic duct
What is cholangitis?
Inflammation of the biliary tree
What is choledocholithiasis?
Gallstones in the common bile duct
In which quadrant in the abdomen is biliary pain usually felt?
Right upper quadrant
