Hepatobiliary Pathology

Question 1

What are examples of pathologies of the liver?

Answer 1

Liver failure

Jaundice

Intrahepatic bile duct obstruction

Cirrhosis

Tumours

Question 2

What is pathology of the gallbladder usually?

Answer 2

Inflammation

Question 3

What is pathology of the extrahepatic bile ducts normally?

Answer 3

Obstruction

Question 4

What 2 broad categories is liver failure a complication of?

Answer 4

Acute liver injury

Chronic liver disease (such as cirrhosis)

Question 5

What are examples of acute liver injury?

Answer 5

Hepatitis

Bile duct obstruction

Question 6

What can cause hepatitis which causes acute liver injury?

Answer 6

Viruses such as hep A, B, C, E, other viruses

Alcohol

Drugs

Question 7

What is the pathology of virus hepatitis?

Answer 7

Inflammation of the liver

Liver cell damage and death of the individual liver cells

Question 8

What are the possible outcomes of acute liver injury?

Answer 8

Resolution (liver function returns to normal)

Liver failure (if severe damage to the liver)

Progression to chronic hepatitis and cirrhosis

Question 9

What hepatitis viruses can cause acute liver injury but then lead to resolution?

Answer 9

Hepatitis A and E

Question 10

What hepatitis can cause acute liver injury and lead to liver failuer?

Answer 10

Hepatitis A, B and E

Question 11

What hepatitis can cause acute liver injury and lead to chronic hepatitis?

Answer 11

Hepatitis B and C

Question 12

What is alcohol liver disease?

Answer 12

Result of consuming too much alcohol, leading to build up of inflammation, fat and scar tissue

Question 13

What is the pathology of alcoholic hepatitis?

Answer 13

Acute inflammation

Liver cell death

Liver failure

Progress to cirrhosis

Question 14

What is alcoholic hepatitis?

Answer 14

Inflammation of the liver caused by drinking to much alcohol

Question 15

What is jaundice caused by?

Answer 15

Increased circulating bilirubin due to altered metabolism of bilirubin

Question 16

What are the 3 broad areas of the body involved in bilirubin metabolism?

Answer 16

Pre-hepatic

Hepatic

Post-hepatic

Question 17

Explain the pathway of bilirubin metabolism?

Answer 17

1) Breakdown of haemoglibin in spleen to form haem and globin (prehepatic)
2) Haem converted to bilirubin (prehepatic)
3) Release of bilirubin into circulation (prehepatic)
4) Uptake of bilirubin by hepatocytes (hepatic)
5) Conjugation of bilirubin in hepatocytes (hepatic)
6) Excretion of conjugated bilirubin into biliary system (hepatic)
7) Transport of conjugated bilirubin in biliary system (posthepatic)
8) Breakdown of bilirubin conjugate in intestine (posthepatic)
9) Reabsorption of bilirubin (posthepatic)

Question 18

What are the 3 broad categories of causes of jaundice?

Answer 18

Pre-hepatic

Hepatic

Post-hepatic

Question 19

What are pre-hepatic causes of jaundice?

Answer 19

Increased release of haemoglobin from red cells (haemolysis)

Question 20

What is the rupture or destruction of red blood cells called?

Answer 20

Haemolysis

Question 21

What are some causes of cholestasis?

Answer 21

Viral hepatitis

Alcoholic hepatitis

Liver failure

Drugs (therpeutical, recreation, can be predictable so dose related or unpredictable so not dose related)

Question 22

What are some

Question 23

What are hepatic causes of jaundice?

Answer 23

Cholestasis

Intra-hepatic bile duct obstruction

Question 24

What is cholestasis?

Answer 24

Accumulation of bile within hepatocytes or bile canaliculi

Question 25

What are causes of intra-hepatic bile duct obstruction?

Answer 25

Primary biliary cholangitis Primary sclerosing cholangitis Tumours of the liver

Question 26

What kind of condition is primary biliary cholangitis?

Answer 26

Autoimmune disease

Question 27

How does the incidence of primary biliary cholangitis change between males and females?

Answer 27

Affects males to females 1:9 ratio

Question 28

What is the pathology of primary biliary cholangitis?

Answer 28

Granulomatous inflammation involving bile ducts Loss of intra-hepatic bile ducts Progression to cirrhosis

Question 29

What does PBC (primary biliary cholangitis) change in the blood?

Answer 29

Raises serum alkaline phosphatase

Question 30

What does PBC stand for?

Answer 30

Primary biliary cholangitis

Question 31

What does PSC stand for?

Answer 31

Primary sclerosing cholangitis

Question 32

What is the pathology of primary sclerosing cholangitis?

Answer 32

Chronic inflammation and fibrous obliteration of bile ducts Loss of intra-hepatic bile ducts Progression to cirrhosis

Question 33

What does PSC increase the risk of?

Answer 33

Developing cholangiocarcinoma

Question 34

What are examples of tumours of the liver?

Answer 34

Hepatocellular carcinoma Tumours of intra-hepatic bile ducts Metastatic tumours

Question 35

What are some post-hepatic causes of jaundice?

Answer 35

Cholelithiasis 9gallstones) Diseases of the gallblader Extrahepatic duct obstruction

Question 36

What is cholelithiasis?

Answer 36

The formation of gallstones

Question 37

What are risk factors for cholelithiasis?

Answer 37

Obesity Diabetes

Question 38

What is inflammation of the gallbladder called?

Answer 38

Cholecystitis

Question 39

What are examples of diseases of the gallbladder?

Answer 39

Acute cholecystitis Chronic cholecystitis

Question 40

What is an empyema?

Answer 40

Pocket of pus collected inside body cavity

Question 41

What causes acute cholecystitis?

Answer 41

Empyema (due to perforation of gallbladder or biliary peritonitis)

Question 42

What are some causes of extra-hepatic obstruction?

Answer 42

Gallstones Bile duct tumours Benign stricture External compression (such as due to tumours)

Question 43

What are some of the consequences of extra-hepatic bile duct obstruction?

Answer 43

Jaundice No bile excreted into duodenum Infection of bile proximal to obstruction (ascending cholangitis) Secondary biliary cirrhosis if obstruction prolonged

Question 44

What is hepatic cirrhosis?

Answer 44

End stage chronic liver disease

Question 45

What is hepatic cirrhosis the response of the liver to?

Answer 45

Chronic injury

Question 46

What are some examples of causes of hepatic cirrhosis?

Answer 46

Alcohol Hepatitis B and C Immune mediated liver disease (such as auto-immune hepatitis or PBC) Obesity (diabetes mellitus)

Question 47

What is the pathology of cirrhosis?

Answer 47

Diffuse process involving whole liver Loss of normal liver structure Replaced by nodules of hepatocytes and fibrous tissue

Question 48

What are some possible complications of liver cirrhosis?

Answer 48

Altered liver function (liver failure) Abnormal blood flow (portal hypertension) Increased risk of hepatocellular carcinoma

Question 49

What are examples of liver tumours?

Answer 49

Hepatocellular carcinoma Cholangiocarcinoma Metastatic tumours

Question 50

What is a malignant tumour of hepatocytes called?

Answer 50

Hepatocellular carcinoma

Question 51

What are examples of liver function tests (LFT)?

Answer 51

Alanine aminotransferase test (ALT) Asparate aminotransferase test (AST) Albumin test Bilirubin test

Question 52

What do ALT and AST tests measure?

Answer 52

Enzymes that the liver releases in response to damage or disease

Question 53

What does ALT stand for?

Answer 53

Alanine transferase test

Question 54

What does AST stand for?

Answer 54

Asparate transferase test

Question 55

What does an albumin test measure?

Answer 55

How well the liver creates albumin

Question 56

What does a bilirubin test measure?

Answer 56

How well the liver disposes of bilirubin