Hepatobiliary Pathology Flashcards
What are examples of pathologies of the liver?
Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours
What is pathology of the gallbladder usually?
Inflammation
What is pathology of the extrahepatic bile ducts normally?
Obstruction
What 2 broad categories is liver failure a complication of?
Acute liver injury
Chronic liver disease (such as cirrhosis)
What are examples of acute liver injury?
Hepatitis
Bile duct obstruction
What can cause hepatitis which causes acute liver injury?
Viruses such as hep A, B, C, E, other viruses
Alcohol
Drugs
What is the pathology of virus hepatitis?
Inflammation of the liver
Liver cell damage and death of the individual liver cells
What are the possible outcomes of acute liver injury?
Resolution (liver function returns to normal)
Liver failure (if severe damage to the liver)
Progression to chronic hepatitis and cirrhosis
What hepatitis viruses can cause acute liver injury but then lead to resolution?
Hepatitis A and E
What hepatitis can cause acute liver injury and lead to liver failuer?
Hepatitis A, B and E
What hepatitis can cause acute liver injury and lead to chronic hepatitis?
Hepatitis B and C
What is alcohol liver disease?
Result of consuming too much alcohol, leading to build up of inflammation, fat and scar tissue
What is the pathology of alcoholic hepatitis?
Acute inflammation
Liver cell death
Liver failure
Progress to cirrhosis
What is alcoholic hepatitis?
Inflammation of the liver caused by drinking to much alcohol
What is jaundice caused by?
Increased circulating bilirubin due to altered metabolism of bilirubin
What are the 3 broad areas of the body involved in bilirubin metabolism?
Pre-hepatic
Hepatic
Post-hepatic
Explain the pathway of bilirubin metabolism?
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)
What are the 3 broad categories of causes of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
What are pre-hepatic causes of jaundice?
Increased release of haemoglobin from red cells (haemolysis)
What is the rupture or destruction of red blood cells called?
Haemolysis
What are some causes of cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs (therpeutical, recreation, can be predictable so dose related or unpredictable so not dose related)
What are some
What are hepatic causes of jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
What are causes of intra-hepatic bile duct obstruction?
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver
What kind of condition is primary biliary cholangitis?
Autoimmune disease
How does the incidence of primary biliary cholangitis change between males and females?
Affects males to females 1:9 ratio
What is the pathology of primary biliary cholangitis?
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
What does PBC (primary biliary cholangitis) change in the blood?
Raises serum alkaline phosphatase
What does PBC stand for?
Primary biliary cholangitis
What does PSC stand for?
Primary sclerosing cholangitis
What is the pathology of primary sclerosing cholangitis?
Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
What does PSC increase the risk of?
Developing cholangiocarcinoma
What are examples of tumours of the liver?
Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours
What are some post-hepatic causes of jaundice?
Cholelithiasis 9gallstones)
Diseases of the gallblader
Extrahepatic duct obstruction
What is cholelithiasis?
The formation of gallstones
What are risk factors for cholelithiasis?
Obesity
Diabetes
What is inflammation of the gallbladder called?
Cholecystitis
What are examples of diseases of the gallbladder?
Acute cholecystitis
Chronic cholecystitis
What is an empyema?
Pocket of pus collected inside body cavity
What causes acute cholecystitis?
Empyema (due to perforation of gallbladder or biliary peritonitis)
What are some causes of extra-hepatic obstruction?
Gallstones
Bile duct tumours
Benign stricture
External compression (such as due to tumours)
What are some of the consequences of extra-hepatic bile duct obstruction?
Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction (ascending cholangitis)
Secondary biliary cirrhosis if obstruction prolonged
What is hepatic cirrhosis?
End stage chronic liver disease
What is hepatic cirrhosis the response of the liver to?
Chronic injury
What are some examples of causes of hepatic cirrhosis?
Alcohol
Hepatitis B and C
Immune mediated liver disease (such as auto-immune hepatitis or PBC)
Obesity (diabetes mellitus)
What is the pathology of cirrhosis?
Diffuse process involving whole liver
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue
What are some possible complications of liver cirrhosis?
Altered liver function (liver failure)
Abnormal blood flow (portal hypertension)
Increased risk of hepatocellular carcinoma
What are examples of liver tumours?
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours
What is a malignant tumour of hepatocytes called?
Hepatocellular carcinoma
What are examples of liver function tests (LFT)?
Alanine aminotransferase test (ALT)
Asparate aminotransferase test (AST)
Albumin test
Bilirubin test
What do ALT and AST tests measure?
Enzymes that the liver releases in response to damage or disease
What does ALT stand for?
Alanine transferase test
What does AST stand for?
Asparate transferase test
What does an albumin test measure?
How well the liver creates albumin
What does a bilirubin test measure?
How well the liver disposes of bilirubin
