hepatobiliary pathology

Question 1

describe the function of liver

Answer 1

• protein synthesis
• metabolism of fat and carbohydrates
• storage
• detoxification of drugs and toxins

Question 2

what are examples of pathologies of the liver?

Answer 2

• liver failure
• jaundice
• intrahepatic bile duct obstruction
• cirrhosis
• tumours

Question 3

what are examples of pathologies of the gallbladder?

Answer 3

inflammation

Question 4

what are examples of pathologies of the extrahepatic bile ducts?

Answer 4

obstruction

Question 5

what 2 broad categories is liver failure a complication of?

Answer 5

• acute liver injury
• chronic liver injury (such as cirrhosis)

Question 6

what are examples of acute liver injury?

Answer 6

hepatitis

bile duct obstruction

Question 7

what can cause hepatitis which causes acute liver injury?

Answer 7

• viruses: hep A, B, C, E, other viruses
• alcohol
• drugs

Question 8

what is the pathology of virus hepatitis?

Answer 8

• inflammation of the liver
• liver cell damage and death of the individual liver cells

Question 9

what are the possible outcomes of viral hepatitis

Answer 9

• resolution: liver function returns to normal (hep A &E)
• liver failure: if severe damage to the liver (hep A, B & E)
• progression to chronic hepatitis and cirrhosis (hep B & C)

Question 10

what is alcohol liver disease?

Answer 10

fatty change of liver to excess alcohol

alcohol hepatitis: acute inflammation, liver cell death, liver failure, progress to cirrhosis

Question 11

what is jaundice caused by?

Answer 11

increased circulating bilirubin

caused by altered metabolism of bilirubin

Question 12

what are the pathways of bilirubin metabolism?

Answer 12

1. pre-hepatic
2. hepatic
3. post-hepatic

Question 13

describe the pre-hepatic pathway of bilirubin metabolism

Answer 13

breakdown of haemoglobin in spleen to form haem and globin

haem is converted into bilirubin

release of bilirubin into circulation

Question 14

describe the hepatic pathway of bilirubin metabolism

Answer 14

uptake of bilirubin by hepatocytes

conjugation of bilirubin in hepatocytes

excretion of conjugated bilirubin into biliary system

Question 15

describe the post-hepatic pathway of bilirubin metabolism

Answer 15

transport of conjugated bilirubin in biliary system

breakdown of bilirubin conjugate in small intestine

re-absorption of bilirubin

Question 16

what are the 3 broad categories of causes of jaundice?

Answer 16

pre-hepatic: increased haemolysis

hepatic: cholestasis, intrahepatic bile duct obstruction

post-hepatic: cholelithiasis, gall bladder diseases, extrahepatic bile duct obstruction

Question 17

what is haemolysis

Answer 17

increased release of haemoglobin from red cells

Question 18

what is cholestasis?

Answer 18

accumulation of bile within hepatocytes or bile canaliculi

Question 19

what are some causes of cholestasis?

Answer 19

• viral hepatitis
• alcoholic hepatitis
• liver failure
• drugs

Question 20

what are causes of intra-hepatic bile duct obstruction?

Answer 20

• primary biliary cholangitis
• primary sclerosing cholangitis
• tumours of the liver

Question 21

what is primary biliary cholangitis?

Answer 21

an organ specific autoimmune disease

granulomatous inflammation of bile ducts → loss of intrahepatic bile ducts → cirrhosis

F>M

serum: anti-mitochondrial auto antibodies, alkaline phosphatase is raised

Question 22

what is primary sclerosing cholangitis?

Answer 22

chronic inflammation and fibrous obliteration of bile ducts → loss of intra-hepatic bile ducts → cirrhosis

increased risk of developing cholangiocarcinoma

Question 23

what is hepatic cirrhosis?

Answer 23

the response of liver to chronic liver injury → end stage chronic liver disease

liver is replaced by nodules of hepatocytes and fibrous tissue

Question 24

what causes hepatic cirrhosis?

Answer 24

• alcohol
• hepatitis B and C
• immune mediated liver disease (such as auto-immune hepatitis or PBC)
• metabolic disorders (haemochromatosis, Wilson’s disease)
• obesity (diabetes mellitus)

Question 25

what are some possible complications of liver cirrhosis?

Answer 25

altered liver function (liver failure)

abnormal blood flow (portal hypertension)

increased risk of hepatocellular carcinoma

Question 26

what are examples of tumours of the liver?

Answer 26

• hepatocellular carcinoma (tumour of hepatocytes)
• cholangiocarcinoma (tumour of bile duct)
• metastatic tumours

Question 27

what is cholelithiasis?

Answer 27

gallstones

risk factors: obesity, diabetes

Question 28

what are examples of diseases of the gallbladder?

Answer 28

acute cholecystitis

chronic cholecystitis

Question 29

what is cholecystitis

Answer 29

inflammation of the gallbladder

Question 30

what causes acute cholecystitis?

Answer 30

empyema: pocket of pus collected inside body cavity
- perforation of gallbladder
- biliary peritonitis

Question 31

what causes of extra-hepatic obstruction?

Answer 31

• gallstones
• bile duct tumours
• benign stricture
• external compression (such as due to tumours)

Question 32

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

Answer 32

• jaundice
• no bile excreted into duodenum
• ascending cholangitis (infection of bile proximal to obstruction)
• secondary biliary cirrhosis if obstruction prolonged