Hepatobiliary Pathology Flashcards
Blood supply of liver
Hepatic artery
Portal vein
Function of liver
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
2 Causes of acute liver injury
Hepatitis
Bile duct obstruction
Broad causes of hepatitis
Viral
Alcohol
Drugs
Causes of viral hepatitis
A, B, C, E or other (EBV)
3 Outcomes of viral hepatitis and their associated infection
Resolution - A and E
Liver failure with severe damage - A, B, E
Chronic hepatitis and cirrhosis - B, C
What is alcoholic liver disease?
Fatty changes in liver in response to alcohol excess
Alcoholic hepatitis can progress to liver failure and cirrhosis
3 categories of Jaundice
Pre-hepatic
Hepatic
Post hepatic
Describe pre-hepatic how pre-hepatic jaundice occurs
Breakdown of haemoglobin in the spleen leading to bilirubin within circulation
Increased release of haemoglobin (HAEMOLYSIS) leads to jaundice
Describe how hepatic jaundice can occur
Bilirubin is taken up and conjugated by hepatocytes before excretion to the biliary system
Cholestasis and Intrahepatic Bile duct obstruction causes Jaundice
Causes of cholestasis
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs
3 Causes of Intrahepatic bile duct obstruction
Primary biliary Cholangitis
Primary Sclerosing Cholangitis
Tumours of the liver
What type of disease is Primary Biliary cholangitis?
Autoimmune
What investigations can diagnose Primary Biliary cholangitis?
Antimitochondrial Antibodies in serum
Raised Serum ALP
What type of inflammation occurs in primary biliary cholangitis
Granulomatous in bile ducts - leading to loss of ducts
Consequence of inflammation in primary biliary cholangitis
Loss of ducts leading to cirrhosis
What type of disease is primary sclerosing cholangitis?
Chronic inflammation and fibrous obliteration of bile ducts
Which condition is associated with primary sclerosing cholangitis
Inflammatory Bowel Disease
Consequences of primary sclerosing cholangitis
Cirrhosis
Increased risk of cholangiocarcinoma
What occurs in end stage chronic liver disease?
Hepatic cirrhosis
Causes of Hepatic cirrhosis?
Alcohol Hepatitis B and C Immune mediated - Autoimmune hepatitis, PBC Metabolic disorders - Primary haemochromatosis - Wilson's disease Obesity - Diabetes mellitus Cryptogenic
What structural changes occur in cirrhosis?
Nodules and fibrous tissue replace normal structure
Triad of consquences in cirrhosis
Liver failure
Hypertension
Hepatocellular carcinoma
Tumours of the liver
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours
3 causes of post hepatic jaundice
Cholelithiasis
Acute or Chronic Cholecystitis
Extra-hepatic bile duct obstruction
Exampes of extra hepatic bile duct obstruction
Gallstone
Bile duct tumour
Benign stricture
External compression tumour
How does ascending cholangitis occur following bile duct obstruction?
Bile cannot pass into duodenum
Infection of bile occurs proximal to obstruction
What is the consequence if extra hepatic bile duct obstruction is prolonged?
Secondary biliary cirrhosis
