Hepatobiliary Pathology

Question 1

Blood supply of liver

Answer 1

Hepatic artery

Portal vein

Question 2

Function of liver

Answer 2

Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol

Question 3

2 Causes of acute liver injury

Answer 3

Hepatitis

Bile duct obstruction

Question 4

Broad causes of hepatitis

Answer 4

Viral
Alcohol
Drugs

Question 5

Causes of viral hepatitis

Answer 5

A, B, C, E or other (EBV)

Question 6

3 Outcomes of viral hepatitis and their associated infection

Answer 6

Resolution - A and E
Liver failure with severe damage - A, B, E
Chronic hepatitis and cirrhosis - B, C

Question 7

What is alcoholic liver disease?

Answer 7

Fatty changes in liver in response to alcohol excess

Alcoholic hepatitis can progress to liver failure and cirrhosis

Question 8

3 categories of Jaundice

Answer 8

Pre-hepatic
Hepatic
Post hepatic

Question 9

Describe pre-hepatic how pre-hepatic jaundice occurs

Answer 9

Breakdown of haemoglobin in the spleen leading to bilirubin within circulation
Increased release of haemoglobin (HAEMOLYSIS) leads to jaundice

Question 10

Describe how hepatic jaundice can occur

Answer 10

Bilirubin is taken up and conjugated by hepatocytes before excretion to the biliary system
Cholestasis and Intrahepatic Bile duct obstruction causes Jaundice

Question 11

Causes of cholestasis

Answer 11

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

Question 12

3 Causes of Intrahepatic bile duct obstruction

Answer 12

Primary biliary Cholangitis
Primary Sclerosing Cholangitis
Tumours of the liver

Question 13

What type of disease is Primary Biliary cholangitis?

Answer 13

Autoimmune

Question 14

What investigations can diagnose Primary Biliary cholangitis?

Answer 14

Antimitochondrial Antibodies in serum

Raised Serum ALP

Question 15

What type of inflammation occurs in primary biliary cholangitis

Answer 15

Granulomatous in bile ducts - leading to loss of ducts

Question 16

Consequence of inflammation in primary biliary cholangitis

Answer 16

Loss of ducts leading to cirrhosis

Question 17

What type of disease is primary sclerosing cholangitis?

Answer 17

Chronic inflammation and fibrous obliteration of bile ducts

Question 18

Which condition is associated with primary sclerosing cholangitis

Answer 18

Inflammatory Bowel Disease

Question 19

Consequences of primary sclerosing cholangitis

Answer 19

Cirrhosis

Increased risk of cholangiocarcinoma

Question 20

What occurs in end stage chronic liver disease?

Answer 20

Hepatic cirrhosis

Question 21

Causes of Hepatic cirrhosis?

Answer 21

Alcohol
Hepatitis B and C
Immune mediated - Autoimmune hepatitis, PBC
Metabolic disorders 
- Primary haemochromatosis
- Wilson's disease
Obesity - Diabetes mellitus
Cryptogenic

Question 22

What structural changes occur in cirrhosis?

Answer 22

Nodules and fibrous tissue replace normal structure

Question 23

Triad of consquences in cirrhosis

Answer 23

Liver failure
Hypertension
Hepatocellular carcinoma

Question 24

Tumours of the liver

Answer 24

Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours

Question 25

3 causes of post hepatic jaundice

Answer 25

Cholelithiasis
Acute or Chronic Cholecystitis
Extra-hepatic bile duct obstruction

Question 26

Exampes of extra hepatic bile duct obstruction

Answer 26

Gallstone
Bile duct tumour
Benign stricture
External compression tumour

Question 27

How does ascending cholangitis occur following bile duct obstruction?

Answer 27

Bile cannot pass into duodenum

Infection of bile occurs proximal to obstruction

Question 28

What is the consequence if extra hepatic bile duct obstruction is prolonged?

Answer 28

Secondary biliary cirrhosis