Hepatobillary pathology

Question 1

Causes of Hepatitis?

Answer 1

Drug (prescribed or recreational)
Viral (hep A,B,C, E and others)
Alcohol

Question 2

How is Cirrhosis caused by alcohol?

Answer 2

Excess alcohol leads to disrupted fat metabolism. This leads to fatty change in the liver and can progress on to Cirrhosis.

Question 3

What hepatitis liver infections can lead to resolution?

Answer 3

Hep A and E

Question 4

What is the potential outcome of Hep A,B or E infection?

Answer 4

Liver failure

Question 5

What is the likely outcome of a Hep B or C infection?

Answer 5

Chronic hepatitis or cirrhosis.

Question 6

What is Cirrhosis?

Answer 6

A chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue.

Question 7

What is hepatitis?

Answer 7

A disease characterized by inflammation of the liver.

Question 8

Causes of acute liver failure?

Answer 8

Hepatitis

Bile duct obstruction

Question 9

What is Bilirubin?

Answer 9

It is a yellow-orange pigment that is a product of heme breakdown.

Question 10

What is Jaundice?

Answer 10

It is an increase in circulation of bilirubin. There are three different ways in which this can occur; pre-hepatic, hepatic and post-hepatic.

Question 11

Where is bilirubin conjugated and what does conjugation mean?

Answer 11

Conjugated means the bilirubin has been made water soluable, this is done in the liver and can therefore be used to distinguish between pre-hepatic and hepatic/post-hepatic jaundice (depending on whether the bilirubin is conjugated or not).

Question 12

What causes pre-hepatic jaundice?

Answer 12

Increased haemolysis (increased breakdown of RBC so more haemoglobin released and therefore more bilirubin). 
This only results in a small increase in bilirubin so a lot is required before jaundice.

Question 13

What causes hepatic jaundice?

Answer 13

Cholestasis

Intra-hepatic bile duct obstruction.

Question 14

What is Cholestasis?

Answer 14

It is a decrease in bile flow due to impaired secretion by hepatocytes.
or Accumulation of bile within hepatocytes or bile canaliculi

Question 15

What can cause Cholestasis?

Answer 15

Viral or alcohol hepatitis
Liver failure
Drugs
(In these circumstances Cholestasis is caused by hepatocytes becoming swollen and then narrowing the bile canaliculi)

Question 16

What is a dose related drug-induced cholestasis called?

Answer 16

Predictable

non-dose related is unpredictable and this is more likely

Question 17

What is cholangitis?

Answer 17

Inflammation of the bile duct system.

Question 18

What is the difference between primary biliary cholangitis and primary sclerosing cholangitis?

Answer 18

Biliary is an autoimmune condition (so you are Born with it). Anti-mitochondrial auto-antibodies.
Sclerosing is prolonged inflammation of the billary system which causes hardening of tissue, replacement with fibrous tissue.

Question 19

What can cause intra-hepatic bile duct obstruction?

Answer 19

Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis(PSC)
Tumours of the liver

Question 20

How can PBC be diagnosed?

Answer 20

Detecting anti-mitochondrial auto-antibodies in the serum or raised serum alkaline phosphatase.

Question 21

What is PSC?

Answer 21

Chronic inflammation and fibrous obliteration of bile ducts.
Associated with Inflammatory bowel disease.
Also associated with increased risk of cholangiocarcinoma which is an adenocarinoma arising from the intrahepatic bile ducts.

Question 22

Causes of Cirrhosis?

Answer 22

Alcohol
Hepatitis B, C
Immune mediated liver disease (autoimmune hepatitis and primary biliary cholangitis)
Metabolic disorders (excess iron, excess copper-Wilson’s disease, diabetes or obesity).

Question 23

What is the pathology of Cirrhosis?

Answer 23

It is a diffuse process involving the whole liver, there is a loss of liver structure with replacement by nodules of hepatocytes that are separated by fibrous tissue.

Question 24

What are the complications of Cirrhosis?

Answer 24

Altered liver function- liver failure
Abnormal blood flow due to nodular structure- portal hypertension
Increased risk of hepatocellular carcinoma.

Question 25

What are the causes of Post-hepatic jaundice?

Answer 25

Cholelithiasis (gallstones)
Diseases of the gall bladder (cholecystitis)
Extra-hepatic duct obstruction.

Question 26

What are the risk factors of Cholelithiasis?

Answer 26

Risk factors for gallstones are obesity and diabetes

Question 27

What is inflammation of the gall bladder called?

Answer 27

Cholecystitis

It can be acute or chronic.

Question 28

What are potential complications of acute cholecystitis?

Answer 28

Empyema (collection of pus and fluid in body cavity)
Biliary peritonits
Progression to chronic cholecystitis

Question 29

Describe chronic cholecystitis

Answer 29

There is fibrous thickening of gallbladder wall.

Due to the gallbladder having a muscular wall, the fibrosis will disrupt its functioning and can cause pain.

One of the main presentations of this condition is pain in relation to eating particularly when eating fatty foods.

Question 30

What are common causes of biliary duct obstruction?

Answer 30

Gall stones
Bile duct tumours (cholangiocaarcinoma)
Bengin stricture
External compression (tumours)

Question 31

What is an infection proximal to an obstruction in a bile duct called?

Answer 31

Ascending cholangitis