Hepatobillary pathology Flashcards
Causes of Hepatitis?
Drug (prescribed or recreational)
Viral (hep A,B,C, E and others)
Alcohol
How is Cirrhosis caused by alcohol?
Excess alcohol leads to disrupted fat metabolism. This leads to fatty change in the liver and can progress on to Cirrhosis.
What hepatitis liver infections can lead to resolution?
Hep A and E
What is the potential outcome of Hep A,B or E infection?
Liver failure
What is the likely outcome of a Hep B or C infection?
Chronic hepatitis or cirrhosis.
What is Cirrhosis?
A chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue.
What is hepatitis?
A disease characterized by inflammation of the liver.
Causes of acute liver failure?
Hepatitis
Bile duct obstruction
What is Bilirubin?
It is a yellow-orange pigment that is a product of heme breakdown.
What is Jaundice?
It is an increase in circulation of bilirubin. There are three different ways in which this can occur; pre-hepatic, hepatic and post-hepatic.
Where is bilirubin conjugated and what does conjugation mean?
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).
What causes pre-hepatic jaundice?
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.
What causes hepatic jaundice?
Cholestasis
Intra-hepatic bile duct obstruction.
What is Cholestasis?
It is a decrease in bile flow due to impaired secretion by hepatocytes.
or Accumulation of bile within hepatocytes or bile canaliculi
What can cause Cholestasis?
Viral or alcohol hepatitis
Liver failure
Drugs
(In these circumstances Cholestasis is caused by hepatocytes becoming swollen and then narrowing the bile canaliculi)
What is a dose related drug-induced cholestasis called?
Predictable
non-dose related is unpredictable and this is more likely
What is cholangitis?
Inflammation of the bile duct system.
What is the difference between primary biliary cholangitis and primary sclerosing cholangitis?
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.
What can cause intra-hepatic bile duct obstruction?
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis(PSC)
Tumours of the liver
How can PBC be diagnosed?
Detecting anti-mitochondrial auto-antibodies in the serum or raised serum alkaline phosphatase.
What is PSC?
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.
Causes of Cirrhosis?
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).
What is the pathology of Cirrhosis?
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.
What are the complications of Cirrhosis?
Altered liver function- liver failure
Abnormal blood flow due to nodular structure- portal hypertension
Increased risk of hepatocellular carcinoma.