Hepatobilliary Pathology Flashcards
structure of the liver
Dual blood supply
Hepatic artery, portal vein
functions of the liver
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol
what are some pathologies of the liver
Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours
what is the pathology associated with the gall bladder
Inflammation
what is the pathology associated with extrahepatic bile ducts
Obstruction
what is liver failure caused by
Acute liver injury
Chronic liver injury i.e. cirrhosis
Acute liver injury
Hepatitis
- Viruses
- Alcohol
- Drugs (particularly paracetomol overdose)
Bile duct obstruction
what are the different types of viral hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Other viruses
what pathologies does viral hepatitis cause
inflammation of liver
Liver cell damage and death of individual liver cells
what are the different outcomes from acute inflammation
resolution
liver failure
progression to cirrhosis
when is resolution most common
hepatitis A and E
when is liver failure most common
hepatitis A,B and E
when is progression to chronic hepatitis or cirrhosis most common
hepatitis B,C
what is alcoholic liver disease
Response of liver to excess alcohol
fatty change
what occurs as a result of Alcoholic hepatitis
Acute inflammation
Liver cell death
Liver failure
can alcoholic liver disease progress to cirrhosis
yes
what is jaundice caused by
Increased circulating bilirubin
when is there Increased circulating bilirubin
Caused by altered metabolism of bilirubin
what phases is the pathway of bilirubin metabolism made up of
Pre-hepatic
Hepatic
Post-hepatic
what are the characteristic features of jaundice
yellow features
particularly eyes
pre-hepatic phase
Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation
hepatic phase
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system
post-hepatic phase
Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin
causes of pre-hepatic jaundice
Increased release of haemoglobin from red cells (haemolysis)
hepatic causes of jaundice
Cholestasis
Intra-hepatic bile duct obstruction
cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
causes of cholestasis
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs:
Therapeutic
Recreational
predictable cholestasis
dose related
unpredictable cholestasis
not dose related
causes of Intra-hepatic Bile Duct Obstruction
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of liver
what are the different types of tumours of the liver
Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours
what is primary biliary cholangitis
Inflammation of the gall bladder that can lead to liver dysfunction, inherited condition
who is mainly affected by primary biliary cholangitis
females
what does primary biliary cholangitis raise
serum alkaline phosphatase
what are pathologies associated with Primary
Biliary Cholangitis
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
what would be the symptoms of Primary Sclerosing Cholangitis 1
Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Associated with inflammatory bowel disease
what would be the symptoms of Primary Sclerosing Cholangitis 2
Progression to cirrhosis
Increased risk of development of cholangiocarcinoma
hepatic cirrhosis
End stage chronic liver disease
Response of liver to chronic injury
what are causes of cirrhosis 1
Alcohol
Hepatitis B, C
Immune mediated liver disease
immune mediated liver disease
Auto-immune hepatitis
Primary biliary cholangitis
what are causes of cirrhosis 2
Metabolic disorders
Obesity
metabolic disordees
Excess iron [Primary haemochromatosis]
Excess copper [Wilson’s disease]
obesity cause
diabetes mellitus
what pathologies are associated with cirrhosis
Diffuse process involving whole liver
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue
what are complications of cirrhosis
Altered liver function [Liver failure]
Abnormal blood flow [Portal hypertension]
Increased risk of hepatocellular carcinoma
liver tumours
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours
Hepatocellular carcinoma
Malignant tumour of hepatocytes
Cholangiocarcinoma
Malignant tumour of bile duct epithelium
Metastatic tumours
Common site of metastases
post hepatic jaundice pathologies
Cholelithiasis (gallstones)
Diseases of gall bladder
Extra-hepatic duct obstruction
what are risk factors for gall stones
obesity
diabetes
what is characteristic of diseases of the gall bladder
Inflammation;
Acute cholecystitis
Chronic cholecystitis
Acute Cholecystitis
Acute inflammation of gall bladder
can progress to chronic inflammation
what can accompany acute inflammation of the gall bladder
Empyema;
Perforation of gall bladder
Biliary peritonitis
Chronic Cholecystitis
Chronic inflammation and fibrosis of gall bladder
Causes of Common Bile Duct Obstruction
Gallstones
Bile duct tumours
Benign stricture [passing gall stones]
External compression
Tumours
effects of common bile duct obstruction
jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction
Ascending cholangitis
Secondary biliary cirrhosis if obstruction prolonged
