Hepatobilliary Pathology

Question 1

structure of the liver

Answer 1

Dual blood supply
Hepatic artery, portal vein

Question 2

functions of the liver

Answer 2

Protein synthesis

Metabolism of fat and carbohydrate

Detoxification of drugs and toxins including alcohol

Question 3

what are some pathologies of the liver

Answer 3

Liver failure
Jaundice
Intrahepatic bile duct obstruction
Cirrhosis
Tumours

Question 4

what is the pathology associated with the gall bladder

Answer 4

Inflammation

Question 5

what is the pathology associated with extrahepatic bile ducts

Answer 5

Obstruction

Question 6

what is liver failure caused by

Answer 6

Acute liver injury

Chronic liver injury i.e. cirrhosis

Question 7

Acute liver injury

Answer 7

Hepatitis
- Viruses
- Alcohol
- Drugs (particularly paracetomol overdose)

Bile duct obstruction

Question 8

what are the different types of viral hepatitis

Answer 8

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
Other viruses

Question 9

what pathologies does viral hepatitis cause

Answer 9

inflammation of liver

Liver cell damage and death of individual liver cells

Question 10

what are the different outcomes from acute inflammation

Answer 10

resolution
liver failure
progression to cirrhosis

Question 11

when is resolution most common

Answer 11

hepatitis A and E

Question 12

when is liver failure most common

Answer 12

hepatitis A,B and E

Question 13

when is progression to chronic hepatitis or cirrhosis most common

Answer 13

hepatitis B,C

Question 14

what is alcoholic liver disease

Answer 14

Response of liver to excess alcohol

fatty change

Question 15

what occurs as a result of Alcoholic hepatitis

Answer 15

Acute inflammation
Liver cell death
Liver failure

Question 16

can alcoholic liver disease progress to cirrhosis

Answer 16

yes

Question 17

what is jaundice caused by

Answer 17

Increased circulating bilirubin

Question 18

when is there Increased circulating bilirubin

Answer 18

Caused by altered metabolism of bilirubin

Question 19

what phases is the pathway of bilirubin metabolism made up of

Answer 19

Pre-hepatic
Hepatic
Post-hepatic

Question 20

what are the characteristic features of jaundice

Answer 20

yellow features
particularly eyes

Question 21

pre-hepatic phase

Answer 21

Breakdown of haemoglobin in spleen to form haem and globin

Haem converted to bilirubin

Release of bilirubin into circulation

Question 22

hepatic phase

Answer 22

Uptake of bilirubin by hepatocytes

Conjugation of bilirubin in hepatocytes

Excretion of conjugated bilirubin into biliary system

Question 23

post-hepatic phase

Answer 23

Transport of conjugated bilirubin in biliary system

Breakdown of bilirubin conjugate in intestine

Re-absorption of bilirubin

Question 24

causes of pre-hepatic jaundice

Answer 24

Increased release of haemoglobin from red cells (haemolysis)

Question 25

hepatic causes of jaundice

Answer 25

Cholestasis Intra-hepatic bile duct obstruction

Question 26

cholestasis

Answer 26

Accumulation of bile within hepatocytes or bile canaliculi

Question 27

causes of cholestasis

Answer 27

Viral hepatitis Alcoholic hepatitis Liver failure Drugs: Therapeutic Recreational

Question 28

predictable cholestasis

Answer 28

dose related

Question 29

unpredictable cholestasis

Answer 29

not dose related

Question 30

causes of Intra-hepatic Bile Duct Obstruction

Answer 30

Primary biliary cholangitis Primary sclerosing cholangitis Tumours of liver

Question 31

what are the different types of tumours of the liver

Answer 31

Hepatocellular carcinoma Tumours of intra-hepatic bile ducts Metastatic tumours

Question 32

what is primary biliary cholangitis

Answer 32

Inflammation of the gall bladder that can lead to liver dysfunction, inherited condition

Question 33

who is mainly affected by primary biliary cholangitis

Answer 33

females

Question 34

what does primary biliary cholangitis raise

Answer 34

serum alkaline phosphatase

Question 35

what are pathologies associated with Primary Biliary Cholangitis

Answer 35

Granulomatous inflammation involving bile ducts Loss of intra-hepatic bile ducts Progression to cirrhosis

Question 36

what would be the symptoms of Primary Sclerosing Cholangitis 1

Answer 36

Chronic inflammation and fibrous obliteration of bile ducts Loss of intra-hepatic bile ducts Associated with inflammatory bowel disease

Question 37

what would be the symptoms of Primary Sclerosing Cholangitis 2

Answer 37

Progression to cirrhosis Increased risk of development of cholangiocarcinoma

Question 38

hepatic cirrhosis

Answer 38

End stage chronic liver disease Response of liver to chronic injury

Question 39

what are causes of cirrhosis 1

Answer 39

Alcohol Hepatitis B, C Immune mediated liver disease

Question 40

immune mediated liver disease

Answer 40

Auto-immune hepatitis Primary biliary cholangitis

Question 41

what are causes of cirrhosis 2

Answer 41

Metabolic disorders Obesity

Question 42

metabolic disordees

Answer 42

Excess iron [Primary haemochromatosis] Excess copper [Wilson’s disease]

Question 43

obesity cause

Answer 43

diabetes mellitus

Question 44

what pathologies are associated with cirrhosis

Answer 44

Diffuse process involving whole liver Loss of normal liver structure Replaced by nodules of hepatocytes and fibrous tissue

Question 45

what are complications of cirrhosis

Answer 45

Altered liver function [Liver failure] Abnormal blood flow [Portal hypertension] Increased risk of hepatocellular carcinoma

Question 46

liver tumours

Answer 46

Hepatocellular carcinoma Cholangiocarcinoma Metastatic tumours

Question 47

Hepatocellular carcinoma

Answer 47

Malignant tumour of hepatocytes

Question 48

Cholangiocarcinoma

Answer 48

Malignant tumour of bile duct epithelium

Question 49

Metastatic tumours

Answer 49

Common site of metastases

Question 50

post hepatic jaundice pathologies

Answer 50

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

Question 51

what are risk factors for gall stones

Answer 51

obesity diabetes

Question 52

what is characteristic of diseases of the gall bladder

Answer 52

Inflammation; Acute cholecystitis Chronic cholecystitis

Question 53

Acute Cholecystitis

Answer 53

Acute inflammation of gall bladder can progress to chronic inflammation

Question 54

what can accompany acute inflammation of the gall bladder

Answer 54

Empyema; Perforation of gall bladder Biliary peritonitis

Question 55

Chronic Cholecystitis

Answer 55

Chronic inflammation and fibrosis of gall bladder

Question 56

Causes of Common Bile Duct Obstruction

Answer 56

Gallstones Bile duct tumours Benign stricture [passing gall stones] External compression Tumours

Question 57

effects of common bile duct obstruction

Answer 57

jaundice No bile excreted into duodenum Infection of bile proximal to obstruction Ascending cholangitis Secondary biliary cirrhosis if obstruction prolonged