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Yr2 GI Joe > Hepatobilliary pathology > Flashcards

Hepatobilliary pathology Flashcards

1
Q

What are the main pathologies of the liver?

A
  • Liver failure
  • Jaundice
  • Cirrhosis
  • Intrahepatic bile duct obstruction
  • Tumours
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2
Q

What is the main pathology that can affect the gallbladder?

A

Inflammation

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3
Q

What is the main pathology that affects the extrahepatic bile ducts?

A

Obstruction

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4
Q

What types of injury to the liver can cause liver failure?

A

Both acute and chronic injuries (cirrhosis etc) can cause it

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5
Q

What acute liver injuries can cause liver failure?

A

Hepatitis:

  • Viruses, alchohol & drugs

Bile duct obstruction

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6
Q

What viruses can cause damage to the liver?

A

Hepatitis A, B, C, E

+ other viruses

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7
Q

Describe the pathology of viral hepatitis

A

Inflammation of the liver

Damage/death of hepatocytes in the liver

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8
Q

Acute infections by which types of hepatitis are able to resolve without causing liver failure?

A

Hepatitis A & E

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9
Q

Acute infections by what types of hepatitis will cause liver failure if there is severe damage?

A

Hepatitis A, B, E

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10
Q

Acute infections by which type of hepatitis are able to progress to chronic hepatitis / cirrhosis?

A

Hepatitis B & C

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11
Q

In summary, which Hepatitis viruses are most damaging to the liver?

A

Hepatitis C

(B isn’t great either)

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12
Q

How does the liver change in alcoholic liver disease?

A

Initial fatty change (followed by high risk of)

Alcoholic hepatitis

This leads to liver failure

This leads to cirrhosis

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13
Q

What are the pathological features of alcoholic hepatitis?

A

Acute inflammation

Cell death

Liver failure

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14
Q

What are the 3 sections of the metabolic pathway for bilirubin?

A

Pre-hepatic

Hepatic

Post-hepatic

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15
Q

What happens in the Pre-hepatic pathway for bilirubin’s metabolism?

A
  1. Breakdown of haemoglobin in spleen to form Haem & globin
  2. Haem converted to bilirubin
  3. Bilirubin released into circulation
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16
Q

What happens in the Hepatic phase of bilirubin metabolism?

A
  1. Hepatocytes suck up bilirubin from the blood
  2. They then conjugate it
  3. Conjugated bilirubin is then excreted into the biliary system
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17
Q

What happens in the post-hepatic phase of bilirubin metabolism?

A
  1. Conjugated bilirubin is transported in biliary system
  2. Bilirubin conjugate is then broken down in the intestine
  3. Bilirubin is then re-absorbed and enters the enterohepatic circulation
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18
Q

What causes pr-hepatic jaundice?

A

Increased release of haemoglobin from RBC’s (haemolysis)

19
Q

What are the hepatic causes of jaundice?

A

Cholestasis - decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow

Intra-hepatic bile duct obstruction

20
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

21
Q

What are the causes of cholestasis? (and thus potential causes of hepatic jaundice)

A
  • Viral hepatitis
  • Alcoholic hepatitis
  • Liver failure
  • Drugs
22
Q

What is the difference between predictable and unpredictable drug induced cholestasis?

A

Predictable = dose related

Unpredictable = not dose related

23
Q

What are the causes of Intra-hepatic bile duct obstruction?

A

Primary biliary cholangitis (PBC)

Primary sclerosing cholangitis (PSC)

Tumours

24
Q

What types of tumours can cause intra-hepatic bile duct obstruction?

A

Hepatocellular carcinoma (HCC)

Tumours of the intrahepatic bile duct

Metastatic tumours from elsewhere

25
Q

What is primary biliary cholangitis?

A

Autoimmune disease in which there is granulomatous inflammation and progressive destruction of intrahepatic bile ducts

Inflammation progresses to cirrhosis

26
Q

Who is most at risk of developing primary biliary cholangitis?

A

Females (9:1)

27
Q

What biomarkers are present in those who have primary biliary cholnagitis?

A

Anti-mitochondrial auto-antibodies in serum

Raised serum alkaline phosphotase (ALP)

28
Q

What is primary Sclerosing cholnagitis?

A

Chronic inflammation and fibrous obliteration of bile ducts - causing loss of intrahepatic bile ducts

Like primary biliary cholangitis - it also progresses to cirrhosis

Linked to inflammatory bowel disease (Crohn’s & UC)

29
Q

Primary sclerosis cholangitis causes an increased risk of what?

A

Increased risk of development of cholangiocarcinoma

30
Q

What condition is referred to as the ‘end stage of chronic liver disease’?

A

Hepatic cirrhosis

31
Q

What are the main causes of Hepatic cirrhosis?

A

Alcohol

Hep B, C (the bad ones)

Immune mediated disease (PBC, Autoimmune Hepatitis)

Metabolic disorders

Obesity (DM)

32
Q

What metabolic disorders can cause hepatic cirrhosis?

A

Primary haemochromatosis (excess iron)

Wilson’s disease (excess copper)

33
Q

What is the histological appearance of cirrhotic liver?

A

Nodules of hepatocytes and fibrous tissue

34
Q

What are the complications of hepatic cirrhosis?

A

Liver doesn’t function (liver failure)

Abnormal blood flow (portal hypertension)

Increased risk of Hepatocellular carcinoma (HCC)

35
Q

What is hepatocellular carcinoma?

A

Malignant tumour of hepatocytes

36
Q

What is cholangiocarcinoma?

A

Malignant tumour of bile duct epithelium

37
Q

What are the causes of post-hepatic jaundice?

A

Cholelithiasis (gallstones)

Gallbladder disease

Extra-hepatic bile duct obstruction

38
Q

What are the main risk factors for gallstones?

A

Obesity

Diabetes

39
Q

Describe the pathology of gallstones in the gall bladder

A

Can cause inflammation called ‘cholecystitis’

This can be acute or chronic (acute cholecystitis etc)

40
Q

What is the main risk with acute cholecystitis?

A

Acute inflammation of the gallbladder can lead to an Empyema (abscess)

This can perforate and may lead to biliary peritonitis (which isnt good)

41
Q

What are the causes of common (extrahepatic) bile duct obstruction?

A

Gallstones

Tumours

Benign structures

External compression (from other tumours)

42
Q

What are the effects of common bile duct obstruction?

A

Jaundice (post hepatic)

Impact on digestion (no bile into duodenum)

Ascending cholangitis (infection of bile proximal to obstruction)

Secondary biliary cirrhosis

43
Q

What would cause secondary biliary cirrhosis?

A

If the bile duct obstruction remains for a prolonged period of time

44
Q
A

Yr2 GI Joe (28 decks)

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