hpb patho (incomplete, summarised version) Flashcards
Obstructive jaundice is due to obstruction of the bile duct from different aetiologies.
- _____ conjugated bilirubin
- conjugated bilirubin found in the ____
Obstructive jaundice is due to obstruction of the bile duct from different aetiologies.
- increased conjugated bilirubin
- conjugated bilirubin found in the urine
Which of the effects of portal hypertension is a medical emergency?
Oesophageal varices
Hepatorenal syndrome
Acute on chronic liver failure is either:
1. An _______________ supervening on a well-compensated late-stage chronic disease
2. Chronic disease has a ___________ that leads directly to liver failure
Acute on chronic liver failure is either:
1. An unrelated acute injury supervening on a well-compensated late-stage chronic disease
2. Chronic disease has a flare of activity that leads directly to liver failure
What is chronic liver failure usually associated with?
Cirrhosis
What are the causes of chronic liver failure?
NAFLD
ALD
Hepatitis B/C
Crytogenic
Gross appearance of cirrhosis?
Shrunken, firm, nodular
Histological features of cirrhosis?
Loss of normal vascular structure
Fibrosis
Regeneration
How often are liver cirrhosis asymptomatic until most advanced stages?
40%
Nonspecific manifestation of liver cirrhosis includes:
anorexia, weight loss, weakness
symptoms and signs of liver failure
Coagulopathy
Portal Hypertension
Hyperestrogenemia
Dupuytren’s contracture
Cholestasis
What is an additional complication of liver cirrhosis?
HCC
What are the most common terminal events in cirrhosis?
hepatic encephalopathy
oesophageal varices
bacterial infection
In matrix remodeling in liver cirrhosis
Synthesis (Scarring) is caused by:
Degradation (Regression) is caused by:
In matrix remodeling in liver cirrhosis
Synthesis (Scarring) is caused by: hepatic stellate cells
Degradation (Regression) is caused by: matrix metalloproteinases
Whats the concern with splenomegaly that is secondary to portal HTN?
increased venous pressure -> congestive splenomegaly -> accumulation of leukocytes, erythrocytes, platelets in spleen -> facilitates capture, phagocytosis, destruction of blood cells by phagocytes -> peripheral cytopenias
Acute liver failure is when there is
massive and sudden destruction of hepatocytes
What is acute liver failure associated with?
encephalopathy
coagulopathy
What are the causes of acute liver failure?
autoimmune hepatitis
acute hepatitis A/B/E
drugs/toxins
Gross appearance of liver in acute liver failure?
shrunken liver with wrinkled liver capsule
Histological features of liver in acute liver failure?
loss of hepatocytes
RBC extravasation
florid ductular reaction
What are the 5 most common sites for portosystemic shunts? (relate to portal HTN)
lower oesophageal
upper anal canal
umbilicus
retroperitoneal
diaphragm surface of liver
The liver has enormous ______________
- so mild liver damage may be clinically masked + liver injury and healing may be asymptomatic
- by the time of clinical presentation, most liver diseases will already be chronic, except acute liver failure
functional reserve
What are the parameters for liver function test?
Hepatocyte integrity (cytosolic hepatocellular enzymes)
- {{c1::AST}}
- {{c1::ALT}}
- {{c1::LDH}}
Biliary excretory function (increase in normal secretions)
- {{c1::Serum bilirubin (total, unconjugated, conjugated)}}
- {{c1::Urine bilirubin}}
- {{c1::Serum bile acids}}
Bile canaliculus integrity
- {{c1::ALP}}
- {{c1::GGT}}
Hepatocyte synthetic function
- {{c1::Serum albumin}}
- {{c1::Coagulation factors (PT, PTT, Factors 1,2,5,7,9,10)}}
Hepatocyte metabolism
- {{c1::Serum ammonia}}
- {{c1::Aminopyrine breath test (hepatic demethylation)}}
- The Child-Pugh liver function test would include (mn “BETA-PTI”)
- {{c2::Big belly - Ascites}}
- {{c2::Encephalopathy}}
- {{c2::Total bilirubin}}
- {{c2::Serum Albumin}}
- {{c2::PT Time}}
- {{c2::INR}}
The Child-Pugh liver function test (in chronic liver cirrhosis) would include:
BETA-PTI
Belly - Ascites
Encephalopathy
Total bilirubin
serum Albumin
PT time
INR
Hyperbilirubinaemia can be predominantly unconjugated or conjugated.
What is the difference between the 2?
Unconjugated bilirubin is water-insoluble and albumin-bound and cannot be excreted in urine even in high doses but can cross BBB in infants and cause kernicterus
Conjugated bilirubin is water soluble, non-toxic and can be excreted out in the urine
Most common cause of post hepatic jaundice is ________
large bile duct obstruction
Budd-Chiari syndrome is associated with…
They present with a clinical triad of…
Budd-Chiari syndrome is associated with hepatic vein thrombosis
They present with a clinical triad of abdominal pain, ascites, liver enlargement
In cholangitis (or ascending cholangitis), there is a specific triad and pentad:
Charcot’s Triad
Reynolds’ pentad
Charcot’s Triad:
- Fever
- Jaundice
- Right upper quadrant pain
Reynolds’ Pentad:
- Charcot’s Triad
- Hypotension
- Altered mental state
Choledochal cyst is {{c1::development malformation of biliary tree, usually CBD}}
What does choledochal cysts predispose the pt to?
{{c1::Stones, stenosis, strictures, pancreatitis, bile duct cancer!!}}
Choledochal cyst is {{c1::development malformation of biliary tree, usually CBD}}
What does choledochal cysts predispose the pt to?
{{c1::Stones, stenosis, strictures, pancreatitis, bile duct cancer!!}}
Focal Nodular Hyperplasia is due to {{c1::focal alterations in hepatic blood supply}}
Focal Nodular Hyperplasia is due to {{c1::focal alterations in hepatic blood supply}}
What is Cholangiocarcinoma?
Carcinoma with bile duct origin, arising from either inside or outside the liver
2nd most common primary malignancy of the liver, after HCC
What are the risk factors of cholangiocarcinoma?
Hepatolithiasis
Fibropolycystic liver disease
How does the location of the cholangiocarcinoma affect presentation?
Intrahepatic: late presentation
Extrahepatic: early presentation and smaller
Factors that affect prognosis of hepatocellular carcinoma (HCC)
Staging
Grading
Number and size of nodules
Vascular spread
Presence of cirrhosis
Islets of Langerhans neoplasms
clinical presentation of insulinoma
Whipple Triad:
Hypoglycaemia
CNS manifestations during fasting/exercise
Symptom relief with administration of glucose
Most common site of pancreatic carcinoma is…
Head of pancreas
Gross appearance of pancreatic carcinoma
Large pale firm mass with infiltrative borders
Adenocarcinoma with desmoplasia
Perineural and lymphatic involvement
Both acute and chronic pancreatitis are initiated by injuries that led to
autodigestion of pancreas by its own digestive enzymes
What are the normal mechanisms that protects the pancreas from self-digestion?
Pancreatitis occurs when these protective mechanisms are deranged/overwhelmed!!
- digestive enzymes synthesise inactive proenzymes
- trypsin is activated only in the duodenum
- inhibitors of trypsin
In cases of jaundice, only hepatic and post-hepatic causes will result in ________ being formed. (not pre-hepatic cause)
pale stools
Acute pancreatitis = {{c1::Reversible pancreatic parenchymal injury associated with inflammation}}
Acute pancreatitis = {{c1::Reversible pancreatic parenchymal injury associated with inflammation}}
What are the main causes of acute pancreatitis?
Chronic pancreatitis = {{c1::prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma and fibrosis}}. In the late stages there is destruction of {{c1::the endocrine parenchyma (Islets of Langerhans)}}
Chronic pancreatitis = {{c1::prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma and fibrosis}}. In the late stages there is destruction of {{c1::the endocrine parenchyma (Islets of Langerhans)}}
hepatitis A is associated with the consumption of raw shellfish
vaccination for hepatitis B prevents hepatitis D infection
hepatitis E has the highest mortality rate in pregnant women
between acute viral and chronic viral hepatitis, it is the pattern of injury that is different, not the nature of inflammatory cell infiltrate
acute viral hepatitis: lobular hepatitis
chronic viral hepatitis: portal hepatitis
both hep B and hep C can progress to chronic hepatitis however patients with hep C infection is more likely to progress to chronic hepatitis while only 20-30% of patients with hep B will progress to chronic hepatitis
donated blood is usually screened for hep B and hep C
hep B is the only DNA virus
hep A is the only one with faecal-oral mode of transmission
What are the key histologic feature of cirrhosis?
loss of normal vascular architecture
fibrosis
regeneration
State the common aetiologies for cirrhosis
NAFLD
ALD
Chronic hep B/C
a1 anti-trysin deficiency
What are the treatment options available for HCC?
Surgical resection
Loop Ablation
Immunotherapy
Liver transplantation
Congenital abnormalities of the pancreas:
Pancreatic division
Annular pancreas
Ectopic pancreas
Agenesis
histological features of HCC
sinusoidal trabeculae
broad and thick trabeculae
high N:C ratio, nuclear atypia
hepatocellular adenoma is a benign lesion that resembles a normal liver and are typically common in women taking oral contraceptives (using oestrogen-containing meds)
