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Alimentary System > Lecture 18 Hepatobiliary Pathology > Flashcards

Lecture 18 Hepatobiliary Pathology Flashcards

1
Q

Functions of the liver

A

Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins, including alcohol

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2
Q

What is liver failure a complication of

A

Acute liver injury

Chronic liver injury

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3
Q

What causes acute liver injury

A

Hepatitis

Bile duct obstruction

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4
Q

What is the resolution of Hepatitis A and E acute inflammation

A

Resolution- liver returns to normal

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5
Q

What is the resolution of hepatitis of Hepatitis A, B, E acute inflammation

A

Liver failure if severe damage

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6
Q

What is the outcome of Hepatitis B, C acute inflammation

A

Progression to chronic hepatitis and cirrhosis

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7
Q

Describe Jaundice

A

Increased circulating bilirubin

Caused by altered metabolism of bilirubin

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8
Q

What are the 3 ways the pathway of Bilirubin can be altered

A

Pre-hepatic
Hepatic
Post-hepatic

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9
Q

Describe the pre-haptic metabolism of bilirubin

A

Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation

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10
Q

How does jaundice occur pre-hepatic

A

Increased release of hb from RBC- haemolysis

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11
Q

Describe the hepatic metabolism of bilirubin

A

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes- male it more water soluble)
Excretion of conjugated bilirubin into biliary system

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12
Q

How does handle occur hepatic

A

Cholestasis (reduction or stoppage of bile flow and accumulation of bile within hepatocytes or bile canaliculi), intra hepatic bile obstruction (All ducts across the liver must be blocked in order for jaundice to occur)

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13
Q

What causes Cholestasis

A
  • Viral hepatitis
  • Alcoholic hepatitis
  • Liver failure
  • Drugs
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14
Q

Which form of Cholestasis is dose related

A

Predictable- dose related

Unpredictable-not dose related

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15
Q

Causes of Intrahepatic bile obstruction

A

Primary biliary cholangitis
Primary sclerosis cholnagitis
Tumours of the liver

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16
Q

What are the tumours of the liver

A

Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic

17
Q

Hepatocellular carcinoma

A

Malignant tumour of hepatocytes

18
Q

Cholangiocarcinoma

A

Tumours of the intra-hepatic bile ducts

19
Q

What are the common sites of metastases

A

Stomach, oesophagus and colon

20
Q

What is primary biliary cholnagitis

A

Inflammation of the bile duct
Organ specific autoimmune disease
Raised serum alkaline phosphatase

21
Q

What is the pathology of primary biliary cholangitis

A

Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
Collection go macrophages and giant cells

22
Q

What is primate sclerosis cholangitis

A

– Chronic inflammation and fibrous obliteration of bile ducts
– Loss of intra-hepatic bile ducts
– Associated with inflammatory bowel disease
– Progression to cirrhosis
– Increased risk of development of cholangiocarcinoma

23
Q

What are the causes of hepatic cirrhosis

A 
Alcohol
Hep B and C
Immune mediated liver disease
Primary biliary cholangitis 
Wilson'd disease
Obesity-DM
24
Q

Pathology of hepatic cirrhosis

A

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

25
Q

Complications of Hepatic cirrhosis

A

Liver failure

Portal hypertension

26
Q

Describe the post hepatic metabolism of bilirubin

A
  • Transport of conjugated bilirubin in biliary system
  • Breakdown of bilirubin conjugate in intestine
  • Re-absorption of bilirubin
  • Entero-hepatic circulation of bilirubin
27
Q

How does jaundice occur post hepatic

A

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

28
Q

What is Cholecystitis

A

Inflammation of gall bladder

29
Q

What are the 2 types of gallbladder inflammation

A

Acute and chronic

30
Q

What are the causes of extra-hepatic duct obstruction

A
  • Gallstones
  • Bile duct tumours
  • Benign stricture
  • External compression
  • Tumours

Alimentary System (39 decks)

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