Lecture 18 Hepatobiliary Pathology Flashcards
Functions of the liver
Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins, including alcohol
What is liver failure a complication of
Acute liver injury
Chronic liver injury
What causes acute liver injury
Hepatitis
Bile duct obstruction
What is the resolution of Hepatitis A and E acute inflammation
Resolution- liver returns to normal
What is the resolution of hepatitis of Hepatitis A, B, E acute inflammation
Liver failure if severe damage
What is the outcome of Hepatitis B, C acute inflammation
Progression to chronic hepatitis and cirrhosis
Describe Jaundice
Increased circulating bilirubin
Caused by altered metabolism of bilirubin
What are the 3 ways the pathway of Bilirubin can be altered
Pre-hepatic
Hepatic
Post-hepatic
Describe the pre-haptic metabolism of bilirubin
Breakdown of haemoglobin in spleen to form haem and globin
Haem converted to bilirubin
Release of bilirubin into circulation
How does jaundice occur pre-hepatic
Increased release of hb from RBC- haemolysis
Describe the hepatic metabolism of bilirubin
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes- male it more water soluble)
Excretion of conjugated bilirubin into biliary system
How does handle occur hepatic
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)
What causes Cholestasis
- Viral hepatitis
- Alcoholic hepatitis
- Liver failure
- Drugs
Which form of Cholestasis is dose related
Predictable- dose related
Unpredictable-not dose related
Causes of Intrahepatic bile obstruction
Primary biliary cholangitis
Primary sclerosis cholnagitis
Tumours of the liver
What are the tumours of the liver
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic
Hepatocellular carcinoma
Malignant tumour of hepatocytes
Cholangiocarcinoma
Tumours of the intra-hepatic bile ducts
What are the common sites of metastases
Stomach, oesophagus and colon
What is primary biliary cholnagitis
Inflammation of the bile duct
Organ specific autoimmune disease
Raised serum alkaline phosphatase
What is the pathology of primary biliary cholangitis
Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
Collection go macrophages and giant cells
What is primate sclerosis cholangitis
– 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
What are the causes of hepatic cirrhosis
Alcohol Hep B and C Immune mediated liver disease Primary biliary cholangitis Wilson'd disease Obesity-DM
Pathology of hepatic cirrhosis
Diffuse process involving whole liver
Loss of normal liver structure
Replaced by nodules of hepatocytes and fibrous tissue
Complications of Hepatic cirrhosis
Liver failure
Portal hypertension
Describe the post hepatic metabolism of bilirubin
- Transport of conjugated bilirubin in biliary system
- Breakdown of bilirubin conjugate in intestine
- Re-absorption of bilirubin
- Entero-hepatic circulation of bilirubin
How does jaundice occur post hepatic
Cholelithiasis (gallstones), Disease of gall bladder, Extra-hepatic duct obstruction
What is Cholecystitis
Inflammation of gall bladder
What are the 2 types of gallbladder inflammation
Acute and chronic
What are the causes of extra-hepatic duct obstruction
- Gallstones
- Bile duct tumours
- Benign stricture
- External compression
- Tumours
