Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Alimentary > Lecture 23 - Hepato-biliary Pathology > Flashcards

Lecture 23 - Hepato-biliary Pathology Flashcards

1
Q

What are the functions of the liver?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What pathologies can affect the liver?

A 
Liver failure
Jaundice
Intra-hepatic bile duct obstruction 
Cirrhosis
Tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How might pathology affect the extra-hepatic ducts?

A

By obstructing them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Liver failure is caused by which two types of liver injury?

A

Acute liver injury
Chronic liver injury, e.g. cirrhosis
The two are usually quite separate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some common acute liver injuries and what cause each?

A

Hepatitis (inflammation of the liver) caused by viruses, alcohol and other toxins and drug use
Bile duct obstruction - if you can’t expose of bilirubin properly it can be very toxic to the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What types of hepatitis can you contract?

A

Hepatitis A, B, C, E (D is a parasite of B)

nb. other viruses can also cause liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the general pathology of viral hepatitis

A

Inflammation of the liver and loss of lots of liver cells leading to liver failure
Outcome of acute inflammation
Resolution - return to normal, no long-term consequences in Hep A and E
Liver failure if severe damage to the liver in Hep A, B and E
Progression to chronic hepatitis and cirrhosis in Hep B and C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the modes of transmission in viral hepatitis?

A

Hep A - faecal-oral
Hep B and C - blood borne
Hep E - consumption of infected pork

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is alcoholic liver disease?

A

A response of the liver to excess alcohol involving a fatty change leading to alcoholic hepatitis (acute inflammation –> liver cell death –> liver failure –> cirrhosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is jaundice? What causes it?

A

Increased circulating bilirubin which causes a yellowish/green-sh pigmentation of the skin and sclera of the eye

It is caused by altered metabolism of bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the three pathways involved in bilirubin metabolism?

A

Pre-hepatic
Hepatic
Post-hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is bilirubin?

A

The result of the breakdown of haemoglobins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the pre-hepatic phase of bilirubin metabolism

A

Breakdown of Hb in spleen to form harm and global (protein component)
Haem converted to bilirubin
Release of bilirubin into circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is it normal for bilirubin to be travelling about in the bloodstream?

A

Yes, it is physiological for a small amount of bilirubin to circulate in the body without causing symptoms of jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the hepatic phase of bilirubin metabolism

A

Uptake of bilirubin by hepatocytes where it is processed
Conjugation of bilirubin (make it more water soluble and more easily excreted) in hepatocytes
Excretion of conjugated bilirubin into the biliary system (into the bile canaliculi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the post-hepatic phase of bilirubin metabolism

A

Transportation of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-asborption of bilirubin via the entero-hepatic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where can some bilirubin be stored?

A

In the gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the enter-hepatic circulation?

A

The circulation of biliary acids, bilirubin, drugs and other substances from the liver to the bile, followed by entry into the small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three classifications of causes of jaundice? Give examples of diseases that come under these headings

A

Pre-hepatic jaundice - increased release of haemoglobin from red cells (haemolysis)
Hepatic - cholestasis, intra-hepatic bile duct obstruction
Post-hepatic jaundice - cholelithiasis (gallstones), disease of gallbladder, extra-hepatic duct obstruction

20
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

21
Q

What can cause cholestasis?

A

Viral hepatitis (bile canaliculi/ducts can swell blocking release of bile)
Alcoholic hepatitis
Liver failure
Drugs (therapeutic, recreational)

22
Q

Drug induced cholestasis can be predictable or unpredictable, explain what this means?

A

If you know a drug has a risk of liver damage, it is ‘predictable drug-induced cholestasis’ and this is dose related

If a drug you don’t suspect to cause liver harm, causes liver harm it is ‘unpredictable drug-induced cholestasis’ and it is not dose related

23
Q

What things can cause intra-hepatic bile duct obstruction?

A

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver

24
Q

What kinds of tumours might you get obstructing the intra-hepatic bile duct?

A

Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours

25
Q

What is primary biliary cholangitis?

A

Organ specific auto-immune disease mainly affecting females (9:1)
Causes granulomatous inflammation involving the bile ducts and loss of intra-hepatic bile ducts (obstructing bile secretion)
Diffuse process leading to cirrhosis

26
Q

How can you diagnose primary biliary cholangitis?

A

Anti-mitochondrial auto-antibodies in serum

Raised serum alkaline phosphatase very helpful in diagnosis

27
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrous obliteration of bile ducts leading to loss of intra-hepatic bile ducts
Progression to cirrhosis

28
Q

What disease is PSC strongly associated with?

A

Inflammatory bowel disease

29
Q

What are PSC patients at higher risk of? What is done to try to combat this?

A

Developing cholangiocarcinoma

Regular screening of patients with PSC to allow early intervention on any suspicious masses

30
Q

What is hepatic cirrhosis?

A

Liver dysfunction due to long-term damage, leading to the replacement of healthy liver with fibrotic tissue - END STAGE of CHRONIC LIVER DISEASE

31
Q

What are the causes of cirrhosis?

A

Alcohol - recurrent episodes of alcoholic hepatitis
Hep B and C
Immune mediated liver disease (e.g. auto-immune hepatitis, PBC, PSC)
Metabolic disorders (genetically determined) - e.g. primary haemochromatosis, Wilson’s disease
Obesity (DM, fatty liver disease)
Most commonly cryptogenic

32
Q

What is primary haemochromatosis?

A

Excess iron in the liver which is toxic to the liver
Primary - genetic
Secondary - developed

33
Q

What is Wilson’s disease?

A

Autosomal recessive disorder of Cu metabolism, characterised by excessive Cu deposition in several organs, including the liver
Can be fatal

34
Q

Which part of the liver does cirrhosis affect?

A

It is a diffuse process, affecting the whole liver leading to loss of normal liver structure

35
Q

What does a cirrhotic liver look like?

A

It is replaced by noodles of hepatocytes separated by broad bands of fibrotic tissue
It looks shrunken, nodular and fibrosed

36
Q

What are the main complications of cirrhosis?

A

Altered liver function (liver failure)
Abnormal blood flow
- portal hypertension leading to varices (more difficult for venous blood to pass through liver, so creates pressure leading to back up of blood)
- pressure rising in splenic vein can cause splenomegaly (–> haematological consequences and more susceptible to trauma and a BIG bleed)
Increased risk of hepatocellular carcinoma

37
Q

What is a hepatocellular carcinoma?

A

A malignant tumour of hepatocytes

38
Q

What is a cholangiocarcinoma?

A

A malignant tumour of bile duct epithelium

39
Q

What kind of cancer often affects the liver?

A

Metastatic disease

40
Q

What are the risk factors for gallstones?

A

4 Fs - fat, female, fertile, forty

and also diabetes

41
Q

What are the local effects of gallstones?

A

They cause inflammation of the gallbladder (cholecystitis) - can be acute cholecystitis or chronic cholecystitis or a mixture of both

42
Q

What is acute cholecystitis? And what are its complications?

A

Acute inflammation of the gallbladder
If severe and long lived can lead to empyema (pus filling the gallbladder), perforation of the gallbladder, or biliary peritonitis (release of bile and infective contents into the peritoneum causing inflammation of the peritoneum)

Can also progress to chronic inflammation

43
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of the gallbladder wall and dysfunction (thin, muscle wall replaced by fibrosis)

44
Q

What are the causes of common bile duct obstruction?

A

Gallstones (move from gallbladder into cystic or bile duct)
Bile duct tumours
Benign strictures (e.g. as a result of PSC)
External compression, e.g. tumours (esp. tumours of the head of the pancreas)

45
Q

What are the effects of common bile duct obstruction?

A

Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction (ascending cholangitis)
Secondary biliary cirrhosis if obstruction prolonged

Alimentary (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions