Liver Pathology Flashcards
What is the function of the liver
Fat and carb metabolism via production of bile
Protein synthesis
Removal of toxins
What are causes of acute live injury
Hepatitis from viruses alcohol and drugs
Bile duct obstruction
List the different hepatitis viruses
A,B,C,E
How do the different hepatitis viruses differ from one another
Structurally and mode of transmission
What is the pathology of viral hepatitis
Causes cell death and damage to individual cells
Leads to inflammation
What percentage of cells need to die for viral hepatitis to cause liver failure
Around 70%
What viral hepatitis may resolve acute inflammation
A and E
What viral hepatitis may lead to sever damage to liver
A,B and E
What viral hepatitis may lead to chronic hepatitis and cirrhosis
A and B
What is the pathology of alcoholic liver hepatitis
Acute inflammation Liver cell death Liver failure Same as viral Can lead to cirrhosis
What are the 3 phases for bilirubin metabolism
Pre hepatic
Hepatic
Post hepatic
Describe the pre-hepatic stage of bilirubin metabolism
Separation of haemaglobin to haem And globin
Haem is then converted to bilirubin which is released into circulation
What is the hepatic stage to bilirubin metabolism
Bilirubin is conjugated in the hepatocytes and released into bilary system
Describe post-hepatic bilirubin metabolism
Conjugated bilirubin is more water soluble allowing it to be transported to the small intestine and break it down
What is the enterprise-hepatic circulation of bilirubin
Re-absorption of bilirubin back to the liver
How can jaundice be classified
By the stage of bilirubin metabolism effected
Describe pr-hepatic jaundice
Lysis of red blood cells
Though this is usually small amount of bilirubin
What are hepatic causes of jaundice
Cholestatsis
Intra-hepatic bile duct obstruction
In relation to hepatic jaundice, what is cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
In relation to hepatic jaundice, what are the causes of cholestsasis
Viral hepatitis
Alcoholic hepatitis
Liver failure any cause
Drugs
In drug induced cholestasis, are therapeutic drugs most likely to cause predictable or non-predictable reactions
Non-predictable
What does it mean if a drug is predictable vs un predictable reaction
Predictable is dose related
Unpredictable is non dose related
What are causes of intros-hepatic bile obstruction
Primary bilary cholangitis
Primary sclerosing cholangitis
Tumours of the liver
What is primary biliary cholangitis
Organ specific autoimmune disease
In someone with primary bilary cholangitis what clinical things should you consider
Female
Anti-mitochondrial auto antibodies
Raised serum alkaline phosphotase
What is the pathology of primary biliary cholangitis
Granulomatous inflammations involving bile ducts
Loss of intra-hepatic bile ducts
Progression to cirrhosis
What is primary sclerosing cholangitis
Chronic inflammation and fibrous obliteration of bile ducts
Loss of intra-hepatic bile ducts
Someone presents with inflammatory bile disease, what else may you want to check for
Primary sclerosing cholangitis
What is th pathology of primary sclerosising cholangitis
Profession to cirrhosis
What specifically causes increased risk of cholangiocarcinoma
Primary sclerosing cholangitis
Define hepatic cirrhosis
End stage chronic liver disease effecting whole of liv r
What are the causes to cirrhosis
Alcohol Hep B and C Immune mediated Metabolic disorders: excess iron (primar haemochromatosis), excess copper (Wilson’s) Obesity, diabetes mellitus
What are the associated complications with liver cirrhosis
Altered liver function > liver failure
Abnormal blood flow > portal hypertension
Increased risk of hepstocellulaf carcinoma
What are the different liver tumours
Hepatocellular carinoma (associate with cirrhosis Cholangiocarcinoma (assoicated with primary biliary cholangitis Metastatic (other alimentary tumours)
What are post hepatic jaundice causes
Cholelithiasis (gall(
Disease of gall
Extra-hepatic duct obstruction
What are the risk factors for gallstones
Obesity
Diabetes
What is the pathology of gall stones
Acute cholecystitis
Chronic cholecystitis
What are the outcomes of acute cholecystitis
1) empyema
2) perforation leading to bilary peritonitis
3) progression to chronic
What are th symptoms of chronic cholecystitis
Pain when eating
Especially fatty foods
What is ascending cholangitis
Inflammation of bile duct due to California organism
How is ascending cholangitis formed
Usually secondary to obstruction , gall stones for example
