Pathology of Hepato-Biliary Flashcards
Why do viruses lead to inflammation of the liver
Viruses target the hepatocytes causing inflammation and cell damage.
If severe, many cells die leading to liver failure due to function being unable to be maintained
How does the liver respond to excess alcohol
Alcohol disrupts FA metabolism leading to fat accumulation in the liver
Recurrent alcohol hepatitis progresses to cirrhosis
What is jaundice caused by
Excess circulating bilirubin
Pre-hep cause of jaundice
Haemolysis
Hep causes of jaundice
Cholestasis
Intra-hepatic bile duct obstruction
- Primary biliary cholangitis
- Primary sclerosing cholangitis
- Liver tumours
What is cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
Causes of cholestasis
Viral hep
Alcoholic hep
Liver failure
Drugs
What is PBC
Autoimmune condition where bile ducts become damaged by GRANULOMATOUS inflammation
Makes it more difficult for bile to be secreted
Progresses to cirrhosis
Diagnosis of PBC
Anti-mitochondrial auto-antibodies
Raised ALP
What is primary sclerosing cholangitis
Chronic inflammation and fibrous obliteration of bile ducts
NO GRANULOMAS
Post hep causes of jaundice
Cholelithiasis (gallstones)
Cholecystitis
Common bile duct obstruction
Risk factors for cholelithiasis
Obesity
Diabetes
What can occur in prolonged and severe acute cholecystitis
Empyema
Perforation of gallbladder
Biliary peritonitis - leakage of bile and pus into abdomen
What happens to the gallbladder in chronic cholecystitis
Fibrosis
Causes of common bile duct obstruction
Gallstones
Bile duct tumours
Stricture
External compression (i.e. by tumour)
Effects of common bile duct obstruction
Jaundice
No bile excreted into duodenum
Ascending cholangitis (infection of bile proximal to obstruction)
Secondary biliary cirrhosis if obstruction prolonged
What is hepatic cirrhosis
End stage chronic liver disease
- the response of the liver to chronic injury
Cause of hepatic cirrhosis
Alcohol Hep B & C Autoimmune hep PBC Haemochromatosis Wilson's disease Obesity - DM
Pathology of hep cirrhosis
Normal liver structure is lost and replaced with nodules of hepatocytes and fibrous tissue
Complications of cirrhosis
Abnormal blood flow - PHTN as blood can’t make it through portal system
Increased risk of hepatocellulr carcinoma
Types of liver tumours
Hepatocellular carcinoma (malignant tumour of hepatocytes)
Cholangiocarcinoma (malignant tumour of bile duct epithelium)
Metastatic tumour
