Week 2.11 - Hepato-Biliary Pathology

Question 1

What are the functions of the liver?

Answer 1

• protein synthesis
• bile synthesis
• metabolism
• detoxification

Question 2

Why cant the liver store bile?

Answer 2

doesn’t have correct epithelial lining - needs mucous secreting like in gallbladder. bile will damage cells if not stored correctly due to toxicity

Question 3

What are 5 pathologies of the liver?

Answer 3

• liver failure
• jaudice
• intrahepatic bile duct obstruction
• cirrhosis
• tumours

Question 4

Why does liver failure cause oedema in abdomen?

Answer 4

abnormal liver function, no albumin protein made so osmotic pressure effected - water not pushed back into blood stream

Question 5

What is liver failure?

Answer 5

a complication of an acute liver injury, which leads to chronic liver injury, and cirrhosis.

Question 6

What are some acute liver injuries?

Answer 6

hepatitis or bile duct obstruction

Question 7

What are some causes of hepatitis and types?

Answer 7

may be viral, alcohol, drugs…

A and E are from feco-oral food bourne
B and C are from lifestyle.

Question 8

What does hepatitis lead to?

Answer 8

inflammation of liver, leading to oedema, swelling, physical pressure, low pH, cells cant function so they die.

Question 9

What are the 3 outcomes of hepatitis?

Answer 9

• complete resolution, common in A and E
• liver failure
• chronic hepatitis/cirrhosis

Question 10

What is alcohol liver disease?

Answer 10

response to excess alcohol. see steatohepatitis (fatty change), causing acute inflammation, liver cell failure and death. can progress to cirrhosis.

Question 11

What are 3 types of jaundice?

Answer 11

pre-hepatic, hepatic and post hepatic causes

Question 12

What causes pre-hepatic jaundice?

Answer 12

increased haemoglobin from erythrocytes to break down - too much to break down in spleen. occurs in infections, drugs, fever

Question 13

What causes hepatic jaundice?

Answer 13

intra-hepatic bile blockage (cholestasis) whether in hepatocytes or bile canaliculi,

Question 14

What causes cholestasis?

Answer 14

viral hepatitis, alcoholic hepatitis, liver failure, drugs (commonly oral contraceptive)

Question 15

What causes post-hepatic jaundice?

Answer 15

• cholelithiasis (gallstones),
• disease of gallbladder and
• extra-hepatic obstruction

Question 16

What are risk factors for gallstones?

Answer 16

obesity and diabetes

Question 17

What is cholecystitis?

Answer 17

inflammation of gallbladder, usually by gallstone blocking cystic duct. can be acute or chronic

Question 18

What is cholecystitis vs cholangitsis?

Answer 18

inflammation of gallbladder vs inflammation of bile system

Question 19

acute vs chronic cholecystitis?

Answer 19

acute is urgent - sharp pain. caused by gallstone blockage generally.
chronic is swelling over time, hypertrophy of gallbladder due to stone causing high pressure over time. may lead to rupture.

Question 19

What are 3 tumours of the hepatobilliary system??

Answer 19

• hepatocellular carcinoma (of hepatocytes)
• cholangiocarcinoma (of bile ducts)
• metastatic tumours from elsewhere

Question 20

What are 2 intrahepatic bile duct obstruction diseases?

Answer 20

• PBC primary biliary cholangitis
• PSC primary sclerosing cholangitis

Question 21

What is PBC?

Answer 21

primary biliary cholangitis
9x more in women. autoimmune organ specific - antimitochondrial auto-antibodies sent to bile ducts and inflammation, destroying ducts. leads to cirrhosis. bile damages liver cells

Question 22

What is PSC?

Answer 22

primary sclerosing cholangitis
more common in men.
chronic inflamamton with plasma cells and lymphocytes, fibrous obliteration of bile ducts, progress to cirrhosis. increased risk of cholangiocarcinoma.

Question 23

How can we detect PBC?

Answer 23

raised serum alkaline phosphatase on liver function tests

Question 24

What is hepatic cirrhosis?

Answer 24

end stage chronic liver disease. irreversable damage following fibrotic scarring and loss of function.

Question 25

What are causes of hepatic cirrhosis?

Answer 25

• autoimmune diseases (PBC and PSC),
• alcohol,
• hep B+C,
• also metabolic disorder like excess iron or excess copper

Question 26

What causes excess iron and excess copper?

Answer 26

• iron - too much bilirubin so increased risk of damage
• copper - wilsons disease, cant digest copper so accumulates

Question 27

What does diffuse mean?

Answer 27

involves whole liver.

Question 28

What are complications of hepatic cirrhosis?

Answer 28

• liver failure
• abnormal blood flow - portal hypertension
• increased risk of hepatocellular carcinoma