Week 2.11 - Hepato-Biliary Pathology Flashcards
What are the functions of the liver?
- protein synthesis
- bile synthesis
- metabolism
- detoxification
Why cant the liver store bile?
doesn’t have correct epithelial lining - needs mucous secreting like in gallbladder. bile will damage cells if not stored correctly due to toxicity
What are 5 pathologies of the liver?
- liver failure
- jaudice
- intrahepatic bile duct obstruction
- cirrhosis
- tumours
Why does liver failure cause oedema in abdomen?
abnormal liver function, no albumin protein made so osmotic pressure effected - water not pushed back into blood stream
What is liver failure?
a complication of an acute liver injury, which leads to chronic liver injury, and cirrhosis.
What are some acute liver injuries?
hepatitis or bile duct obstruction
What are some causes of hepatitis and types?
may be viral, alcohol, drugs…
A and E are from feco-oral food bourne
B and C are from lifestyle.
What does hepatitis lead to?
inflammation of liver, leading to oedema, swelling, physical pressure, low pH, cells cant function so they die.
What are the 3 outcomes of hepatitis?
- complete resolution, common in A and E
- liver failure
- chronic hepatitis/cirrhosis
What is alcohol liver disease?
response to excess alcohol. see steatohepatitis (fatty change), causing acute inflammation, liver cell failure and death. can progress to cirrhosis.
What are 3 types of jaundice?
pre-hepatic, hepatic and post hepatic causes
What causes pre-hepatic jaundice?
increased haemoglobin from erythrocytes to break down - too much to break down in spleen. occurs in infections, drugs, fever
What causes hepatic jaundice?
intra-hepatic bile blockage (cholestasis) whether in hepatocytes or bile canaliculi,
What causes cholestasis?
viral hepatitis, alcoholic hepatitis, liver failure, drugs (commonly oral contraceptive)
What causes post-hepatic jaundice?
- cholelithiasis (gallstones),
- disease of gallbladder and
- extra-hepatic obstruction
What are risk factors for gallstones?
obesity and diabetes
What is cholecystitis?
inflammation of gallbladder, usually by gallstone blocking cystic duct. can be acute or chronic
What is cholecystitis vs cholangitsis?
inflammation of gallbladder vs inflammation of bile system
acute vs chronic cholecystitis?
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.
What are 3 tumours of the hepatobilliary system??
- hepatocellular carcinoma (of hepatocytes)
- cholangiocarcinoma (of bile ducts)
- metastatic tumours from elsewhere
What are 2 intrahepatic bile duct obstruction diseases?
- PBC primary biliary cholangitis
- PSC primary sclerosing cholangitis
What is PBC?
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
What is PSC?
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.
How can we detect PBC?
raised serum alkaline phosphatase on liver function tests
What is hepatic cirrhosis?
end stage chronic liver disease. irreversable damage following fibrotic scarring and loss of function.
What are causes of hepatic cirrhosis?
- autoimmune diseases (PBC and PSC),
- alcohol,
- hep B+C,
- also metabolic disorder like excess iron or excess copper
What causes excess iron and excess copper?
- iron - too much bilirubin so increased risk of damage
- copper - wilsons disease, cant digest copper so accumulates
What does diffuse mean?
involves whole liver.
What are complications of hepatic cirrhosis?
- liver failure
- abnormal blood flow - portal hypertension
- increased risk of hepatocellular carcinoma
