Flashcards in Hepato-Biliary Pathology Deck (34)
What is the structure of the liver and what makes the structure unusual?
Large vascular soft organ with a tough capsule.
Has a dual blood supply from hepatic portal vein and hepatic artery
What are the functions of the liver?
Metabolism of fats and carbohydrates
Detoxification of drugs and toxins including alcohols
What is Liver Failure?
Run out of hepatocytes that are functioning
Functions of the liver can't happen or at least not at the normal level
What causes liver failure?
Acute liver injury
Chronic liver injury (i.e. cirrhosis)
What conditions are included in acute liver injury?
-Virus, Alcohol, Drugs
Bile duct obstruction (leaks out of biliary system into liver)
What are the virus' of Hepatitis?
What is the pathology of Viral Hepatitis?
Inflammation of the liver
Cell damage and death (individual cells)
What are the outcomes of Viral Hepatitis?
(A and E)
Liver failure if severe damage to liver
(A, B and E)
Progression to Chronic Hepatitis and Cirrhosis
(B and C)
What is the progression of alcoholic liver disease?
Response of liver to excess alcohol
-Liver Cell Death
Progress to cirrhosis
What is Jaundice?
Increased circulating Bilirubin due to altered metabolism
What is the pre-hepatic pathway for the metabolism of bilirubin?
Breakdown of haemoglobin into haem and globin
Haem is converted to bilirubin
Bilirubin released into circulation.
What is the hepatic pathway for the metabolism of bilirubin?
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin to facilitate secretion
Release of conjugated bilirubin into bile canuliculi
What is the post-hepatic pathway for the metabolism of bilirubin?
Transport of conjugated bilirubin in the biliary system
Digestion of conjugated bilirubin to bilirubin
Some reabsorption of bilirubin into circulation
Describe the different classifications of jaundice.
Increased release of haemoglobin from RBC's (haemolysis)
What is cholestasis?
Accumulation of bile within hepatocytes or bile canuliculi
What are the causes of cholestasis?
Drugs: Both recreation and therapeutic
What are the two subdivisions of drug induced cholestasis?
Predictable = Dose related
Unpredictable = Not dose related
What are the causes of Intra-Hepatic Bile Duct Obstruction?
Primary biliary cirrhosis
Biliary Sclerosing Cholangitis
Tumours of the liver
-Tumours of Intra-Hepatic ducts
What is primary biliary cirrhosis?
Affecting predominantly women
What blood tests can point towards primary biliary cirrhosis?
Anti-mitochondrial autoantibodies in serum
Raised serum Alkaline Phosphatase
What is the pathology of primary biliary cirrhosis?
Granulomatous inflammation involving bile ducts
Loss of intrahepatic bile ducts
Progression to cirrhosis
Give a summary of Primary Sclerosing Cholangitis
Chronic inflammation and obliteration of bile ducts
Loss of intrahepatic bile ducts
Highly associated with inflammatory bowel disease
-Progression to cirrhosis
-Increased risk of development of cholangiocarcinoma
What is hepatic cirrhosis?
End stage chronic liver disease
(response of liver to chronic injury)
List the causes of cirrhosis
Hepatitis B and C
Immune mediated liver disease
-Primary billiary cirrhosis
-Excess iron (Haemachromatosis)
-Excess Copper (Wilson's Disease)
Obesity (Diabetes mellitus)
Cryptogenic (Most common)
What is the pathology of liver cirrhosis?
Diffuse process involves whole liver
Loss of structure
Replaced by nodules of hepatocytes and fibrous tissue
What are the complications of liver cirrhosis?
Altered liver function (liver failure)
Abnormal blood flow (portal hypertension)
Increased risk of hepatocellular carcinoma
What are the 3 types of liver tumour?
-Malignant tumour of hepatocytes
-Malignant tumour of bile duct epithelium
-Common site of metastases (BREAST, LUNG, COLON, stomach, pancreas)
What are the post-hepatic causes of jaundice?
Diseases of the gallbladder
Extra-hepatic duct obstruction
What are the risk factors for gallstones?
Very common occurrence without any risk factors
What is the pathology of diseases of the gallbladder?
What is acute cholecystitis?
Acute inflammation of the gallbladder
-Risk of perforation of gallbladder
Repeat episodes can cause progression to chronic cholecystitis
What is chronic cholecystitis?
Chronic inflammation and fibrosis of the gallbladder
What are the causes of common bile duct obstruction?
Bile Duct Tumours
-Tumour of head of pancreas
-Lymphadenopathy of portal hepatis lymph nodes