Hepato-Biliary Pathology

Question 1

What two structures supply the liver to give it a dual blood suppply?

Answer 1

Hepatic artery

Hepatic portal vein

Question 2

What are the three functions of the liver?

Answer 2

Protein synthesis
Fat and carbohydrate metabolism
Detoxification of drugs and toxins including alcohol

Question 3

What causes jaundice?

Answer 3

Increased circulating bilirubin caused by an altered metabolism making the skin yellow

Question 4

Where is haemoglobin broken down in the body?

Answer 4

Spleen

Question 5

What is converted to bilirubin and what causes pre-hepatic jaundice?

Answer 5

The haem part of haemoglobin

Increased release of haemoglobin from red cells

Question 6

Where is bile from hepatocytes first excreted into and where after that?

Answer 6

Bile canaliculi

Duodenum

Question 7

What causes hepatic jaundice?

Answer 7

Cholestasis

Intra-hepatic bile duct obstruction

Question 8

What causes cholestasis?

Answer 8

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

Question 9

What causes an intra-hepatic bile duct obstruction?

Answer 9

Primary biliary cirrhosis
Primary sclerosing cholangitis
Liver tumours

Question 10

What is primary biliary cirrhosis (PBC)?

Answer 10

Organ specific auto-immune disease that causes granulomatous inflammation involving bile ducts with the loss of intra-hepatic bile ducts leading to cirrhosis

Question 11

What is primary sclerosing cholangitis (PSC)?

Answer 11

Chronic inflammation with fibrous obliteration of bile ducts leading to a loss of intra-hepatic bile ducts leading to cirrhosis and it is associated with IBD

Question 12

What do PBC and PSC have in common?

Answer 12

They both lead to the loss intra-hepatic bile ducts and the progression of cirrhosis

Question 13

What does PBC show on LFT blood results?

Answer 13

Raised Alk phos

Question 14

What are the three types of liver tumour that present?

Answer 14

Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours

Question 15

Where does a hepatocellular carcinoma affect?

Answer 15

Malignant hepatocyte tumour

Question 16

Where does a Cholangiocarcinoma affect?

Answer 16

Malignant tumour of the bile duct epithelium

Question 17

What do most tumours present in combination with?

Answer 17

Some stage of cirrhosis

Question 18

What are the risk factors for cholelithiasis (Gallstones)?

Answer 18

Obesity

Diabetes

Question 19

What can gallstones lead to?

Answer 19

Inflammation

*Acute/Chronic Cholecystitis

Question 20

What can acute inflammation of the gallbladder lead to?

Answer 20

Empyema which could result in gallbladder perforation and biliary peritonitis Ending in chronic inflammation

Question 21

What does chronic cholecystitis cause?

Answer 21

Thickening of the gallbladder wall with pain in the RUQ and gallstones can cause obstruction if they leave the gallbladder

Question 22

What can cause a bile duct obstruction?

Answer 22

Bile duct tumour
Gallstones
Benign structre & External compression - Tumour elsewhere

Question 23

What are the effects of a bile duct obstruction?

Answer 23

No bile excreted into the duodenum
Ascending cholangitis - Infection of biliary tract
Secondary biliary cirrhosis if obstruction is prolonged

Question 24

What happens in liver failure in terms of hepatocytes?

Answer 24

Effectively you run out of functioning hepatocytes and you have to rely on the liver to regenerate itslef
Acute or Chronic causes

Question 25

What are acute causes of LF?

Answer 25

Hepatitis (A, B, C, E & Others) from Viruses Alcohol or Drugs Bile duct obstruction

Question 26

What is a chronic cause of LF?

Answer 26

Cirrhosis

Question 27

What does hepatitis cause?

Answer 27

Liver cell damage and death of individual liver cells

Question 28

What are the three possible outcome from Hepatitis?

Answer 28

Resolution - Hep A & E Liver failure if severe - Hep A, B & E Progression to chronic hepatitis and cirrhosis - Hep B & C

Question 29

What is hepatic cirrhosis?

Answer 29

End stage chronic liver disease in response of liver to chronic injury

Question 30

What are the causes of Cirrhosis? (6)

Answer 30

Alcohol Hepatitis B & C PBC & Auto-immune hepatitis Metabolic disorders - Haemachromatosis & Wilson's disease Obesity Cryptogenic - Unknown cause and most common

Question 31

What structural come about from cirrhosis?

Answer 31

Loss of normal structure which is replaced by nodules of hepatocytes and fibrous tissue

Question 32

How large is a cerotic liver compared to that of a healthy liver?

Answer 32

Much smaller

Question 33

What are the complications of cirrhosis?

Answer 33

Altered liver function Abnormal blood flow Increased risk of hepatocellular carcinoma

Question 34

What is the abnormal blood flow like in cirrhosis?

Answer 34

Portosystemic anastomoses dilate in portal hypertension giving large dilated distended vascular structures, aka varices

Question 35

What are the five stages in the development of gastric cancer?

Answer 35

``` Normal and H. pylori infection Atrophic gastritis Intestinal metaplasia Dysplasia Gastic cancer - Adenocarcinoma ```