Hepato-biliary Pathology

Question 1

Liver failure is a complication of what?

Answer 1

Acute or Chronic liver injury

Question 2

Acute causes of liver injury?

Answer 2

Hepatitis

Bile duct obstruction

Question 3

What are the main types of hepatitis?

Answer 3

Viral
Autoimmune
Drug
Alcohol

Question 4

What viruses cause Hepatitis?

Answer 4

Hep A, B, C, E

Epstein Barr

Question 5

How does viral hepatitis cause damage?

Answer 5

Inflammation

Damage/death of individual liver cells

Question 6

Possible outcomes of acute Hepatitis A, E?

Answer 6

Resolution - return to normal

Question 7

Possible outcomes of acute Hep A, B, E?

Answer 7

Liver failure in severe damage

Question 8

Possible outcomes of acute Hep B, C?

Answer 8

Progression to chronic hepatitis - cirrhosis

Question 9

Which forms of hepatitis are blood borne?

Answer 9

Hep B, C

Question 10

What is the process to cirrhosis in alcoholic liver disease

Answer 10

Fatty change in liver
Alcoholic hepatitis
(acute inflam, liver cell death)
Cirrhosis

Question 11

What is the cause of jaundice?

Answer 11

Increased circulating bilirubin

Question 12

What is the pre-hepatic metabolism of bilirubin?

Answer 12

Haemoglobin broken down in spleen -> haem and globin
Haem -> bilirubin
Bilirubin released

Question 13

What is the hepatic metabolism of bilirubin?

Answer 13

Bilirubin -> hepatocytes
Conjugation of bilirubin
Excretion into biliary system

Question 14

Why is bilirubin conjugated in the hepatocytes?

Answer 14

Increase solubility

Question 15

What is the post-hepatic metabolism of bilirubin?

Answer 15

Biliary system –> intestine

Broken down and re-absorbed

Question 16

What is the cause of pre-hepatic jaundice?

Answer 16

Increased haemolysis, not related to the liver

Question 17

What are the hepatic causes of jaundice?

Answer 17

Cholestasis

Intra-hepatic bile duct obstruction

Question 18

What is cholestasis?

Answer 18

Accumulation of bile within the hepatocytes or canaliculi

Question 19

What causes Cholestasis?

Answer 19

Viral, Alcoholic Hep
Liver failure
Drugs (must be excluded)

Question 20

Causes of Intra-hepatic bile duct obstruction

Answer 20

Primary biliary Cholangitis
Primary sclerosing cholangitis
Liver tumours

Question 21

What is Primary Biliary Cholangitis?

Answer 21

Autoimmune disease, causing granulomatous inflammation in bile ducts
Progresses to cirrhosis

Question 22

What are the tests for primary biliary cholangitis?

Answer 22

Anti-mitochondrial auto-antibodies in serum

Raised serum alkaline phosphatase

Question 23

What is primary sclerosing cholangitis?

Answer 23

Chronic inflammation leading to fibrotic obliteration of bile ducts

Question 24

Primary sclerosing cholangitis is associated with what?

Answer 24

Chronic Inflammatory Bowel disease

Question 25

Primary sclerosing cholangitis can progress to what?

Answer 25

Cirrhosis | Cholangiocarcinoma

Question 26

What is hepatic cirrhosis?

Answer 26

End stage liver disease

Question 27

What are the causes of cirrhosis?

Answer 27

``` Alcohol Hep B, C Immune mediated liver diseases Excess iron, copper Obesity Cryptogenic (most common) ```

Question 28

What are the complications of cirrhosis?

Answer 28

Liver failure Portal hypertension Hepatocellular carcinoma

Question 29

Hepatocellular carcinoma are tumours of what?

Answer 29

Malignant tumour of hepatocyte

Question 30

Cholangiocarcinoma are tumours of what?

Answer 30

Malignant tumours of bile ducts

Question 31

What are the post-hepatic causes of jaundice?

Answer 31

Cholelithiasis (gallstones) Diseases of gall bladder Extra-hepatic duct obstruction

Question 32

Risk factors for Gallstones

Answer 32

Obesity | Diabetes

Question 33

What are the outcomes of acute cholecystitis

Answer 33

Empyema leading to perforation - peritonitis | Progression to chronic disease

Question 34

Chronic cholecystitis leads to what?

Answer 34

Fibrosis of the gallbladder wall leading to impairment of gallbladder contraction (pain)

Question 35

Causes of common bile duct obstruction?

Answer 35

Gallstones Bile duct tumours Stricture Compression (tumours)

Question 36

Effects of common bile duct obstruction

Answer 36

Jaundice Infection of proximal bile duct Seconday biliary cirrhosis