Hepato-biliary Pathology

Question 1

What is liver failure a complication of?

Answer 1

Acute liver injury and chronic liver injury e.g.cirrhosis

Question 2

What are the causes of hepatitis?

Answer 2

Viruses, alcohol and drugs

Question 3

What are pathologies are classed as acute liver injuries?

Answer 3

Hepatitis and bile duct obstruction

Question 4

What is the pathology of viral hepatitis?

Answer 4

Inflammation of the liver

Liver cell damage and death of individual liver cells

Question 5

What are the outcomes of acute inflammation?

Answer 5

Resolution, liver failure and progression to chronic hepatitis and cirrhosis

Question 6

What is jaundice?

Answer 6

Increased circulating bilirubin

Question 7

How is bilirubin metabilised pre-hepatically?

Answer 7

Breakdown of haemoglobin and the haem is converted to bilirubin

Question 8

What is the cause of pre-hepatic jaundice?

Answer 8

Increased release of haemoglobin from RBCs

Question 9

What are the hepatic causes of jaundice?

Answer 9

Cholestasis and intra-hepatic bile duct obstruction

Question 10

What is cholestasis?

Answer 10

Accumulation of bile within the hepatocytes or bile canaliculi

Question 11

What are the causes of cholestasis?

Answer 11

Viral hepatitis, alcoholic hepatitis, liver failure and drugs (therapeutic & recreational)

Question 12

What is primary biliary cholangitis?

Answer 12

Organ specific auto-immune disease

Question 13

What is the pathophysiology of primary biliary cholangitis?

Answer 13

Anti-mitochondrial auto-antibodies in serum and raised serum alkaline phosphatase

Question 14

What are the consequences of primary biliary cholangitis?

Answer 14

Granulomatous inflammation involving bile ducts
Loss of intra-hepatic bile ducts
Cirrhosis

Question 15

What is the pathophysiology of primary sclerosing cholangitis?

Answer 15

Chronic inflammation, fibrous obliteration of bile ducts, loss of intra-hepatic bile ducts and associated with IBD

Question 16

What are the consequences of primary sclerosing cholangitis?

Answer 16

Progression to cirrhosis and increased risk of development of cholangiocarcinoma

Question 17

What are the causes of cirrhosis?

Answer 17

Alcohol, hepatitis A, B & C, immune mediated liver disease, metabolic disorders (excess iron & copper), obesity (diabetes) and cryptogenic (unknown cause)

Question 18

What is the pathology of cirrhosis?

Answer 18

Loss of normal liver structure and replaced by nodules of hepatocytes and fibrous tissue

Question 19

What are the complications of cirrhosis?

Answer 19

Liver failure, portal hypertension and increased risk of hepatocellular carcinoma

Question 20

What are the types of liver tumour?

Answer 20

Hepatocellular carcinoma (hepatocytes)
Cholangiocarcinoma (bile duct epithelium)
Metastatic Tumours

Question 21

What are cholelithiasis?

Answer 21

Gallstones

Question 22

What are the causes of post-hepatic jaundice?

Answer 22

Gallstones, gall bladder diseases and extra-hepatic duct obstruction

Question 23

What are the risk factors for gallstones?

Answer 23

Obesity and Diabetes

Question 24

What is the pathophysiology of acute cholecystitis?

Answer 24

Acute inflammation
Empyema - perforation and biliary peritonitis
Progression to chronic inflammation

Question 25

What is chronic cholecystitis?

Answer 25

Chronic inflammation and fibrosis of gall bladder

Question 26

What are the causes of common bile duct obstruction?

Answer 26

Gallstones, bile duct tumours, benign strictures and external compression (tumours)

Question 27

What are the effects of common bile duct obstruction?

Answer 27

Jaundice, no bile excreted into the duodenum, infection of bile (ascending cholangitis) and secondary biliary cirrhosis