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*GI System - Pathology > Hepato-Biliary Pathology > Flashcards

Hepato-Biliary Pathology Flashcards

(56 cards)

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1
Q

Describe the blood that the hepatic artery supplies the liver

A

Oxygen rich

Nutrient depleted

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2
Q

Describe the blood that the hepatic portal vein supplies the liver

A

Oxygen depleted

Nutrient rich

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3
Q

What are the functions of the liver (3)?

A

Protein synthesis
Metabolism of fat and carbohydrate
Detoxification of drugs and toxins including alcohol

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4
Q

Give 5 pathologies which can occur in the liver

A 
Liver failure
Jaundice
Intrahepatic bile duct obstruction 
Cirrhosis
Tumours
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5
Q

What pathology can occur in the gall bladder?

A

Inflammation

?gall stones

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6
Q

What can go wrong with the extrahepatic bile ducts?

A

Obstruction

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7
Q

What is a complication of acute/chronic liver injury?

A

Liver failure

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8
Q

What 2 pathologies can cause acute liver injury?

A

Hepatitis (inflammation of liver)

Bile duct obstruction

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9
Q

What are 3 general causes of hepatitis?

A

Virus
Alcohol
Drugs (almost any drug)

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10
Q

What viruses cause viral hepatitis?

A 
Hep A
Hep B
Hep C
Hep E
Others inc megalovirus, EB virus
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11
Q

What are the 2 general steps of viral hepatitis?

A

Inflammation of liver

Liver cell damage and death of individual liver cells

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12
Q

What hep viruses normally have a resolution?

A

Hep A + E

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13
Q

What hep viruses can cause liver failure if serious damage to liver? (if supported through acute phase, can return to normal)

A

Hep A, B, E

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14
Q

What hep viruses progress to chronic hepatitis and cirrhosis?

A

Hep B + C (blood borne viruses)

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15
Q

What can alcoholic liver disease progress to?

A

Cirrhosis

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16
Q

What change occurs in hepatocytes in alcoholic liver disease?

A

Fat accumulates; leads to acute inflammation, liver cell death and liver failure

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17
Q

What is jaundice caused by?

A

Increased circulating bilirubin (altered metabolism of it)

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18
Q

What are the 3 pathways of bilirubin metabolism (also 3 types of jaundice)?

A
  • pre-hepatic
  • hepatic
  • post-hepatic
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19
Q

Describe the pre-hepatic metabolism of bilirubin

A
  1. Breakdown of haemoglobin in spleen to haem and globin
  2. Haem to bilirubin
  3. Release of bilirubin into circulation
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20
Q

Describe the hepatic metabolism of bilirubin

A
  1. Uptake of bilirubin by hepatocytes
  2. Conjugation of bilirubin in hepatocytes
  3. Excretion of conjugated bilirubin into biliary system
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21
Q

Describe the post-hepatic metabolism of bilirubin

A
  1. Transport of conjugated bilirubin in biliary system
  2. Breakdown of bilirubin conjugate in intestine
  3. Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)
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22
Q

What are the 3 classifications of jaundice?

A
  • pre-hepatic
  • hepatic
  • post-hepatic
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23
Q

Describe the pathology associated with pre-hepatic jaundice

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A

Increased release of haemoglobin from red cells (haemolysis)

24
Q

Name 2 hepatic causes of jaundice

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A

CHOLESTASIS

INTRA-HEPATIC BILE DUCT OBSTRUCTION

25
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
26
Name 4 causes of cholestasis
- viral hepatitis - alcoholic hepatitis - liver failure - drugs (therapeutic or recreational)
27
What are the 2 types of drug-induced cholestasis?
Predictable (dose-related) | Unpredictable (not dose related)
28
Name 3 conditions associated with intra-hepatic bile duct obstruction
Primary biliary cholangitis Primary sclerosing cholangitis Tumours of liver
29
What are 3 types of tumour in the liver?
Hepatocellular carcinoma Tumour of intra-hepatic bile ducts Metastatic tumours
30
What type of disease is primary biliary cholangitis?
Organ-specific auto-immune disease
31
Which gender is more affected by PBC?
Females (9:1)
32
What 2 tests are done in PBC?
Anti-mitochondrial auto-antibodies in serum (positive) | Serum alkaline phosphatase (raised)
33
What type of inflammation is found in PBC?
Granulomatous inflammation involving bile ducts
34
What is lost in PBC?
Intra-hepatic bile ducts
35
What can PBC progress to?
Cirrhosis
36
Describe primary SCLEROSING cholangitis
Chronic inflammation and fibrous obliteration of bile ducts
37
What is lost in PSC?
Intra-hepatic bile ducts
38
What is PSC commonly associated with?
Inflammatory bowel disease
39
What can PSC progress to?
Cirrhosis | Increased risk of development of cholangiocarcinoma
40
What is the main difference between PBC and PSC in terms of site of disease?
``` PBC = small bile ducts inside liver only PSC = Bile ducts inside and outside the liver; however in small duct PSC (10-15% of patients) only the small ducts inside the liver are affected ```
41
What is hepatic cirrhosis a response to?
Chronic liver injury (end stage chronic liver disease)
42
Name 6 general causes of cirrhosis
- Alcohol - Hep B + C - Immune mediated liver disease - Metabolic disorders - Obesity - Cryptogenic (unknown cause) - commonest
43
Name the 2 types of immune mediated liver disease associated with cirrhosis
Auto-immune hepatitis | Primary biliary cholangitis
44
Name the 2 metabolic disorders associated with cirrhosis
``` Excess iron (primary haemochromatosis) Excess copper (Wilson's disease) ```
45
What disease linked to obesity leads to cirrhosis?
Diabetes mellitus
46
How is the structure of the liver affected in cirrhosis?
Loss of normal liver structure; replaced by nodules of hepatocytes and fibrous tissue
47
Name 3 possible complications of cirrhosis
- Altered liver function (liver failure) - Abnormal blood flow (portal hypertension) - Increased risk of hepatocellular carcinoma
48
Three liver tumours as previously mentioned are hepatocellular carcinoma, cholangiocarcinoma and metastatic tumours - describe each
``` HC = malignant tumour of hepatocytes C = malignant tumour of bile duct epithelium MT = common site of metastases ```
49
Name 3 causes of post-hepatic jaundice
Cholelithiasis (gallstones) Diseases of gall bladder Extra-hepatic duct obstruction
50
Name 2 risk factors for gallstones
obesity + diabetes
51
Gallstones can lead to inflammation - name the 2 types of inflammation
ACUTE cholecystitis | CHRONIC cholecystitis
52
What complication is associated with acute cholecystitis?
Empyema (bladder fills with purulent material; perforation of gallbladder = biliary peritonitis)
53
What can acute cholecystitis progress to?
Chronic inflammation
54
What is chronic cholecystitis?
Chronic inflammation and fibrosis of gall bladder
55
Name 4 causes of common bile duct obstruction
Gallstones Bile duct tumours Benign structure External compression - tumours
56
Name 4 effects of common bile duct obstruction
Jaundice No bile excreted into duodenum Infection of bile proximal to obstruction (ascending cholangitis) Secondary biliary cirrhosis if obstruction prolonged

*GI System - Pathology (8 decks)

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