Hepato-Biliary Pathology

Question 1

Functions of the Liver

Answer 1

Protein Synthesis
Metabolism of Fat and Carbohydrate
Detox of drugs and toxins

Question 2

Pathologies of the Liver

Answer 2

Liver Failure
Jaundice
Intrahepatic Bile Duct obstruction
Cirrhosis
Tumours

Question 3

Define Liver Failure. What causes it?

Answer 3

Large parts of the liver are damaged and cannot function.

Caused by acute liver injury or chronic injury (cirrhosis)

Question 4

Causes of acute liver injury

Answer 4

Drug Overdose. Hep A, B & E. Epstein Barr. (viruses), alcohol, or bile duct obstruction

Question 5

Outcome of Acute Hepatitis (A,B & E)

Answer 5

These variations of hepatitis cause inflammation and liver cell damage and death.

This will either resolve, result in liver failure or progress to chronic hepatitis and cirrhosis

Question 6

What is alcoholic liver disease and the effects on the liver

Answer 6

ALD is damage to the liver caused by excess alcohol.

Alcohol abuse can impact the liver’s ability to regenerate. Over short periods of time, large amounts of alcohol can lead to a build-up of fats.

Question 7

What are the three stages of ALD

Answer 7

1. Fatty Liver (reversible in two weeks)
2. Alcoholic Hepatitis (usually reversible, acute inflammation, cell death and liver failure)
3. Cirrhosis (point of significant scarring, irreversible damage)

Question 8

Treatment of ALD

Answer 8

No specific treatment. Stop drinking for life :(.

Question 9

Define Cirrhosis

Answer 9

Loss of hepatocytes and permanent scarring leading to loss of function.

Question 10

Define Jaundice and it’s cause

Answer 10

Defintition: Increased circulating bilirubin.

Cause: Altered metabolism of biliruibin (pre-hepatic, hepatic or post hepatic)

Question 11

Pathway of Bilirubin in three steps

Answer 11

1. haemoglobin is broken down into haem and globin in the spleen. haem is converted to bilirubin and released into circulation
2. Bilirubin is brought up by hepatocytes and conjugated before being released to the biliary tree.
3. Bilirubin conjugate in intesine is broken down and reabsorbed.

Question 12

Causes of Pre-Hepatic Jaundice

Answer 12

Increased release of haemoglobin from red blood cells -haemolytic anaemia

Question 13

Cause of hepatic jaundice

Answer 13

Cholestais

Intra-hepatic bile duct obstruction

Question 14

Define Cholestasis

Answer 14

Reduction/Obstruction of Bile flow leading to accumulation of bile within the hepatocytes or bile canaliculi.

Question 15

Causes of cholestasis

Answer 15

Viral Hepatitis
Alcoholic hepatitis
Liver Failure
Drugs

Question 16

Cause of intra-hepatic bile duct obstruction

Answer 16

Primary Biliary cholangitis (cirrhosis)(destruction of the bile ducts- autoimmune).

Primary sclerosing cholangitis (chronic inflammation and fibrous obliteration of bile ducts) associated with IBD, progressing to cirrhosis. Increased risk of cholangiocarcinoma

Tumours of the liver - Hepatocelluar carcinoma
Intra-hepatic bile ducts
Metastatic tumours

Question 17

What is Primary Biliary Cholangitis?

Answer 17

Cirrhosis of the bile ducts. It is an organ specific autoimmune disease affecting woman.

Anti-mitochondrial auto-antibodies can be found in serum and will have elevated ALP

Question 18

Pathology of primary biliary cholangitis

Answer 18

Granulomatous inflammation of the bile ducts.

Loss of intra-hepatic bile ducts

Progressing cirrhosis.

Question 19

Define Hepatic Cirrhosis

Answer 19

End stage chronic liver disease in response to chronic injury

Question 20

Causes of Cirrhosis

Answer 20

• Alcohol
• Hepatitis B & C
• Autoimmune disease (autoimmune hepatitis or primary biliary cholangitis)
• Metabolic Disorders - excess iron (primary haemochromatosis), Excess copper (wilsons disease)
• Obesity - Diabtes mellitus

Question 21

Pathology of Cirrhosis

Answer 21

Loss of Liver structure throughout the liver. Replaced by nodules of hepatocytes and fibrous tissue

Question 22

Complication of Cirrhosis

Answer 22

Altered Liver Function - Liver Failure.

Abnormal Blood flow - portal hypertension

Increased risk of hepatocelluar carcinoma

Question 23

What is hepatocellular hepatocytes

Answer 23

Malignant Tumour of Hepatocytes

Question 24

What is cholangiocarcinoma

Answer 24

Malignant tumour of the bile duct epithelia

Question 25

Risk Factors of Gallstones

Answer 25

Obesity

Diabetes

Question 26

What is Cholelithiasis

Answer 26

Formation of gallstones

Question 27

Causes of common bile duct obstruction

Answer 27

Gallstones
Bile duct tumours
Benign Stricture
Extrenal compression of tumours

Question 28

Effects of common bile duct obstruction

Answer 28

Jaundice
No Bile excretion into the duodenum.
Infection of bile proximal to the obstruction. Cholangitis.(inflammation of the bile duct.)