Hepato-biliary Pathology Flashcards Preview

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Flashcards in Hepato-biliary Pathology Deck (35)
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1
Q

What is the structure and function of normal liver?

A

Functions:

Protein synthesis

Metabolism of fat and carbohydrate

Detoxification of drugs and toxins (including alcohol)

2
Q

What are the possible pathologies of the liver?

A

Liver failure

Jaundice

Intrahepatic bile obstruction

Cirrhosis

Tumours

3
Q

What pathologies are associated with the gall bladder?

A

Inflammation

4
Q

What pathologies are associated with extrahepatic bile ducts?

A

Obstruction

5
Q

What results in liver failure?

A

•Complication of

–Acute liver injury

–Chronic liver injury i.e. cirrhosis

6
Q

What causes acute liver injury?

A

•Hepatitis

–Viruses

–Alcohol

–Drugs

•Bile duct obstruction (bile is toxic to the liver and can damage the liver)

7
Q

What happens as a result of inflamamtion of the liver?

A

Liver cell damage and damage to individual cancer cells

8
Q

Which strains of viral hepatitis will likely have a resolution and return to normal?

A

Hepatitis A and E

9
Q

Which strains of viral hepatits can cause chronic hepatitis?

A

Hepatitis B and C

10
Q

Which strains of viral hepatitis can cause progression to chronic hepatitis and cirrhosis?

A

Hepatits B and C

11
Q

What is the disease progression of alcoholic liver disease?

A

Fatty change

Alcoholic hepatitis

  • Acute inflammation
  • Liver cell death
  • Liver failure

Progress to cirrhosis

12
Q

What is the cause of jaundice?

A

Increased circulating bilirubin

13
Q

What is pre-hepatic metabolism of bilirubin?

A

–Breakdown of haemoglobin in spleen to form haem and globin

–Haem converted to bilirubin

–Release of bilirubin into circulation

14
Q

What is the hepatic section of the bilirubin metabolism?

A

–Uptake of bilirubin by hepatocytes

–Conjugation of bilirubin in hepatocytes

–Excretion of conjugated bilirubin into biliary system

15
Q

What is the post hepatic metabolism of bilirubin?

A

–Transport of conjugated bilirubin in biliary system

–Breakdown of bilirubin conjugate in intestine

–Re-absorption of bilirubin

•Entero-hepatic circulation of bilirubin

16
Q

What are the three classifications of jaundice?

A

Pre-hepatic

Hepatic

Post-hepatic

17
Q

What is the cause of pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells (haemolysis)

18
Q

What are the hepatic causes of jaundice?

A
  • Cholestasis
  • Intra-hepatic bile duct obstruction
19
Q

What is cholestasis defined as?

A

•Accumulation of bile within hepatocytes or bile canaliculi

20
Q

What are causes of cholestasis?

A

Viral hepatitis

Alcoholic hepatits

Liver failure

Drugs

21
Q

What are the different types of drug induced cholestasis?

A

Predictable vs unpredictable

Predicatable = dose related

Unpredicatable = not dose related

22
Q

What are the different causes of bile duct obstruction?

A
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
  • Tumours of liver

–Hepatocellular carcinoma

–Tumours of intra-hepatic bile ducts

–Metastatic tumours

23
Q

What cancer risk does sclerosing cholangitis have?

A

Development of cholangiocarcinoma

24
Q

What are the causes of cirrhosis?

A

Alcohol

Hepatitis B and C

Immune mediated liver disease

(–Auto-immune hepatitis

–Primary biliary cholangitis)

Metabolic disorders

–Excess iron

Primary haemochromatosis

–Excess copper

•Wilson’s disease

•Obesity

–Diabetes mellitus

•Cryptogenic (unknown cause)

–Commonest cause

25
Q

How does primary sclerosing cholangitis result in cirrhosis?

A

Chronic inflammation and fibrous alteration of bile ducts

26
Q

What is normal liver structure replaced by in fibrosis?

A

•Replaced by nodules of hepatocytes and fibrous tissue

27
Q

What are complications of cirrhosis?

A

•Altered liver function

–Liver failure

•Abnormal blood flow

–Portal hypertension

•Increased risk of hepatocellular carcinoma

28
Q

What are the different tumours of the liver?

A

•Hepatocellular carcinoma

–Malignant tumour of hepatocytes

•Cholangiocarcinoma

–Malignant tumour of bile duct epithelium

•Metastatic tumours

–Common site of metastases

29
Q

What are post hepatic causes of jaundice?

A
  • Cholelithiasis (gallstones)
  • Diseases of gall bladder
  • Extra-hepatic duct obstruction
30
Q

What are risk factors for gallstones?

A

Obesity

Diabetes

31
Q

What results from acute inflammation of the gallbladder?

A

- Empyema

(Perforation of gall bladder)

Biliary Peritonitis

Progression to chronic inflammation

32
Q

What happens as a resut of chronic cholecystitis?

A

Fibrosis

33
Q

What causes common bile duct obstruction?

A

Gallstones

Bile duct tumours

Benign strictures

External compression (tumours)

34
Q

What are the effects of common bile duct obstruction?

A
  • Jaundice
  • No bile excreted into duodenum
  • Infection of bile proximal to obstruction

–Ascending cholangitis

•Secondary biliary cirrhosis if obstruction prolonged

35
Q
A