Hepatobiliary I

Question 1

Biliary Tract blood supply

Answer 1

Hepatic Artery, which comes from Celiac

Question 2

Describe materials and cells at the cords from luminal to basal, plus cancer possibilities.

Answer 2

Sinusoidal Space - Mix of blood from PV and HA
Kupffer Macrophages
Endothelial Cells - Cavernous Hemangioma
Space of Disse w HSC Hepatic Stellate Cells
Hepatocytes - HCA (benign) and HCC (malignant) - also Adenocarcinomas
- Cholangiocarcinoma - CC (adenocarcinoma)

Nearer to Bile Duct:
Hepatocytes secrete bile into Canaliculi, then Canaliculi transitions to Intralobulated DUCTS; between this is called Canal of Herring - made of cholangiocytes and hepatocytes + STEM CELL NICHE
- transition to bile ductal simple cuboidal cells

Question 3

Serum alkaline phosphatase liver indication

Answer 3

Damage to bile ducts

Question 4

Hepatocyte changes in

Liver Injury and Repair

Scar formation and Architecture

+ P HT changes

Answer 4

Injury Triggers: Steatosis, Cholestasis
Ballooning degeneration
Necrosis, Apoptosis

Repair:
Regeneration: Hepatocyte mitosis; Stem cell activation @ Canal of Hering called Ductular Reaction - Bile duct cell proliferation; so,,, Hepatocyte + Choliangiocyte proliferation

Fibrosis:

1: Reticulin collapse
2: HSC activate, covert to fibrogenic myofibroblasts
- fibrosis from Portal fibrosis to Portal-Central

Resulting in Fibrous scars around REGENERATIVE NODULES

Portal HT: sinusoidal remodeling, vasoconstriction

Question 5

Acute Liver Failure top causes

Answer 5

Drugs, Toxins - fast onset
Viral Hep - A, B, E

Auto-immune

Question 6

Chronic Liver Failure causes

Answer 6

NAFLD, NASH
AFLD,
Hep B and C

Question 7

Distinct between Cirrhosis and ESLF

Answer 7

Chronic Liver Failure is clinical
- not all CLF have cirrhosis, not all cirrhosis means failure
Cirrhosis is pathology, clinical presentation

Question 8

Cirrhosis pathology description [4]

Answer 8

Regenerative parenchymal nodules w Fibrous scarring
w Disturbed vascular architecture; lymphocytes, inflammation

• note nodules can be neoplasm;

Question 9

Chronic Liver Disease

every presentation ever + PTH Cx
think liver functions!!!

Answer 9

Jaundice + Icterus + Puritis

Easy bruising - Coagulopathy

Hyperestrogenia

• Gynecomastia, Testes atrophy (hypogonadism)
• Spider nevi
• Palmar erythema

Portal Hypertension
- Ascites - Splanchnic vasodilation to compensate, RAAS
- Hepatic encephalopathy - more ammonia shunt to Brain (asterixis, hepatic flap)
- Esophageal Varices - portal-systemic shunt; caput medusae @ umbilicus
- Pedal Edema - Hypoalbuminemia
- Splenomegaly - Cytopenia - bleeding and whatnot
NOTE splenomegaly can CAUSE PHT too through increase in blood flow;
- Hepatorenal syndrome - secondary to splanchnic vasodilation, effective circulatory volume decreases, RAAS activated, plus renal vasoconstriction
- Hepatopulmonary syndrome - liver disease releases vasodilators PG, NO, decreased destruction of vasodilators - PULMONARY VASODILATION - VQ mismatch

Question 10

Portal hypertension pathophysiology

Answer 10

Sinusoid vasoconstriction, remodeling, intrahepatic shunting - increase VASCULAR RESISTANCE!!!

Fibrosis, Nodules - disrupts flow

Increase venous flow from splanchnic vasodilation anyways