Hepatobiliary pathology

Question 1

What are the 2 blood supplies to the liver?

Answer 1

Hepatic artery

Portal vein

Question 2

What are the functions of the liver?

Answer 2

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

Question 3

What is liver failure a complication of?

Answer 3

Acute or chronic liver injury

Question 4

What are the causes of acute liver injury?

Answer 4

Hepatitis- viruses, alcohol, drugs

Bile duct obstruction

Question 5

What are the causes of chronic liver injury?

Answer 5

Cirrhosis

Question 6

What does viral hepatitis do?

Answer 6

Targets liver cells and causes inflammation

Causes liver cell damage and death of individual liver cells

Question 7

What are the outcomes of acute inflammation in the liver?

Answer 7

Resolution
Liver failure
Progression to chronic hepatitis and cirrhosis

Question 8

What is alcoholic liver disease?

Answer 8

Response of the liver to excess alcohol

Question 9

What is the progression of alcoholic liver disease?

Answer 9

Acute inflammation –> liver cell death –> liver failure–> progression to cirrhosis

Question 10

What is jaundice?

Answer 10

Increased circulating bilirubin causing the skin and eyes to take on a yellow tone
Caused by altered metabolism of bilirubin

Question 11

What are the 3 parts of bilirubin metabolism?

Answer 11

Prehepatic
Hepatic
Post hepatic

Question 12

What happens in the pre hepatic stage of bilirubin metabolism?

Answer 12

Breakdown of haemoglobin in spleen to form haemorrhage and globin
Globin converted to bilirubin
Release of bilirubin into curculation

Question 13

What happens in the hepatic stage of bilirubin metabolism?

Answer 13

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system

Question 14

What happens in the post hepatic stage of bilirubin metabolism?

Answer 14

Transport of conjugated bilirubin in biliary system
Breakdown on bilirubin conjugate in intestine
Reabsorption of bilirubin

Question 15

What is the enterohepatic circulation?

Answer 15

Circulation of substances, such as bilirubin, from the liver to the bile, entering the small intestine, absorption into he enterocyte and transport back to the liver

Question 16

What are the 3 classifications of jaundice?

Answer 16

Pre hepatic
Hepatic
Post hepatic

Question 17

What is the pre hepatic cause of jaundice?

Answer 17

Increased release of haemoglobin from red cells

Question 18

What are the hepatic causes of jaundice?

Answer 18

Cholestasis

Intrahepatic bile duct obstruction

Question 19

What is cholestasis?

Answer 19

Accumulation of bile in hepatocytes or bile canaliculi

Question 20

What causes cholestasis?

Answer 20

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs- therapeutic or recreational

Question 21

What are the causes of intrahepatic bile duct obstruction?

Answer 21

Primary biliary cholangitis
Primary sclerosis cholangitis
Tumours of the liver

Question 22

What is primary biliary cholangitis?

Answer 22

Female predominant organ specific autoimmune disease

Question 23

What is the pathology of primary biliary cholangitis?

Answer 23

Granulomatous inflammation involving bile ducts
Loss of intrahepatic bile ducts
Progression to cirrhosis

Question 24

What is primary sclerosis cholangitis?

Answer 24

Chronic inflammation and fibrous obliteration of bile ducts, causing loss of intrahepatic bile ducts

Question 25

What are the types of tumour of the liver?

Answer 25

Hepatocellular carcinoma Tumours of intrahepatic bile ducts Metastatic tumours

Question 26

What are the post hepatic causes f jaundice?

Answer 26

Cholelithiasis (gallstones) | Extra hepatic bile duct obstruction

Question 27

What are he risk factors of cholelithiasis?

Answer 27

Obesity | Diabetes

Question 28

What is the pathology of cholelithiasis?

Answer 28

Acute or chronic inflammation

Question 29

What are the causes of extra hepatic bile obstruction?

Answer 29

Gallstones Bile duct tumours Benign stricture External compression (tumours)

Question 30

What are the effects of extra hepatic bile obstruction?

Answer 30

No bile secreted into duodenum | Infection of bile proximal to obstruction

Question 31

What is cirrhosis?

Answer 31

End stage chronic liver disease | Response pf the live to chronic injury

Question 32

What are the causes of cirrhosis?

Answer 32

``` Alcohol Hep B, C Immune mediated liver disease Metabolic disorders Obesity Unknown cause ```

Question 33

What immune mediated liver diseases can cause cirrhosis?

Answer 33

Autoimmune hepatitis | Primary biliary cholangitis

Question 34

What metabolic disorders can cause cirrhosis?

Answer 34

Primary haemochromatosis- excess iron | Wilson's disease- excess copper

Question 35

What is the most common cause of cirrhosis?

Answer 35

Unknown cause

Question 36

What is the pathology of cirrhosis?

Answer 36

Diffuse process involving the whole liver Loss of normal liver structure Hepatocytes replaced by fibrous tissue

Question 37

What are the complications of cirrhosis?

Answer 37

Altered liver function- liver failure Abnormal bloodflow- portal hypertension Increased risk of hepatocellular carcinoma