Hepatobiliary Pathology

Question 1

what is liver failure a complication of?

Answer 1

acute or chronic liver injury

Question 2

what can cause acute liver injury?

Answer 2

> hepatitis

> bile duct obstruction

Question 3

describe the pathology of viral hepatitis

Answer 3

there is inflammation of the liver that causes cell damage and death of individual liver cells

Question 4

what may be the outcome of acute inflammation of the liver caused by viral hepatitis?

Answer 4

> resolution
liver failure if damage is severe
progression to chronic hepatitis or cirrhosis

Question 5

what is the response of the liver to excess alcohol?

Answer 5

alcoholic liver disease, there is a fatty change and acute inflammation leading to liver cell death and liver failure.

Question 6

what can alcoholic hepatitis progress to?

Answer 6

cirrhosis

Question 7

what causes jaundice?

Answer 7

increased circulating bilirubin from altered metabolism of bilirubin

Question 8

describe the pre-hepatic metabolism of bilirubin

Answer 8

> haemoglobin is split in the spleen into haem and globin

> haem is converted to bilirubin and released into the circulation

Question 9

in the hepatic stage of bilirubin metabolism what happens to the bilirubin in hepatocytes?

Answer 9

it is conjugated then excreted into the biliary system

Question 10

describe the post hepatic pathway of bilirubin metabolism

Answer 10

> transport through the biliary system
bilirubin conjugate is broken down in the intestine
bilirubin is then reabsorbed

Question 11

what is the cause of pre-hepatic jaundice?

Answer 11

increased release of haemoglobin form red blood cells

Question 12

what are causes of hepatic jaundice?

Answer 12

> cholestasis

> intra-hepatic bile duct obstruction

Question 13

what is cholestasis?

Answer 13

accumulation of bile within hepatocytes or bile canaliculi

Question 14

what can cause cholestasis?

Answer 14

> viral hepatitis
alcoholic hepatitis
liver failure
drugs

Question 15

what is the difference between predictable and non-predictable drug induced cholestasis?

Answer 15

predictable is dose related and unpredictable is not dose related

Question 16

what can cause intra-hepatic bile duct obstruction?

Answer 16

> primary biliary cholangitis
primary sclerosing cholangitis
tumours of the liver

Question 17

what is primary biliary cholangitis?

Answer 17

> organ specific autoimmune disease

Question 18

describe serum changes in primary biliary cholangitis

Answer 18

> anti-microbial autoantibodies present

> raised serum alkaline phosphatase

Question 19

describe the inflammation in primary biliary cholangitis

Answer 19

granulomatous inflammation involving the bile ducts (can progress to cirrhosis)

Question 20

describe the pathology of primary sclerosing cholangitis

Answer 20

> chronic inflammation
fibrous obliteration of bile ducts
= loss of intra-hepatic bile ducts

Question 21

what condition is primary sclerosing cholangitis associated with?

Answer 21

inflammatory bowel disease

Question 22

what may progress form primary sclerosing cholangitis?

Answer 22

> cirrhosis

> cholangiocarcinoma

Question 23

what is hepatic cirrhosis?

Answer 23

end stage chronic liver disease that is a response of the liver to chronic injury

Question 24

what is the aetiology of cirrhosis?

Answer 24

> alcohol
> hep. b, c
> immune mediated liver disease
> metabolic disorders
> obesity
> idiopathic

Question 25

what metabolic disorders can cause cirrhosis?

Answer 25

> primary haemochromatosis (excess iron) | > wilson's disease (excess copper)

Question 26

describe the pathology of cirrhosis

Answer 26

> diffuse process involving the whole liver > loss of normal liver structure > replaced by nodules of hepatocytes and fibrous tissue

Question 27

what are the complications of cirrhosis?

Answer 27

> altered liver function-failure > abnormal blood flow-portal hypertension > increased risk of hepatocellular carcinoma

Question 28

what tumours can develop in the liver?

Answer 28

> hepatocellular carcinoma > cholangiocarcinoma > metastatic tumours

Question 29

what is a hepatocellular carcinoma?

Answer 29

a malignant tumour of hepatocytes

Question 30

what is a cholangiocarcinoma?

Answer 30

malignant tumour of bile duct wpithelium

Question 31

what can cause post-hepatic jaundice?

Answer 31

> cholelithiasis (gallstones) > diseases of gall bladder > extra-hepatic duct obstruction

Question 32

what are the risk factors for gall stones?

Answer 32

> obesity | > diabetes

Question 33

what is cholecystitis?

Answer 33

inflammation of the gall bladder, can be acute or chronic

Question 34

how may acute cholecystitis progress?

Answer 34

empyema: > perforation of gall bladder > biliary peritonitis > can progress to chronic inflammation

Question 35

what can cause obstruction of the common bile duct?

Answer 35

> gallstones > bile duct tumours > benign stricture > external compression (tumour)

Question 36

what are the effects of common bile duct obstruction?

Answer 36

> jaundice > no bile excreted into duodenum > infection of bile proximal to obstruction > secondary biliary cirrhosis if obstruction is prolonged

Question 37

what is ascending cholangitis?

Answer 37

infection of the bile proximal to the obstruction in common bile duct obstruction