Hepatobiliary Pathology

Question 1

Describe the blood that the hepatic artery supplies to the liver

Answer 1

Oxygen rich

Nutrient depleted

Question 2

Describe the blood that the hepatic portal vein supplies to the liver

Answer 2

Oxygen depleted

Nutrient rich

Question 3

What are the functions of the liver?

Answer 3

Protein synthesis
Metabolism of fat and carbohydrate
Metabolism of alcohol
Biliary metabolism

Question 4

Where is bile stored?

Answer 4

In the gall bladder

Question 5

What is liver failure a complication of?

Answer 5

Acute liver injury

Chronic livery injury

Question 6

What is hepatits?

Answer 6

Liver inflammation

Question 7

What can cause hepatitis?

Answer 7

Viruses
Alcohol
Drugs

Question 8

What viruses target the liver?

Answer 8

Hep A
Hep B
Hep C
Hep E

Question 9

Which virus is Hep D associated with?

Answer 9

Hep B

Question 10

Which hepatitis viruses normally resolute?

Answer 10

A and E

Question 11

What is jaundice caused by?

Answer 11

Increased circulating bilirubin

Question 12

What are the 3 classifications of jaundice?

Answer 12

Pre-hepatic
Hepatic
Post-hepatic

Question 13

Where are RBC processed?

Answer 13

Spleen

Question 14

Describe the pre-hepatic metabolism of bilirubin

Answer 14

• Breakdown of haemoglobin in spleen (as this is where RBC are processed) to form haem and globin
• Haem converted to bilirubin
• Release of bilirubin into circulation
• There is a normal low circulating level of bilirubin

Question 15

Describe the hepatic metabolism of bilirubin

Answer 15

• Uptake of bilirubin by hepatocytes
• Conjugation of bilirubin in hepatocytes (make it go water soluble)
• Excretion of conjugated bilirubin into biliary system

Question 16

Describe the Post-hepatic metabolism of bilirubin

Answer 16

• Transport of conjugated bilirubin in biliary system
• Breakdown of bilirubin conjugate in intestine
• Re-absorption of bilirubin
• Entero-hepatic circulation of bilirubin

Question 17

What are the 3 classifications of jaundice?

Answer 17

Pre-hepatic
Hepatic
Post-hepatic

Question 18

What is cholestasis?

Answer 18

Accumulation of bile within hepatocytes or bile canaliculi

Question 19

What are some causes for cholestasis?

Answer 19

o	Viral hepatitis 
o	Alcoholic hepatitis 
o	Liver Failure 
o	Drugs 
-	Therapeutic 
-	Recreational 
o	Any drug can potentially cause liver harm

Question 20

What 2 conditions cause intra-hepatic bile duct obstruction?

Answer 20

Primary biliary cholangitis

Primary sclerosing cholangitis

Question 21

Does PBC mainly affect males or females?

Answer 21

Females

Question 22

What is hepatic cirrhosis?

Answer 22

End stage liver disease
Response of liver to chronic injury
Scarring of the liver

Question 23

What are some causes of cirrhosis?

Answer 23

Alcohol 
Hepatitis B and C 
Immune mediated liver disease (auto-immune hepatitis, primary biliary cholangitis)
Excess iron 
Wilson's disease (excess copper)
Obesity 
Fatty liver disease
Cryptogenic

Question 24

What is the pathology of liver cirrhosis like?

Answer 24

o	Diffuse process involving whole liver 
o	Loss of normal liver structure 
o	Replaced by nodules of hepatocytes separated by large bands of fibrous tissue o	Smaller than normal 
o	Fibrosed 
o	Nodules of various size

Question 25

What are the complications of cirrhosis?

Answer 25

Altered liver function Abnormal blood flow Increased risk of hepatocellular carcinoma

Question 26

What tumours can occur in the liver?

Answer 26

Hepatocellular carcinoma Cholangiocarcinoma Metastatic tumours

Question 27

What is hepatocellular carcinoma?

Answer 27

Malignant tumour of hepatocytes

Question 28

What is cholangiocarcinoma?

Answer 28

Malignant tumour of bile duct epithelium

Question 29

Is the liver a common site for metastases?

Answer 29

Yes

Question 30

What are the risk factors for cholelithiasis?

Answer 30

``` Obesity Diabetes Fat Female Forty Fertile ```

Question 31

What is cholelithiasis?

Answer 31

Gallstones

Question 32

What is cholecystitis?

Answer 32

Inflammation of the gall bladder

Question 33

What is empyema in the gall bladder?

Answer 33

Accumulation of pus in the hollow organ

Question 34

What is chronic cholecystitis?

Answer 34

Chronic inflammation and fibrosis of the gall bladder

Question 35

What are causes of common bile duct obstruction?

Answer 35

``` Gallstones Bile duct tumours in the duct Compression from external tumours Benign tumours Benign strictures ```

Question 36

What are the consequences of common bile duct obstruction?

Answer 36

Jaundice as no bile is excreted into the duodenum Infection of bile proximal to obstruction Secondary biliary cirrhosis

Question 37

What causes biliary colic?

Answer 37

When the GB contracts after a fatty meal to try release bile but gallstones get pushed in to the cystic duct

Question 38

What is cholangitis?

Answer 38

Inflammation of the biliary tree

Question 39

What is choledocholithiasis?

Answer 39

Gallstones in the common bile duct

Question 40

In which quadrant in the abdomen is biliary pain usually felt?

Answer 40

Right upper quadrant