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Pathology of the Hepatobiliary S

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					The Hepatobiliary System



 Marilyn Rose
 DMI 56
Common Diseases Associated With
The Hepatobiliary System
•   Cirrhosis- -Esophageal Varices
•   Ascites
•   Hepatitis
•   Cholelithiasis
•   Medical/Surgical Jaundice
•   Hemangioma
•   Hepatoma
    ▫ Hepatoblastoma- # 1 Pediatric tumor
• Pancreatitis
Functions Of The Liver

• Metabolism

• Synthesis

• Detoxification

• Excretion
Review of Liver’s Blood Supply

• Dual Supply of blood
 ▫   Hepatic Artery
 ▫   Delivers oxygenated blood
 ▫   Portal Vein
 ▫   Returns venous blood from abdominal
     viscera- nutrient rich

• Both are going the same direction-towards
  the liver!!! (Both are imaged RED- when
 normal…)
Assessory Digestive Organs
• Functions Of The Gallbladder
 ▫ Store and concentrate bile
• Functions Of The Pancreas
 ▫ Both exocrine and endocrine
    Exocrine- trypsin, amylase, lipase-
     panc duct to duodenum
    Endocrine- islets of Langerhans- insulin
     and glucagon
     direct to bloodsteam.
 ▫ Hyperglycemic- insulin
 ▫ Hypoglycemic- glucagon- liv break down glycogen
              Pancreas



Gallbladder
    Cirrhosis
•   Liver parenchyma/ architecture destroyed
•   Asymptomatic in early stages
•   End stage-of chronic alcoholism
•   Causes impaired liver function
•   Portal hypertension= PHTN
•   Development of
    ▫ collateral venous to vena cava
    ▫ esophageal varices
    ▫ high risk of hemmorhage
Cirrhotic liver on CT




                        http://health.allrefer.com/health/cirrhosis-liver-cirrhosis-ct-scan.html
Ascites

• Fluid within peritoneal cavity

• May result from hepatitis, renal failure,
  cancer, CHF

• Very difficult to image radiographically

• Sonography is generally used
upload.wikimedia.org/wikipedia/commons/f/f8/A.




   Ascites




                                            http://images.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/common
                                            s/f/f8/Ascites_ultrasound_2.JPG&imgrefurl=http://commons.wikimedia.org/wiki/File:Asc
                                            ites_ultrasound_2.JPG&usg=__syKFdMwyucRFDiMRtaf35fOl74w=&h=484&w=629&sz=3
                                            2&hl=en&start=22&um=1&tbnid=R51-
                                            slJlOixQZM:&tbnh=105&tbnw=137&prev=/images%3Fq%3Dimages%2Bof%2Bascites%26n
                                            dsp%3D18%26hl%3Den%26rlz%3D1T4GGLF_enUS223US223%26sa%3DN%26start%3D18
                                            %26um%3D1
Viral Hepatitis
• Estimated 70,000 cases reported annually
• Acute inflammation of the liver
• Interferes with liver’s ability to secrete bile

•   Hepatitis A
•   Infectious hepatitis- Most common form
•   Short incubation period, 15 - 20 days, mild
•   Excreted in GI tract
•   Ingestion of contaminated food or water

•   Hepatitis B
•   Serum hepatitis- blood products
•   Long incubation period, 50 - 160 days
•   Much more severe than A
•   Result in acute or chronic hepatitis, cirrhosis, and HCC

•   Hepatitis C
•   Parenterally transmitted RNA virus
•   90% of Hepatitis cases after transfusion
•   Can cause either acute or chronic hepatitis
•   10 - 20% of patients develop cirrhosis
Cholecyctitis
• Acute inflammation of the
  gallbladder
• Sudden onset pain,
  nausea, vomiting
• Characterized by a
  thickened GB wall
• Chronic- risk= Porcelain
  GB> chance of CA…

• Sometimes US show
  pericholecystic fluid
• Also a stone can erode      http://img.medscape.com/pi/emed/ckb/general_surgery/188616-195165-
                              2288.jpg

  through the wall=
  gallstone ileus
Cholelithiasis
• Fairly common

• About 10% of stones are radiopaque

• Can be viewed with radiographic contrast

• Sonography is now the method of choice

• Composition of stones vary
 ▫ cholesterol, bilirubin, calcium
Gallstones




     http://www.goldbamboo.com/pictures-t1349.html
Pancreatitis

• Acute or chronic inflammation

• Extremely complex disorder

• Acute- resolves from biliary tract dz

• Chronic- does not resolve…histologically

• Pancreas may begin to digest itself (trypsin)
 ▫ Creating a Pseudocyst
Pancreas contd.
  • High mortality rate
  • Causes:
   ▫ Excessive alcohol consumption
   ▫ Obstruction of the Ampulla of Vater
   ▫ Injection of contrast media during ERCP
  • Labs: amylase/lipase

  • Chronic pancreatitis can increase the risk
    of pancreatic cancer.
    Pancreas


                                                                                           http://images.google.com/imgres?imgurl=http://www.ultrasound-
                                                                                           images.com/images/FATTY-PANCREAS-1a.jpg&imgrefurl=http://www.ultrasound-
                                                                                           images.com/pancreas.htm&usg=__GEC0IVhrd50Rg9H85uxlmRtnXVA=&h=480&w=640&sz
                                                                                           =39&hl=en&start=17&um=1&tbnid=MHpijl8AiMGENM:&tbnh=103&tbnw=137&prev=/imag
                                                                                           es%3Fq%3Dimages%2Bof%2Bpancreas%26hl%3Den%26rlz%3D1T4GGLF_enUS223US223%
                                                                                           26sa%3DX%26um%3D1




http://images.google.com/imgres?imgurl=http://www.gopetsamerica.com/anatomy/illustration
s/pancreas.jpg&imgrefurl=http://anatomytopics.wordpress.com/tag/duct-of-
santorini/&usg=__5LUCTLqS7yEk9tnfqF9Yy8bycuI=&h=363&w=434&sz=35&hl=en&start=4&
um=1&tbnid=uWVIILoXVawf_M:&tbnh=105&tbnw=126&prev=/images%3Fq%3Dimages%2Bof
%2Bpancreas%26hl%3Den%26rlz%3D1T4GGLF_enUS223US223%26sa%3DX%26um%3D1
Medical and Surgical Jaundice
 • Yellow discoloration of skin/whites of eyes
 • Excess bilirubin in the blood
 • Produced by breakdown of hemoglobin,
   normally eliminated

 • Medical
  ▫ Occurs due to hemolytic disease
 • Surgical
  ▫ Occurs due to obstruction
Hemangioma

• Most common tumor

• Benign neoplasm

• Generally insignificant
  unless occurring with a
  malignancy

• More common in
  postmenopausal women
Hepatoma-Hepatocellular Carcinoma
• Primary carcinoma of the liver

• Uncommon in the U.S. - less than 2%

• Associated with alcoholism and Chronic
  Hep B or C

• Pediatrics- primary liver tumor in the first
  year of life- Hepatoblastoma

• Very poor prognosis
Liver



                                                        Normal Liver
                                                                           Lhttp://images.ask.com/pictures?l=dis&o=101881&q=liver&qsrc=8&qid=11FF
                                                                           DFD4C14B127C7FF0A9338A8624F2&pstart=30&page=2




                                                                 Adenoma
http://emedicine.medscape.com/article/940516-overview
                                                                            Hepatoblastoma- easy to resect
Metastatic Liver
Disease

From where?
-Colon
-pancreas
-stomach
-lung
-breast



http://www.learningradiology.com/archives2007/COW%20235-
Liver%20mets/livermetscorrect.html
Carcinoma of the Gallbladder                                    http://drjoea.googlepa
                                                                ges.com/calculi-

• Infrequent                                                    multiple-
                                                                1e.jpg/calculi-
                                                                multiple-1e-full.jpg


• Malignant
• 85%-Adenocarcinoma
• More common in
  women/elderly
• Gallstone present in 75%
  of cases
• Jaundice, wt loss, RUQ
  pain-not specific to CA


                       http://canliv.org/making-the-diagnosis
Biliary Atresia-not cancer…but not good
• Born without a gallbladder or ducts

• The incomplete formation of the biliary system is
  incompatible with life.

• A child diagnosed with biliary atresia needs a Liver
  Transplant to survive.

• The sequele of biliary atresia is the same as
  cirrhosis…esophageal varicies, GI bleeding, ascites
  and liver/multi-organ system failure.
                        Primary Diagnosis of Pediatric Liver Transplant Patients




                               Other                 Acute Hepatitis
                                11%                       14%



                  M etdis
                       9%

                                                                                   Acute Hepatitis
                                                                                   Biliary Atresia

M alignant Neoplasms                                                               Cirrhosis

        9%                                                                         M alignant Neoplasms
                                                                                   M etdis
                                                                                   Other
               Cirrhosis
                  5%


                                                         Biliary Atresia
                                                                52%
Carcinoma Of The Pancreas
 • Usually fatal

 • 5th most common cancer death in US

 • Very difficult diagnosis

 • CT is the best imaging method

 • Lack of early symptoms lead to failure of
   early detection
  Pancreatic
  CA




                                                http://upload.wikimedia.org/wikipedia/commons/f/f6/MBq_cystic-carcinoma-pancreas.jpg




http://www.goldbamboo.com/pictures-t2873.html

				
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