The color of BILE when it is caught in liver.

biliary Cirrhosis

Irregular, Peripheral bile duct proliferation

Feathery degeneration of hepatocytes

bile lakes

Results in FLORID DUCT LESION - 

in the west, 80% of gall stones are:

the rest?

Cholesterol Stones,

the rest  are BILIRUBIN CALCIUM SALTS CALLED pigment stones

Pigmented = sterile gallbladder bile

cholesterol = infected intrehepatic fucts

"Onion skin fibrosis"

assoc with?

Primary Sclerosing Cholangitis

Destruction of large intrhepatic bile duct

ASSOC WITH IBD

70% have UC

Compairison:

A     SBC SECONDARY BILLIARY CIRRHOSIS

B     PSC  PRIMARY BILLIARY CIRRHOSIS

C     PRIMARY SCLEROSING CHOLIANGITIS

0) Describe eitology

 1) F:M ratio

2)  lab specificity

3)Histology

4)Rads

           SBC                       PBC                     PSC

a)   Extrahepatic     b) Small Ducts      c) large ducts

______________________________

1)      A) 1:1                 B) 6:1               C)  1:2

 ----------------------------------------------

2            only primary sclerosing is specific

--------------------------------------------------

nonspec    Florid duct lesion    Obliterative fibrosis

____________________________________________

extrahepatic        nonspec                     beading

PBC  Primary Biliary Cirrhosis

highly lymphocitic and Granulomas can occur

-Mainly afects middle age women

-AMA antimitochondrial Antibodies are the marker!!!

FLORID DUCT LESION

1)  Flourid Duct Lesion

2)  Obliterative fibrosis with bleeding

 3) 1:1 Male female

1)  Primary Biliary Cirrhosis (sm/med ducts)

2) PSC - Priary Sclerosing Cholangitis (Large ducts)

3)  Secondary Biliary Cirrhosis (it is secondary, so eaual effect)

1.  6:1 male to female

1.   Primary biliary cirrhosis (s/m)
2. primary sclerosing choliangitis (large)

Sinusoidal dialation occurs any time an efflux of hepatic blood is impeded.

________ is a rare condition in which the dilation is PRIMARY

Peliosis hepatis

(Liver looks like shot with shotgun)

result of steroid use and oral birth control

primary sinusoidal dialation

asspoc with exposure to anabolic steroids, oral contraceptives

thrombosis of two or more major hepatic veins leads to  hepatomegally, weight gain, ascites, and abdominal pain

can occur for a variety of reasons

nonsuppurative destructive cholangitis and is characterized by mononuclear inflammatory cells surrounding a small bile duct.

Seen in Primary Biliary Cholangitis

Primary Sclerosing choliangitis

Men predom

Beading appearance

Large duct

Obliterative Fibrosis

Cholelithiasis

Risk factors***

 Cholesterol or Mixed Stones:

condtions:

CHOLESTEROL

• Supersaterated with cholest
• nucleation kinetically favorable
• time (remain in GB)

 PIGMENTED

• abn insoluble calcium salt
• unconj bilirubin

Risk Factors = 4 F's

Female

Fertility

Fat

Fourty

OCP (oral contr), Malabsorption, American Indian, HA

Colicky Pain because GB contracting and relaxing

intrahepatic thrombisis of portal vein

no necrosis, but hepatocellular atrophy

Congestion and distened sinusoids

SOS - Sinusoidal Obstruction Syndrome

central venous sclerosis

dammaged endothelial cells slough off and create emboli that black blood flow

Dmg accompanied by rbc's breaking off into space of disse

 ***Sinusoidal obstruciton occurs 20-30 days after bone marrow transplantation***

resembles GVH dz

Pulmonary Hypertension

Cause of nutmeg liver

cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

these tumours present late and therefore are usually not resectable at the time of presentation. Complete resection of the tumour offers hope of long term survival and of late there has been renewed interest in liver transplantation from deceased donors along with adjuvant therapy. Prognosis remains poor today.

cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

Poor prognisos