Sudan National University

collage of graduate study and scientific

research
Radio-diagnostic department
seminar about:
Hepatobiliary System Pathology

The hepatobiliary system is composed of the liver,
gallbladder, and biliary tree. The pancreas is closely
related and shares a portion of the biliary ductal
system.
Liver:
The liver is the largest organ in the body and is sheltered
by the ribs in the right upper quadrant (RUQ) of the
abdomen. It is kept in position by peritoneal
ligaments and intraabdominal pressure from the
muscles of the abdominal wall.
The liver has a double supply of blood, coming from the
hepatic artery and the portal vein. The hepatic artery
usually originates from the celiac axis. The portal
vein is formed by the union of the superior & inferior
mesenteric and splenic veins.
Biliary Tree:
A system of ducts acts to drain bile produced in the liver into the
duodenum (Fig. 6-2). Bile from the livers twand left hepatic
ducts. These unite to form the common hepatic duct, which is
joined usually in its midportion by the cystic duct from the
gallbladder. Together, the cystic duct and the common hepatic duct
form the common bile duct. The common bile duct descends
posterior to the descending duodenum to enter at its posteromedial
aspect. Before its entrance into the duodenum, the common bile duct
may be joined by the pancreatic duct from the head of the
pancreas. The short part of the common bile duct, after joining the
pancreatic duct, is known as the hepatopancreatic ampulla or, more
commonly, the ampulla of Vater.
The purpose of bile is to emulsify fats so that they may be absorbed.
The liver is divided into the left and right lobe, and each lobe is divided
into segments on the basis of its vascular anatomy and biliary
drainage. The intrahepatic bile ducts generally follow the internal
hepatic segmental anatomy. In the left lobe, a left medial segment
duct and a left lateral segment duct normally join to form the main
left hepatic duct. The right hepatic duct branches near its origin at
the common hepatic duct. Frequently, the right hepatic duct has a
dorso-caudal branch, draining the posterior segment of the right
lobe, and a ventro-cranial branch, draining the anterior segment of
the right lobe.
Gallbladder:
The gallbladder, a digestive organ, is a pearshaped sac located on
the undersurface on the right lobe of the liver.
The sole function of the gallbladder is to store and concentrate bile
that has been produced in the liver.
Pancreas:
The pancreas is an elongated, flat organ that obliquely crosses the
left side of the abdomen behind the stomach; it is a powerful
digestive organ. Its functions are both exocrine and endocrine
 Imaging Technique
Many different methods of imaging the hepatobiliary system and
pancreas are available, including plain films, contrast
examinations of the biliary system, ultrasound, computed
tomography (CT), radionuclide imaging and magnetic
resonance imaging (MRI). Invasive studies such as
percutaneous or operative cholangiography and endoscopic
retrograde cholangiopancreatography (ERCP) may be
indicated, as may selective arteriography. Each of these tests
has its own advantages and disadvantages.
 Ultrasound, for example, is particularly useful for diagnosing
gall bladder disease, recognizing dilated bile ducts, diagnosing
cysts and abscesses, and defining perihepatic fluid collections,
where as CT and MRI are particularly sensitive for detecting
mass lesions such as metastases and abscesses. Often the
various methods complement each other.
Interventional techniques designed to treat or remove gallstones
and to drain the biliary system.
 Hepatobiliary pathology
Cirrhosis
End stage liver disease characterized by fibrosis and regenerative
nodules
Causes
- alcohol viral hepatitis (HBV&HCV)
- metabolic and hereditary (hemachromatosis, Wilsonsdisease)
- drugs
- biliary cirrhosis
Complications
- Portal hypertension
- varices, ascites, splenomegaly
Hepatitis
Inflammation of the liver parenchyma.
Non-infectious causes: metabolic disorders
- Hemochromatosis
Autosomal recessive disorder of iron metabolism resulting in
increased deposition of iron in various organs including liver, heart,
pancreas
- Wilsons disease
Autosomal recessive disorder of copper metabolism resulting in
increased deposition of copper in various organs including liver,
brain, and eye
- Alpha 1 antitrypsin deficiency
Autosomal recessive disorder resulting in decreasedalpha 1
antitrypsin, may cause emphysema, cirrhosis
Non-infectious causes: drug/toxin induced
- Acetaminophen
Dose related necrosis of liver cells
- Alcohol
Three pathologic changes linked to alcohol use
fatty liver (steatosis) all alcoholics show steatosis [fatty yellow
liver]
- Alcoholic hepatitis
Acute inflammation with fibrosis
- Cirrhosis
Viral hepatitis (usually due to hepatotropic viruses [Hepatitis
virus A,B, C, D, E, G]
Neoplastic liver disease
Benign neoplasms\
- cavernous hemangioma
benign neoplasm of endothelial (blood vessel ) origin
most common benign neoplasm
- hepatocellular adenoma
benign neoplasm of hepatocyte origin
young females on OCP
 Malignant neoplasms
- hepatocellular carcinoma [HCC]
malignant neoplasm of hepatocytes
risk factors include cirrhosis, HBV, HCV, hemochromatosis,
alpha 1 antitrypsin deficiency
tumors may be diffuse, solitary, or multiple nodules
AFP is a protein usually secreted by fetal hepatocytes
AFP levels are elevated in HCC and useful as tumormarker
- metastatic carcinoma
most common malignancy of the liver
usual primary sites are GI tract, lung, breast
Biliary tract pathology
Gallstones (cholelithiasis)
presence of stones in the gall bladder
types of stones
cholesterol stones (10 %)
pigment stones (15%),
mixed stones (75%)
Cholecystitis
inflammation of the gallbladder (acute vs. chronic)
usually due to gallstones
 Neoplasms
adenocarcinomas
cholangiocarcinoma
associated with PSC, clonorchiasis
Pancreas pathology
Pancreatitis
inflammation of the cells of the pancreas
Acute Pancreatitis
acute inflammation with tissue necrosis due to release of pancreatic
enzymes
alcohol and gallstones responsible for 80 % of cases
complications
abscess
pseudocyst
peritonitis
chronic pancreatitis
diabetes
 Chronic Pancreatitis
persistence of inflammation after original incitingagent
removed
progressive fibrosis
alcohol important factor
Pancreatic neoplasms
Malignant
pancreatic carcinoma
adenocarcinoma arising from duct epithelial cells
poor prognosis
THANK ,U ^_^