Pathology
Hepatobiliary System
Hepatobiliary pathology for MBBS and NEET-PG: bilirubin metabolism and jaundice, viral and alcoholic hepatitis, cirrhosis, portal hypertension and hepatocellular carcinoma, mapped to NMC codes PA25.1 to PA25.6.
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Hepatobiliary System
Hepatobiliary pathology for MBBS and NEET-PG: bilirubin metabolism and jaundice, viral and alcoholic hepatitis, cirrhosis, portal hypertension and hepatocellular carcinoma, mapped to NMC codes PA25.1 to PA25.6.
This chapter covers the pathology of the liver and biliary system. It includes bilirubin metabolism and the classification of jaundice, hepatic failure and its consequences, viral and alcoholic liver disease progressing to cirrhosis, portal hypertension, and hepatocellular carcinoma.
High-yield: Hepatobiliary System
- Jaundice becomes clinically visible when the serum bilirubin exceeds about 2 to 3 mg/dL.
- Prehepatic (haemolytic) jaundice raises unconjugated bilirubin, while obstructive jaundice raises conjugated bilirubin.
- Conjugated hyperbilirubinaemia produces dark urine and pale stools; unconjugated bilirubin is not excreted in urine.
- Cirrhosis is the end stage of chronic liver injury, defined by diffuse fibrosis and regenerative nodules.
- The common causes of cirrhosis are chronic viral hepatitis, alcohol and non-alcoholic fatty liver disease.
- Portal hypertension leads to oesophageal varices, splenomegaly, ascites and caput medusae.
- Bleeding oesophageal varices are a life-threatening complication of portal hypertension.
- Viral hepatitis B and C are the main viral causes of chronic hepatitis and hepatocellular carcinoma.
- Hepatitis A and E are enterically transmitted and cause acute, self-limiting hepatitis, though E can be severe in pregnancy.
- Councilman bodies are apoptotic hepatocytes seen in viral hepatitis.
- Mallory-Denk bodies (Mallory hyaline) are eosinophilic cytoplasmic inclusions seen in alcoholic hepatitis.
- Hepatocellular carcinoma often arises on a background of cirrhosis and is associated with a raised alpha-fetoprotein.
- Alpha-fetoprotein is the main tumour marker used in the diagnosis and follow-up of hepatocellular carcinoma.
- Hepatic encephalopathy results from failure of the liver to clear ammonia and other toxins from the blood.
Classification of jaundice
- **Prehepatic:** Haemolysis; raised unconjugated bilirubin; normal urine bilirubin.
- **Hepatic:** Hepatocellular injury; mixed hyperbilirubinaemia; raised transaminases.
- **Posthepatic:** Obstruction; raised conjugated bilirubin; dark urine, pale stools.
- **Complication:** Cirrhosis leads to portal hypertension, varices and hepatocellular carcinoma.
NMC competencies in this chapter
- **PA25.1:** Bilirubin metabolism and the aetiology and classification of jaundice
- **PA25.2:** Pathophysiology and complications of hepatic failure
- **PA25.3:** Aetiology and pathogenesis of viral and toxic hepatitis
- **PA25.4:** Pathophysiology and progression of alcoholic liver disease and cirrhosis
- **PA25.5:** Aetiology, pathogenesis and complications of portal hypertension
- **PA25.6:** Classification and pathology of liver tumours
Frequently Asked Questions
How is jaundice classified?
Into prehepatic (haemolytic, unconjugated), hepatic (hepatocellular, mixed) and posthepatic (obstructive, conjugated) types, each with characteristic bilirubin and urine findings.
What defines cirrhosis?
Diffuse fibrosis of the liver with regenerative nodules, the end stage of chronic liver injury from viruses, alcohol or fatty liver disease.
What are the complications of portal hypertension?
Oesophageal varices that may bleed, splenomegaly, ascites and caput medusae from opening of portosystemic collaterals.
Which tumour marker is used for hepatocellular carcinoma?
Alpha-fetoprotein, which is raised in most hepatocellular carcinomas and used for diagnosis and follow-up.
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