Anatomy and Clinical

Question 1

what happens if portal venous blood escapes via anastomoses and veins become tortuous and dilated

Answer 1

they become varicose. rupture of these may cause haemorrhage.

Question 2

varicosity haemorrhage at lower third of oesophagus

Answer 2

oesophageal varices: haematemesis

Question 3

varicosity haemorrhage halfway down anal canal

Answer 3

piles or haemorrhoids

Question 4

varicosity haemorrhage at para-umbilical veins

Answer 4

caput medusae

Question 5

4th site where varicosity haemorrhage can occur

Answer 5

veins of retroperitoneal ascending colon, descending colon, duodenum, pancreas and liver anastomose with renal, lumbar, phrenic veins

Question 6

post-hepatic causes of portal hypertension

Answer 6

cardiac disease
hepatic vein thrombosis
IVC thrombosis

Question 7

hepatic causes of portal hypertension

Answer 7

cirrhosis !!! (alcohol, hepatitis)

Question 8

pre-hepatic causes of portal hypertension

Answer 8

portal vein thrombosis, splenic vein thrombosis

Question 9

Key history symptoms (liver/biliary disease)

Answer 9

itching preceding jaundice 
abdominal pain (suggests stones) 
weight loss (chronic liver disease and malignancy) 
dark urine, pale stools 
fever with/without rigors 
dry eyes/mouth 
fatigue

Question 10

other things to make sure you ask about in exam re liver/biliary disease

Answer 10

exposure to IV drugs/blood transfusions 
travel history and country of birth 
family history of liver disease 
autoimmune disease history 
alcohol history 
IBD
metabolic syndrome (BMI +/- DM II/hypertension)

Question 11

what provides the driving force for bile flow?

Answer 11

hepatocytes by creating osmotic gradients of:
bile acids (form micelles in bile: bile-acid dependent flow)
and of sodium (bile acid-independent flow)

Question 12

12 things at the transpyloric plane

Answer 12

1. origin of inferior mesenteric artery
2. origin of portal vein
3. hilum of lungs
4. fundus of gallbladder
5. pylorus of stomach
6. neck of pancreas
7. 2nd part of duodenum
   8.
   9.
9. end of spinal column L1/L2
10. 9th costal cartilage

Question 13

Functions of liver

Answer 13

nutrient metabolism (carbs, lipids, protein)

protein synthesis (albumin, coagulation factors, complement factors, haptoglobin, caeruloplasmin (copper carrier and inolved in iron metabolism), transferin, protease inhibitors eg. alpha 1 antitrypsin)

storage (iron, copper, vitamins A, D, B12)

excretion (bile salts, bilirubin, drugs, phopholipids, cholesterol)

Question 14

4 stigmata of chronic liver disease

Answer 14

gynaecomastia
spider nevi
palmar erythema
duypteren’s contracture

Question 15

biggest cause of abdominal swelling in liver disease

Answer 15

ascites (due to low albumin and osmotic pressure. the liver makes albumin)
(central oedema)

Question 16

telltale blood test for PSC

Answer 16

AMA

Question 17

what would you use to treat ascites

Answer 17

direutics/drainage

spironolactone or eplerenone

Question 18

bilirubin and urobilinogen result in urinanlysis of pre-hepatic urine

Answer 18

high urobilinogen 
low bilirubin (none leaking through urine as it's still unconjugated and therefore not water soluble)

Question 19

Causes of haemolytic anaemia

Answer 19

thalasseamia
sickle cell disease
drug-induced
autoimmune

Question 20

Which blood test is most indicative of obstructive jaundice

Answer 20

alkaline phosphate

Question 21

which hepatitis is faecal/oral?

Answer 21

A

Question 22

which hepatitis is sex/drugs?

Answer 22

B or C

Question 23

levels of ALT in viral hepatitis

Answer 23

can be above 10,000

Question 24

What virus causes sore throats and hepatitis

Answer 24

EBV (Epstein Barr Virus)

Question 25

Other word for jaundice

Answer 25

icteric

Question 26

Red flags in jaundice

Answer 26

alcoholic liver disease
hepatitis B
drug-induced hyperbilirubinaemia
ascending cholangitis (Charcot)
Autoimmune hepatitis 
Pancreatic carcinoma 
Cholangiocarcinoma 
Pregnancy

Question 27

Most common cause of obstruction of bile duct?

Answer 27

Benign: gallstones

Malignant: carcinoma of the head of the pancreas

Question 28

at what concentration of bilirubin is jaundice usually detectable?

Answer 28

40micro/mol

Question 29

what makes up the cystohepatic/Calot’s triangle

Answer 29

superior border: inferior border of liver
R: cystic duct
L: common hepatic duct

Question 30

clinical significance of Calot’s triangle

Answer 30

dissected during cholecystecomy

it’s how they locate the cystic artery to clamp it !

Question 31

What’s contained in the free edge of the lesser omentum/hepatoduodenal ligament?

Answer 31

BAP!
Bile duct
hepatic Artery proper
Portal vein

these are the portal triad in the porta hepatis

Question 32

if you had a gastric ulcer of the posterior wall and it perforates, where would the gastric contents spill into?

Answer 32

Lesser sac (and acids could erode into the pancreas)

Question 33

Lesser sac communicates with greater sac via what?

Answer 33

epiploic foramen

Question 34

What if spleen ruptures?

Answer 34

intraperitoneal haemorrhage and shock

Question 35

What is Kehr’s sign

Answer 35

left shoulder tip referred pain (if enlarged spleen pushes up on diaphragm)

Question 36

what’s the biggest cause of extrahepatic obstruction of the biliary ducts?

Answer 36

carcinoma of the pancreas head

Question 37

what type of epithelial cells can be ciliated?

Answer 37

SIMPLE!!! not stratified

Question 38

what enzymes break disaccharides into monosaccharides?

Answer 38

brush border enzymes
maltase
lactase
sucrase