Conditions of the Liver, Gallbladder and Pancreas Flashcards
Describe the condition of jaundice, including SSX, pathophysiology, and underlying conditions
- yellow appearance of skin, sclerae and mucous membrane
Pathophysiology:
- caused by elevated bilirubin levels (pigment made in the liver during breakdown of RBCs and key component of bile)
Conditions:
- usually hepatic (ie: cirrhosis, hepatitis, drug toxicity)
- can be cholestatic (obstruction of bile ducts caused by cirrhosis, neoplasia, cystic fibrosis)
- can be haemolytic (caused by excessive RBC destruction, drug reactions, thalassaemia)
Briefly describe the metabolism of bilirubin
Bilirubin is a pigment created by the destruction of RBCs in the liver and spleen
Liver conjugates bilirubin and releases it as a component of bile
Bilirubin is reduced by intestinal bacteria to urobilinogen
Most is secreted in faeces or urine
A small amount enters portal circulation and is re-excreted by liver
Describe the condition of viral hepatitis, including types of viruses, stages and associated SSX, and complications
Pathophysiology:
- virus causes inflammatory reaction in liver
- inflammation leads to hepatocyte necrosis
Viruses:
- Hep A: mild, vaccine
- Hep B: mild to severe, vaccine
- Hep C: mild, no vaccine
- Epstein Barr
Stages:
- pre-clinical
- asymptomatic, virus replicating - prodromal / pre-icteric
- nausea, vomiting
- diarrhoea
- upper abdo discomfort
- anorexia
- malaise, fever, HA - icteric
- jaundice
- hepatomegaly / splenomegaly - Convalescent
- SSX subside over several weeks
Complications:
- necrosis of whole lobes can cause acute hepatic failure
- 25% will develop cirrhosis
- patients with cirrhosis can go on to develop liver cancer
What are the 4 stages of alcoholic liver disease and cirrhosis and their associated SSX?
- Fatty liver
- destruction of rough ER in hepatocytes reduces amount of lipoproteins secreted
- causes cells to become swollen with lipids
- can be reversible
- SSX: maybe hepatomegaly - Alcohol hepatitis:
- hepatocyte necrosis triggers infiltration of inflammatory cells
- SSX: hepatomegaly, jaundice, fever, ascites - Cirrhosis:
- chronic inflammation and progressive fibrosis of hepatocytes
- regenerating hepatocytes don’t conform to normal cytoarchitecture
- hepatocyte function impeded
- SSX: jaundice, RUQ pain, hepatomegaly (adv. cases will shrink), fever, nausea and vomiting, anorexia and weight loss, malaise - Cirrhosis with complications
- portal hypertension (SSX: ascites, caput medusa, varicose veins in abdomen, splenomegaly
- hepatocellular failure (SSX: peripheral oedema, endocrine changes, changes in intellect / mood / alertness, hyper-reflexia and Babinski response, flapping tremour)
What is hepatocellular failure?
- acute or chronic liver failure
- liver becomes unable to perform its normal synthetic and metabolic functions
SSX:
- changes in intellect, mood, alertness
- hyper reflexia and Babinski response
- flapping tremour
- peripheral oedema
- endocrine changes
Describe the condition of portal hypertension
- hypertension and congestion in the portal venous system
- usually caused by hepatic pathologies (ie: cirrhosis) that occludes blood flow in the liver
SSX:
- ascites
- splenomegaly (passive congestion in splenic vein)
- varicose veins
- caput medusa
What are the causes of cirrhosis?
- usually caused by alcohol damage
other causes:
- non alcoholic fatty liver disease (obesity, hyperlipidaemia, insulin resistance)
- hepatitis
- chelestasis
- metabolic disorders
What is the simple mechanism of damage in alcoholic liver disease?
- alcohol induces oxidases into the liver
- oxidases damage hepatocytes with chronic exposure
- liver responds with hypertrophy and hyperplasia, but new growth does not conform to normal cytoarchitecture
- chronic inflammation, fibrosis, and hyperplasia / disrupted cytoarchitecture impairs liver function
- eventually causes cirrhosis (terminal)
Describe the condition of liver malignancy, including types of malignancies, risk factors, and SSX
Types:
- Benign
- haemagiomas
- adenomas
- focal nodular hyperplasia - Primary malignant
- hepatocellular carcinoma (common)
- cholangiocarcinoma - Secondary malignant
- relatively common
Risk factors:
- cirrhosis
- hepatitis
SSX:
- irregular hepatomegaly
- RUQ pain
- jaundice
- SSX cirrhosis
- constitutional (anorexia, weight loss, fever)
Describe the condition of cholelithiasis, including incidence, risk factors, and pathophysiology
- gall stones
Incidence:
- most common GB disorder
- affects 11%
Pathophysiology:
- cholesterol stones form when bile is supersaturated with cholesterol
- pigment stones more common in developing countries and associated with infection
Risk factors:
- obesity
- diabetes
- high sugar intake
- age
SSX:
- often asymptomatic until secondary complication arises (often cholecystitis)
Describe the condition of cholecystitis:
- inflammation of gallbladder
- caused by impaction in cystic duct and biliary stasis
SSX:
- sudden onset RUQ pain
- pain can refer to right shoulder (via phrenic nerve)
- maybe fever / chills
- Murphy’s sign
What is the difference between cholecystitis, cholelithiasis, and choledocholithiasis?
Cholecystitis = inflammation of gall bladder
Cholelithiasis = gall stones
Choledocholithiasis = impaction of gallstone in bile duct and inflammation of duct
Briefly describe the condition of acute pancreatitis:
- obstruction of hepatopancreatic ampulla
- causes pancreatic secretions to flow back up to pancreatic duct
SSX:
- severe pain in LUQ
- pain can refer to left scap
- bloating / swelling
- vomiting and nausea
- fever
Briefly describe the condition of cystic fibrosis
- autosomal recessive disorder affecting exocrine glands
- affects secretions of lungs, pancreas, bile ducts and reproductive tract (reduced viscosity)
