Deck 1 - GI Flashcards
Q. Name four functions of the liver
A. Glucose and fat metabolism
B. Detoxification and excretion (bilirubin, ammonia, drugs/hormones/pollutants)
C. Protein synthesis (albumin, clotting factors)
D. Defence against infection (reticuloendothelial system)
Q. Describe the macroscopic and microscropy anatomy of the liver
A. Lobes: R, L, caudate
B. Blood supply: portal vein (deoxygenated), hepatic artery (oxygenated)
C. Microscopic: sinusoids, hepatocytes
Q. What occurs to the liver during cirrhosis?
A. Scarring and disorganisation
Q. How can chronic liver failure affect the gut?
A. Varices (haematemesis due to high pressure and hepatoma)
Q. Name two causes of acute liver injury and two causes of chronic liver injury
A. Acute: Viral (A, B, EBV), drugs, alcohol, vascular, obstruction, congestion
B. Chronic: alcohol, viral (b and C), auto immune, metabolic (iron, copper)
Q. Name two symptoms of acute liver injury and two symptoms of chronic liver injury
A. Acute: malaise, nausea, anorexia, jaundice (rarer: confusion, bleeding, liver pain, hypoglycaemia)
B. Chronic: ascites (abdo swelling), odema, haematemesis (varices), malaise, anorexia, wasting, easy bruu=ising, itching, hepatomegaly, abnormal LFTs
Q. Name 4 liver function tests
A. Serum bilirubin, albumin, prothrombin time
B. Serum liver enzymes
a. Cholestatic: alkaline phosphatase, gamma-GT
b. Hepatocellular: transaminases (AST, ALT) – destruction
Q. Name the two classifications of jaundice and some causes
A. Unconjugated/Pre hepatic: Obstruction (common bile duct, pancreas –gall stone, malignancy)
B. Cholestatic/hepatic: hepatitis, drugs, immune, alcohol
C. Cholestatic/ post hepatic: (dark urine, pale stools, maybe itchy, abnormal LFTs)
Q. What questions should be asked when a patient presents with jaundice?
A. Dark urine, pale stools, itching?
B. Changes in bowel habits? Hard to flush? Frequency?
C. Symptoms: biliary pain (upper abdo, severe, restlessness, episodic), rigors (conscious shakes – bile duct stone?), abdomen swelling, weight loss?
D. Past history:
a. Biliary disease/intervention
b. Malignancy
c. Heart failure
d. Blood products (transfusion prior to 90s – hep C)
e. Autoimmune disease
f. Drug history (drugs/herbs started recently)
g. Social history: Alcohol, potential hepatitis contact (irregular sex, IVDU, exotic travel, certain foods)
h. Family Hx/system review – rarely helpful
Q. What investigations should be carried out when a patient presents with jaundice?
A. LFT: very high AST/ALT suggests liver disease
B. Ultrasound: dilated intrahepatic bile ducts = biliary obstruction
C. CT/MRI/endoscopic retrograde etc
Q. Name some risk factors that increase the risk of gall stones
A. Female, high BMI, fertile (liver disease etc), most are asymptomatic
B. Cholecystitis (gall bladder inflammation), Cholangitis (bile duct infection/inflammation)
Q. How should patients with gallstones and bile duct stones be managed?
A. Gallbladder stones:
a. Laporoscopic cholecystectomy, Bile acid dissolution therapy (<1/3 success
B. Bile duct stones:
a. ERCP with sphincterotomy and: removal (basket or balloon), crushing (mechanical, laser..), stent placement (90% effective – standard therapy), Surgery (large stones)
Q. What are ascites? Describe the pathogenesis and name 2 causes
A. Accumulation of fluid in the peritoneum
B. High BP leads to systemic vasodilation, this leads to portal HTN (causes secretion of RAAS, noradrenaline and vasopressin) leads to additional fluid retention and liver failure, low serum albumin also leads to ascites
(HF, peritonitis)
Q. What occurs when the liver is subject to high levels of alcohol? Which cells are associated with acute/chronic injury?
A. Acute alcohol related injury: hepatocyte ballooning, mediated by neutrophils, may accumulate a cytoskeletal protein (irregular and fat)
B. Fat accumulation = steatosis (macrovesicular and microvesicular droplets)
C. Chronic liver injury = lymphocytes
Q. What part of the liver do toxins have the greater effect on?
A. The cells with the lowest blood and oxygen supply i.e. zone 3
B. Damage results in fibrosis with pericellullar fibrosis being more common in alcohol-related injury than fibrosis of portal tracts
