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3 - GI > deck_1667821 > Flashcards

deck_1667821 Flashcards

1
Q

How does the liver generate aminoacids?

A

Transamination

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2
Q

What three things are we looking for in a liver function test?

A

• Hepatocellular damage • Cholestasis of bile ducts • Level of synthetic function

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3
Q

What can be detected in hepatocellular damage?

A

• Aminotransferases ○ ALT/AST

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4
Q

What can be detected in Cholestasis?

A

• Bilirubin - Unable to excrete bilrubing, plasma concentration rises • Alkaline phosphatase - Enzymes in cells lining liveres biliary ducts. Plasma levels rise with an obstruction.

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5
Q

What can be detected to determine the synthetic function of the liver?

A

• Albumin - Levels reduced in chronic liver disease • Prothrombin time (clotting) - Measures clotting tendency of blood

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6
Q

What is jaundice?

A

• Damaged hepatocytes have a reduced capacity to excrete bilirubin Bilirubin accumulated in blood, giving jaundice

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7
Q

What does hyperbilirubinaemia result in?

A

• A yellowish pigmentation of the skin, conjunctival membranes over the sclera and other mucus membranes

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8
Q

At what point is jaundice clinically detectable?

A

• >40umol/l of bilibrubin in blood

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9
Q

What are three types of jaundice we must learn to distinguish between?

A

• Pre-hepatic • Hepatic • Post hepatic

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10
Q

What occurs in pre-hepatic jaundice?

A

• Excessive Bilirubin Production, usually due to an increased breakdown of red blood cells (haemolysis) ○ Liver unable to cope with excess bilirubin

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11
Q

What would the labfindings be in a test for pre-hepatics jaundice?

A

• Unconjugated hyperbilirubinaemia • Reticulocytosis • Anaemia • Increased LDH • Decreased Haptoglobin

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12
Q

What is haptoglobin?

A

• Molecule which binds haemoglobin, marking it for destruction

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13
Q

Give three causes of pre-hepatic jaundice

A

• Inherited • Congenital hyperbilirubinaemias • Acquired

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14
Q

What three traits can be inherited which may cause pre-hepatic jaundice?

A

• Red cell membrane defects (spherocytosis) • Haemoglobin abnormalities (sickle cell) • Metabolic defects

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15
Q

Give the main type of congenital hyperbilirubinaemias

A

• Gilbert’s syndrome - 10% population

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16
Q

Give six acquired causes of pre-hepatic jaundice

A

• Immune • Mechanical ß E.g. RBC’s running across metal heart valves • Acquired membrane defects • Infections • Drugs • Burns

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17
Q

What occurs in hepatic jaundice?

A

• Reduced capacity of liver cells to secrete conjugated bilirubin into the blood

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18
Q

What would the labfindings be in a test for hepatics jaundice?

A

• Mixed unconjugated and conjugated hyperbilirubinaemia • Increased Liver enzymes (ALT/AST)Abnormal Clotting

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19
Q

Give five causes of hepatic jaundice

A

• Congenital • Hepatic inflammation • Drugs • CirrhosisHepatic tumours

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20
Q

Give a main cause of congenital hepatic jaundice

A

• Gilbert’s syndrome

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21
Q

Give 5 main causes of hepatic inflammation as a cause of hepatic jaundice

A

• Viral (Hepatitis A, B, C and E, Epstein Barr Virus (EBV)) • Autoimune hepatitis • Alcohol • Haemochromotosis • Wilson’s disease

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22
Q

Give a drug which causes hepatic jaundice

A

• Paracetamol

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23
Q

Give three main causes of cirrhosis as a cause of hepatic jaundice

A

• Alcohol • Chronic hepatitis • Metabolic disorders

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24
Q

Give two main causes of hepatic tumours

A

• Hepatocellular carcinomaMetastases

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25
Q

What is post-hepatic jaundice caused by?

A

• Obstruction to drainage of bile, causing a back up of bile acids into the liver. Can be intrahepatic or extrahepatic. The passage of conjugated bilirubin is blocked.

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26
Q

What lab findings would expect to see in post-hepatic jaundice?

A

• Conjugated hyperbilirubinaemia • Bilirubin in urine (dark) • Increase Canalicular enzymes (ALP) • -/Increase liver enzymes (ALT/AST)

27
Q

What are the two main categories of causes of post-hepatic jaundice?

A

• Intrahepatic • Extrahepatic

28
Q

Give four intrahepatic causes of post-hepatic jaundice

A

• Hepatitis • Drugs • Cirrhosis • Primary biliary colic

29
Q

Give four extrahepatic causes of post-hepatic jaundice

A

• Gallstones/Biliary stricture • Carcinoma • Pancreatitis • Sclerosing Chloangitis

30
Q

Give five types of carcinoma which can cause post-hepatic jaundice

A

• Head of pancreas • Ampulla • Bile duct • Porta hepatis lymph nodes • Liver metastases

31
Q

What is sclerosing cholangitis?

A

Scarring of bileducts inside and outside the liver

32
Q

Give the cause and bilirubin status of pre-hepatic jaundice

A

• Excessive bilrubin production • Unconjugated hyperbilirubinaemia

33
Q

Give the cause and bilirubin status of hepatic jaundice

A

• Reduced capacity to conjugate/excrete bilirubin • Mixed unconjugated and conjugated hyperbilirubinaemia

34
Q

Give the cause and bilirubin status of post-hepatic jaundice

A

• Obstruction to biliary system • Conjugated hyperbilirubinaemia • Bilirubin in urine (dark)None in faeces

35
Q

Give three symptoms of alcoholic liver disease

A

• Fatty liver • Alcoholic HepatitisCirrhosis

36
Q

Outline how a fatty liver develps

A

• Alcohol metabolism generates NADH from NAD+ ○ Increase NADH induces fatty acid synthesis ○ Decrease NAD+ results in decrease fatty acid oxidation • Accumulation of fatty acids in the liver ○ Glycerol converted to TAGs • TAGs accumulate, causing fatty liver

37
Q

What occurs in alcoholic hepatitis?

A

• Inflammation of hepatocytes

38
Q

What is cirrhosis?

A

• Liver cell necrosis followed by nodular regeneration and fibrosis, resulting in increased resistance to blood flow and deranged liver function.

39
Q

Give 6 complications of alcoholic liver disease

A

• Hepatocellular carcinoma • Liver failure • Wernicke-Korsakoff syndrome • Encephalopathy • Dementia • Epilepsy

40
Q

Give 7 causes of cirrhosis of the liver

A

• Alcohol • Wilson’s Disease • a1-antitrypsin deficiency • Biliary cirrhosis • Haemochromotosis • Hepatitis B or C • Autoimmune hepatitis

41
Q

Give 6 features of liver cirrhosis

A

• Liver dysfunction • Jaundice • Anaemia • Bruising • Palmar erythema • Dupuytren’s contracture

42
Q

What would you expect to see on a liver function test which indicated cirrhosis?

A

• - / é ALT/AST • é ALP • é Bilirubin • ê Albumin • Deranged clotting

43
Q

How can cirrhosis be managed?

A

• Stop drinking • Treating complicationsTransplantation

44
Q

What is portal hypertension defined as?

A

• Portal venous pressure >20mmHg.

45
Q

What are two things which can cause portal hypertension?

A

• Obstruction of the portal vein • Obstruction of flow within the liver

46
Q

Give three causes of obstruction of the portal vein

A

• Congenital • Thrombosis • Extrinsic compression

47
Q

Give three causes of obstruction of flow within the liver

A

• Cirrhosis • Hepatoportal sclerosis • Schistomiasis • Sacroidosis

48
Q

Give three of the major effects of portal hypertension

A

• Ascites • Splenomegaly • Porto-systemic anastomoses

49
Q

How is ascites caused in portal hypertension?

A

• High pressure in the portal venous system means blood is backed up into the abdomen • Increase in hydrostatic pressure in the abdomen means less fluid is reabsorbed into blood vessels at end of capillary beds • If the liver is damaged, reduced oncotic pressure inside the vessels due to lack of plasma proteins also emphasised effects

50
Q

How is splenomegaly caused?

A

• Increased BP in the spleen

51
Q

What are the porto-systemic anastamoses, and how can they be an issue

A

• Increased pressure causes vessels to dilate, protrude into lumen, rupture/ulcerate and haemorrhage

52
Q

What are three main results of porto-systemic anastamoses because of portal hypertension?

A

• Oesophageal varices • Rectal varices • Caput medusa

53
Q

Outline four different portal to systemic shunts and what they cause

A

• Left gastric -> Azygous/Oesohageal ○ Oesophageal varices • Superior rectal -> Inferior rectal ○ Rectal varices • Paraumbilical -> Small epigastric of abdominal wall ○ Caput medusa • Colic/splenic/portal -> Retroperitoneal veins of posterior abdominal wall or diaphragm ○ Portal veins at this point on posterior aspect of bare area of the liver

54
Q

Where are bile acids stored before they are needed?

A

• Gall bladder

55
Q

What needs to happen to reduce volume that needs to be stored?

A

Bile acids are concentrated by the transport of salt and water across the gall bladder epithelium

56
Q

What is the risk with the dehydration of bile acids in the gall bladder?

A

• Precipitation, leading to gall stone

57
Q

Why is pain from gall stones worse after eating?

A

• Cholecystokinin released, causing gall bladder to contract

58
Q

What is pancreatitis?

A

• Inflammatory process caused by the effects of enzymes released from pancreatic acini

59
Q

Give four symptoms of acute pancreatitis

A

• Oedema, Haemorrhage, Necrosis • Severe pain, vomiting, dehydration, Shock • Increase Amylase, Glycaemia, ALP/Bilirubin • Decrease Ca2+

60
Q

Give 6 symptoms of chronic pancreatitis?

A

• Fibrosis, Calcification • Pain, Malabsorption (Steatorrhoea, ê albumin, weight loss)Jaundice

61
Q

Give 10 causes of pancreatitis

A

• Gallstones (Block Pancreatic duct/Amuplla of Vater) • Ethanol (Hyper-stimulation of pancreatic secretions) • Trauma • Steroids • Mumps • Autoimmune • Scorpion bite • Hyperlipidaemia • ERCP/Iatrogenic • Drugs

62
Q

What is the most common cause on pancreatic carcinoma?

A

90% Ductal adenocarcinomas

63
Q

What are the main symptoms of pancreatic carcinoma?

A

• Obstructive jaundice • Pain • Vomiting • Malabsorptiondiabetes

3 - GI (36 decks)

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