Diseases of the Hepatobilary Tract Flashcards
What comprises the portal triad?
Bile duct
Branch of portal vein
Branch of hepatic artery
What veins form the hepatic portal vein?
Splenic and superior mesenteric veins
What conditions are caused by a failure of the filtration function of the liver?
Portal hypertension
What conditions are caused by a failure of the elimination function of the liver?
Jaundice
What are the consequences of a failure in the metabolic functions of the liver?
Acidosis
Muscle wasting
Coagulopathy
Hepatorenal syndrome
What are the five locations of porto-systemic anastamosis?
Oesophagus (causes varices) Paraumbilical area (caput medusae) Upper anal canal (rectal varices) Retroperitoneal Bare area of liver
What causes portal hypertension?
Impairment of blood from portal vein to enter the liver, e.g. cirrhosis which causes a backlog of blood in the portal vein causing portal hypertension.
What are the two types of cirrhosis?
Micro and macro nodular cirrhosis
What are the symptoms of encephalopathy?
Confusion
Confabulation
Reversal of daytime and nighttime rhythm
Liver flap
What are symptoms of chronic liver disease?
Spider naevi Clubbing Ascites Palmer erythema Leukonychia Gynaecomastia Splenomegaly Jaundice Encephalopathy Coagulopathy/bleeding
Define ascites
Abnormal accumulation of fluid in the abdomen
What can cause decompensation of liver failure?
Infection Toxins (e.g. alcohol) Trauma Surgery Drugs Variceal bleed
What are the common causes of liver injury?
Fat
Alcohol
Viruses
Iron excess
Define steatohepatitis
Inflammation of liver caused by fat
What do liver function tests detect?
Liver damage
What investigations detect liver distress?
ALT/AST- indicated hepatocyte damage
Alk Phos/GGT - bile duct damage/ obstruction
What investigations indicate liver function?
Prothrombin time Bilirubin (marker of excretion) Albumin Urea/creatinine pH
What imaging methods can be used for liver diagnoses?
Ultrasound +/- liver biopsy
CAT
MRI
Liver fibroscan
What causes jaundice?
Failure of the elimination of bile
What is cholelithiasis?
Gallstones
What is choledocolithiasis?
Bile duct stones
What are the risk factors for gall stones?
Hypercholesterolaemia
What causes gall stones?
Reduce bile secretion or defective reabsorption of bile salts
What are the pros and cons of ultrasound investigations for gallstones?
Pros: simple, non invasive
Cons: poor specificity, poor views of pancreas, operator dependant
What are the causes of
pancreatitis?
Gall stones at distal common bile duct
