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CP > Diseases of the hepatobiliary system > Flashcards

Diseases of the hepatobiliary system Flashcards

1
Q

What are the 3 types of jaundice? And what is meant by this?

A

Pre hepatic - Too much bilirubin
Hepatic - too few functioning liver cells
Post hepatic - bile duct obstruction

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2
Q

Give an example of a disease that causes pre hepatic jaundice

A

Haemolytic anaemia

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3
Q

Give 3 examples of a disease that causes hepatic jaundice

A

Acute diffuse liver cell injury
End stage chronic liver disease
Inborn errors

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4
Q

Give 3 examples of a disease that causes post hepatic jaundice

A

Stones, strictures or tumour in the bile duct of pancreas

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5
Q

At what level should bilirubin reach before jaundice occurs?

A

40umol/l

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6
Q

Explain bilirubin metabolism

A

1) Conjugated billirubin comes from the breakdown of haem
2) Unconjugated bilirubin (lipid soluble) is bound to albumin to be transported through the blood to the liver
3) Liver converts to conjugated bilirubin = water soluble
4) Conjugated bilirubin + bile salts (and other stuff) forms bile = goes to the small intestine
5) Conjugated bilirubin converted by gut bacteria into Urobilinogen
6) Urobilinogen then converted to stercobilin = brown
OR
6) Urobilinogen goes back to the liver and then the kidney
7) Kidney converts to urobilin = yellow

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7
Q

What are the signs of each of the types of jaundice?

A

Pre hepatic = yellow eyes/skin only
Hepatic = Yellow eyes/dark urine
Post hepatic = yelow eyes/pale stools/dark urine

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8
Q

What is the first sign of a liver with obstructive jaundice?

A

Jaundice in the skin

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9
Q

What are later signs of a liver with obstructive jaundice?

A

Oedema

Itchy skin - bile salts on the skin

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10
Q

How does a liver with obstructive jaundice present histologically?

A

Ductal reaction = proliferation of ductules around the edge
Portal tract enlarged - fibrous tissue
Bile plugs in canaliculae

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11
Q

What are the 4 main causes of acute hepatitis?

A

Viruses
Alcohol
Hepatotoxic drugs
Autoimmine

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12
Q

How does acute hepatitis present?

A

From asymptomatic/malaise to encepalopathy/death

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13
Q

Explain the cell/structural changes that occur in hepatitis

A

Hepatocytes vary in size

Necrosis

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14
Q

What are the causes of viral hepatitis?

A

Hepatotropic viruses: A, B, C, D (can only get if affected with Hep B), E
Systemic diseases: Epstein-Barr virus, Cytomegalovirus, Herpes simplex virus

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15
Q

What viral causes of hepatits causes acute jaundice?

A

Hep A and B

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16
Q

How can affects of alcohol on the liver present?

A

Fatty changes
Alcoholic steatohepatitis - inflammation of the liver with fat accumulation
Cirrhosis

17
Q

What are Mallory bodies?

A

Found in the cytoplasm of liver cells

Damaged intermediate filaments within the hepatocytes

18
Q

What is non alcoholic fatty liver disease?

A

Same pathology as alcoholic liver disease

Associated with metabolic syndromes e.g. type 2 diabetes, obesity

19
Q

Cirrhotic liver is a predisposing disease to what?

A

Hepatocellular carcinoma

20
Q

What is the criteria for diagnosing drug induced liver injury?

A

1) Abnormal LFTs after taking drugs
2) Improvement in LFTs after stopping the drug
3) Alternative causes excluded by detailed investigation
4) Increase in LFTs when rechallanged

21
Q

Explain the mechanism of normal paracetamol metabolism

A

Normally metabolised via 3 different pathways:

1) Conjugated into glucuronyl transferase = safe
2) Conjugated into sulphotransferase = safe
3i) Converted into N-acetyl p-benzoquinone-imine (toxic) via P450 enzyme
3ii) NAPQI binds to glutathione = safe

22
Q

Explain the mechanism of paracetamol toxicity

A

When overdosed there is an increase in NAPQI

Takes alternative route of binding to tissue membrane proteins = Necrosis of liver cells

23
Q

What is the treatment for paracetamol toxicity and how does it work?

A

Treatment: N-acetyl cystein

Restores glutathione so more likely to follow the safe pathway of metabolising NAPQI

24
Q

What is the definition of cirrhosis?

A

Diffuse hepatic process
Fibrosis
Structurally abnormal nodules
Liver cells still present but portal vein blood bypasses the sinusoids - first pass metabolism does not occue

25
Q

Cirrhosis causes what to occur due to increase pressure in the liver?

A

Portal hypertension

Liver has to work harder as blood has to travel through it more times

26
Q

What are the 5 main causes of cirrhosis?

A 
Alcohol
Non alcoholic steatohepatitis
Chronic viral infections e.g. Hep B, C
Autoimmune liver disease e.g. primary biliary sclerosis 
Metabolic e.g. alpha 1 antitrypsin
27
Q

Apart from portal hypertension what are the other signs, symptoms and complications of cirrhosis?

A

Synthesis of albumin: Oedema, Bruising, Muscle wasting
Ascites - swollen abdomen
Hormone fluid retention = gynacomastia
Spider navi
Oesophageal varices
Caput medusa - varices from umbilical vein collaterals
Excretion: Itching - accumulation of bile salts, Jaundice
Vulnerable to infection
Drug doses will need lowering

28
Q

What is alpha 1 antitrypsin deficiency?

A

Alpha 1 antitrypsin protects tissues from enzymes of inflammatory cells
Deficiency = accumulation of proteins causes uncontrolled breakdown of cells

29
Q

How does alpha 1 antitrypsin deficiency affect the liver and lungs?

A 
Liver = cirrhosis
Liver = Emphysema
30
Q

What is haemochromatosis?

A 
Inborn error of metabolism
Iron accumulation in many organs of the body including the liver = cirrhosis
Pancreas = diabetes
Skin = pigmented
Joints = arthritis
Heart = cardiomyopathy
31
Q

What is Wilson’s disease?

A 
Inborn error of copper metabolism
Accumulates in: 
Liver = cirrhosis
Eyes = Kayser-Fleischer rings
Brain = ataxia
32
Q

What are the 3 types of portal hypertension with examples

A

Pre-sinusoidal - Portal fibrosis, Non cirrhotic potal hypertention
Sinusoidal - cirrhosis
Post sinusoidal - Hepatic vein thrombosis

33
Q

What are the complications of portal hypertension?

A

Splenomagaly - low platelets due to liver decompesation
Oesophageal varices
Piles
Ascites

CP (50 decks)

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