Gastrointestinal System

Question 1

What sort of things would result in an increase in ALT and AST?

Answer 1

(Hepatocellular)

Viral hepatitis

Liver toxins/drugs

Question 2

What sort of things will result in increased GGT and ALP and Bilirubin?

Answer 2

(Cholestatic)

Gallstones

Some drugs

Question 3

What would be the symptom indicating that you’re breaking down a lot of/extra haem?

Answer 3

If you have an increased rate of RBC, you have more bilirubin to be processed,

This results in more bilirubin+ albumin

This results in more bilirubin-glucuronide

As a result more urobilinogen and increased amounts are found in urine.

Question 4

What are 5 causes of Jaundice?

Answer 4

INCREASED BILLIRUBIN

1) Increased Haemolysis
2) Gilbert’s syndrome (where the albumin sticking onto bilirubin is slow).
3) Cholestasis (drugs, pregnancy, thyroid disease)
4) Obstruction inside liver (hepatitis, cirrhosis, biliary cirrhosis, liver masses)

5) Obstruction outside liver
(gallstones, pancreatic cancer, pancreatitis)

Question 5

What is the cause of jaundice?

Answer 5

INCREASED BILLIRUBIN

1) Increased Haemolysis
2) Gilbert’s syndrome (where the albumin sticking onto bilirubin is slow).
3) Cholestasis (drugs, pregnancy, thyroid disease)
4) Obstruction inside liver (hepatitis, cirrhosis, biliary cirrhosis, liver masses)

5) Obstruction outside liver
(gallstones, pancreatic cancer, pancreatitis)

Question 6

Describe the pattern of serum alkaline phosphatase in different liver diseases

Answer 6

Almost all liver diseases are associated with increased ALP levels.

However some diseases are associated with much high increases (e.g. biliary obstruction)

Question 7

What does the Prothormbin ratio reflect?

Answer 7

Reflects clotting factor synthesis

Rise indicates vitamin deficit (K) or liver failure

Question 8

What does elevated CEA reflect?

Answer 8

Metastic Bowel cancer (usually)

Can also reflect breast, lung, pancreas, thyroid cancer.

Question 9

If you have only increased bilirubin (mild) what is likely to be the diagnosis?

(urine is not dark)
(enzymes are normal)

Answer 9

(probably unconjucated bilirubin because the urine is not dark)

No bile duct obstruction or liver cell injury (enzymes are normal)

Typical of Gilbert’s Syndrome
(or haemolysis, or sex hormones)

(no treatment needed)

Question 10

What is Gilbert’s Syndrome?

Answer 10

Slow bilirubin conjugation

Question 11

What does bilirubin increase, ALP and GGT increase reflect?

(patient also shows oesophageal varices)

Answer 11

Obstruction.

Probably cirrhosis/scarring.

(or bile duct obstruction- but she has portal hypertension).

Question 12

What does the liver do- in terms of blood sugar levels?

Answer 12

Maintains glucose level when fasting.

Question 13

How can albumin levels be normal when someone is having serious liver issues?

Answer 13

If the damage is acute, this can occur as albumin levels takes a while to fall.

Question 14

What is Choledocolithiasis ?

Answer 14

gallstones in the Common Bile Duct

Question 15

What is Caput medusae?

Answer 15

A symptom of portal-hypertension.

• Umbilical vein into superficial veins
• When the pressure forces the ligamentum teres to open.

Question 16

What does Hepatic Failure mean?

Answer 16

• Sudden and massive destruction or endpoint of chronic damage
• Apparent only with loss of 80-90% of heaptocytes
• Decompensation associated with increased demand.
• High mortality
• Clinical features include:
  1) Jaundice
  2) Hypoalbuminaemia
  3) Elevated ammonia leading to encephalopathy

Question 17

What is Cirrhosis

Answer 17

End point of number of pathologies

Where there’s loss of hepatocytes followed by regeneration and proliferation of hepatocytes thereby forming nodules.

This is followed by bridging fibrous septae (surrounded by scar tissue) that is between the portal tracks (due to stellate cells in the space of disse)?

This results in loss of liver functions and lots of shunting (especially in the portal vein).

Question 18

What is Cirrhosis caused by? (steps)

Answer 18

1) Damage to hepatocyte (necrosis/apoptosis)
2) Release of inflammatory cytokines from the Kuffer cells.
3) Promote fibrosis in the liver
4) Initially develop Hepatic fibrosis
5) Cirrhosis

Question 19

What are some causes of portal hypertension? Overall

Answer 19

1) Prehepatic (obstructive thrombosis)
2) Posthepatic (severe R. sided heart failure)
3) Intrahepatic (cirrhosis))
4) Increased resistance to portal blood flow (increased blood pressure)

Question 20

What are some consequences to portal hypertension?

Answer 20

• Ascites (fluid in peritoneum)
• Portosystemic shunts
  (bypasses develops, where systemic and portal circulation share capillary beds)- e..g oesophageal or Rectal Varices
• Congestive splenomegaly (enlargement of spleen)
• Hepatic encephalopathy (ammonia cannot be turned into urea)

Question 21

Describe the features of Hepatitis A

• How it is transmitted
• Symptoms
• Effect on liver

Answer 21

Transmitted: Via person to person, faecal-oral transmission

Symptoms:

• Mild febrile (cold-like) illness
• Jaundice

Hepatocyte effects:
-No risk of chronic hepatitis

Question 22

Describe the features of Hepatitis B

• How it is transmitted
• Effect on liver

Answer 22

Transmitted: Via blood and body fluid

Hepatocyte Outcomes:
-Subclinical disease

• Acute hepatitis with resolution
• Acute hepatitis leading to death or transplant

-Chronic hepatitis may lead to cirrhosis or hepatocellular carcinoma (death or transplant)

(immune response to viral antigens expressed on the infected hepatocytes leads to liver cell damage)

Question 23

Describe the features of Hepatitis C

• How it is transmitted
• Effect on liver

Answer 23

Transmitted: Inoculations and blood transfusions

Outcomes:
-Acute infections are usually undetected

-Chronic disease occurs in majority. (over 20% develop cirrhosis within 5 years of infection).

Question 24

What is Hepatic Steatosis?

Answer 24

Fatty Liver Disease