Gastrointestinal System Flashcards
What sort of things would result in an increase in ALT and AST?
(Hepatocellular)
Viral hepatitis
Liver toxins/drugs
What sort of things will result in increased GGT and ALP and Bilirubin?
(Cholestatic)
Gallstones
Some drugs
What would be the symptom indicating that you’re breaking down a lot of/extra haem?
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.
What are 5 causes of Jaundice?
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)
What is the cause of jaundice?
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)
Describe the pattern of serum alkaline phosphatase in different liver diseases
Almost all liver diseases are associated with increased ALP levels.
However some diseases are associated with much high increases (e.g. biliary obstruction)
What does the Prothormbin ratio reflect?
Reflects clotting factor synthesis
Rise indicates vitamin deficit (K) or liver failure
What does elevated CEA reflect?
Metastic Bowel cancer (usually)
Can also reflect breast, lung, pancreas, thyroid cancer.
If you have only increased bilirubin (mild) what is likely to be the diagnosis?
(urine is not dark)
(enzymes are normal)
(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)
What is Gilbert’s Syndrome?
Slow bilirubin conjugation
What does bilirubin increase, ALP and GGT increase reflect?
(patient also shows oesophageal varices)
Obstruction.
Probably cirrhosis/scarring.
(or bile duct obstruction- but she has portal hypertension).
What does the liver do- in terms of blood sugar levels?
Maintains glucose level when fasting.
How can albumin levels be normal when someone is having serious liver issues?
If the damage is acute, this can occur as albumin levels takes a while to fall.
What is Choledocolithiasis ?
gallstones in the Common Bile Duct
What is Caput medusae?
A symptom of portal-hypertension.
- Umbilical vein into superficial veins
- When the pressure forces the ligamentum teres to open.
What does Hepatic Failure mean?
- 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
What is Cirrhosis
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).
What is Cirrhosis caused by? (steps)
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
What are some causes of portal hypertension? Overall
1) Prehepatic (obstructive thrombosis)
2) Posthepatic (severe R. sided heart failure)
3) Intrahepatic (cirrhosis))
4) Increased resistance to portal blood flow (increased blood pressure)
What are some consequences to portal hypertension?
- 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)
Describe the features of Hepatitis A
- How it is transmitted
- Symptoms
- Effect on liver
Transmitted: Via person to person, faecal-oral transmission
Symptoms:
- Mild febrile (cold-like) illness
- Jaundice
Hepatocyte effects:
-No risk of chronic hepatitis
Describe the features of Hepatitis B
- How it is transmitted
- Effect on liver
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)
Describe the features of Hepatitis C
- How it is transmitted
- Effect on liver
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).
What is Hepatic Steatosis?
Fatty Liver Disease
