GHM PBL 1

Question 1

Describe the anatomy of the billary system

Answer 1

DIAGRAM

RIGHT HEPATIC DUCT
LEFT HEPATIC DUCT
COMMON HEPATIC DUCT
CYSTIC DUCT (liver to gall bladder)
Common bile duct (gall bladder to pancreas + duodenum)
MAJOT PAPILLA
PANCREATIC DUCT

Question 2

Describe the etiology of ICP

Answer 2

1. Immunological - Cytokines
2. Hormonal - Eostrogen (hormonal changes which occur during pregnancy)
3. Environmental - Winter
4. Genetic - MOR3 gene (and genetic changes in certain genes, leads to BSEP proteins not being produced properly)
   BSEP: Hepatic billary transport proteins

Question 3

Describe the epidemiology of ICP

Answer 3

What factors increase the risk of ICP:

• Multifeatel pregnancy (twins)
  -Previous liver issues
  -Older women
  -Much younger women
  -Obese women

Question 4

State the function of hepatic billary transport proteins

Answer 4

BILE SALT EXPORT PUMP (BSEP): transport proteins, export bile acids from hepatocytes into bile (mutations to BSEP associated with ICP)

ABC: ATP-Binding Cassete: transport proteins, in CANALICULAR MEMBRANE of hepatocytes (between adjascent hepatocytes, where bile is produced mainly) - EFFLUX OF BILE SALts

Question 5

Describe the process of hepatoctyte bile acid uptake

Answer 5

• LECTURE MATERIAL

Question 6

State signs and symptoms of ICP

Answer 6

1. Itching of hands + feet (worse at night)
2. Redness
3. Pale stools
   4.Dark urine
4. Yellow skin + sclera (JAUNDICE - due to liver problems)
5. Abdominal pain

-itching occurs from 28 weeks of pregnancy)

Question 7

Describe the pathophysiology of ICP

Answer 7

• Increased ostreogen + progesterone, reduces uptake of bile from liver, cause build up of bile acids
• This causes build up of cholestrol
  -Bile salts stimulate histamine release, higher bile build up increases histamine, leading to ithing

UNDERSTANDING (blockage of bile from liver to small intestine, bile normally removes cholestrol), blockage because increased levels of oestrogen leads to narrowed bile ducts in liver

Question 8

Describe treatments for ICP

Answer 8

1. URSODEOXYCHOLIC ACID: reduces secretion of cholestrol
2. Bethametazone
3. Rifampicin
4. Vit K (cholestasis causes deficiency)
5. Delivering baby

Question 9

Describe the use of ursodeoxycholic acid as treatment for ICP

Answer 9

• Reduces serum bile acid levels
• Dissolves gallstones
• Anti-inflammatory

SIDE EFFECTS:
-NAUSEA
-DIAHORREA

Question 10

Describe acute fatty liver of pregnancy

Answer 10

• linked to fatty acid metabolism

HELPP:

H: haemolysis - red blood cells in blood breakdown
EL: elavated liver enzymes (proteins) - high level of enzymes in liver = sign of liver damage
LP - low platelet count

Question 11

What is pre-eclampsia?

Answer 11

High BP from week 20 of pregnancy

Question 12

How is pre-eclampsia treated?

Answer 12

Treateds by delivery of fetus

Question 13

What is “meconium” ?

Answer 13

• First faeces of new born baby
  -Green / black
• Composed of materials ingested by baby when in uterus, amniotic fluid, mucus

Question 14

Describe meconium aspiration syndrome

Answer 14

Meconium in amniotic fluid before birth
Occurs when baby inhales meconium in lungs, leads to lung damage, therefore, difficulty breathing

Question 15

High levels of ALT are found in a patient’s blood sample. Describe what this indicates

Answer 15

1. ALT: alanine transamanise
2. Produced by hepatocytes
3. ALT released in blood indicates liver damage / inflammation

ALT test:

ALT levels in blood
High ALT - liver damage / inflammation
PROBLEM: cannot show you how much liver damage, scarring, fibrosis there isa