GI 8 - The Liver, Gallbladder + Pancreas Flashcards
In which cells can AST be found?
- Hepatocytes
- Cardiac cells
- Skeletal muscle cells
- Brain cells
What can cause raised AST levels?
- Viral hepatitis
- Toxic hepatitis
- Ischaemic hepatitis
- Cirrhosis
- Infection
- Myocardial infarction
- Muscular dystrophy
- Haemolytic anaemia
Which of AST and ALT are specific to hepatocytes?
ALT
What can cause raised ALP?
- Biliary obstruction
- Bone metastases
- Hyperparathyroidism
What is the most sensitive serum marker of Liver damage? What is its main drawback?
GGT: gamma-glutamyltransferase
Not specific to Liver damage - present elsewhere in body
What changes in albumin levels and prothrombin time would you expect to see in liver failure? Why?
Reduced albumen
Increased prothrombin time
Liver synthesises albumin and clotting factors
Which clotting factors are not synthesised by the Liver?
- Factor VIII
- vWF
If AST:ALT levels = 1, what is the most common explanation?
Ischaemic hepatitis
If AST:ALT < 1, what are the most common explanations?
Viral hepatitis
Toxic hepatitis
Paracetamol OD
If AST:ALT > 2.5, what is the most common explanation?
Alcoholic hepatitis
List some symptoms of liver cirrhosis:
- Jaundice
- Ascites
- Palmar erythema
- Fatigue/lethargy
- Pale conjunctiva
- Caput medusae
- Oedema
- Mental/personality changes
- Asterixis
What is the simple test for hepatic encephalopathy?
Draw a 5-pointed star
- If positive will be unable to draw it
Name the 3 main sites of porto-systemic anastamoses affected by portal hypertension:
- Oesophagus
- Anorectal junction
- Skin of abdomen (caput medusae)
What is the function of the gallbladder?
- Stores bile
- Concentrated bile (removes salt + H2O)
- Releases bile when CCK present
What stimulates the release of bile from the gallbladder?
- Chyme enters duodenum, stimulates release of CCK
- CCK causes contraction of gallbladder, and relaxation of the sphincter of Oddi
What structure controls the release of bile and pancreatic secretions into the duodenum?
Sphincter of Oddi
What are the 3 types of gallstones? Which is most common?
1) Yellow = cholesterol
2) Black = pigments
3) Mixed = most common
What is Cholelithiasis?
Presence of gallstones in gallbladder
Who is most at risk of developing gallstones?
- Female (esp. if had children/on OCP)
- Over forty
- Overweight
- Crohn’s/IBS
- Cirrhosis
- Cholangitis
- Cholestasis
- Family history
- Ceftriaxone
Which main LFT indicates the presence of gallstones?
ALP: Alkaline phosphatase
Which pigments can produce gallstones?
- Bilirubin
- Calcium bilirubinate
How long is the pancreas? Is it peritoneal or retroperitoneal?
~ 14 cm
Retroperitoneal
Name the part of the pancreas which stretches towards the spleen:
Uncinate process
What is the blood supply to the pancreas?
Branches of both:
Coeliac trunk = superior pancreaticoduodenal artery and branches of splenic artery
SMA = inferior pancreaticoduodenal artery
What percentage of pancreatic secretions are exocrine and endocrine?
Exocrine ~ 98%
Endocrine ~ 2%
Name some components of pancreatic exocrine secretions:
- Trypsinogen
- Chemotrypsinogen
- Pancreatic amylase
- Pancreatic lipase
- Cholesterol esterase
What endocrine hormones are produced by the pancreas? Which cells release which hormones?
Alpha cells = Glucagon
Beta cells = Insulin
Delta cells = Somatostatin
Gamma cells = Pancreatic polypeptide
What can cause acute pancreatitis?
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion bite
- Hyperlipidaemia
- ERCP
- Drugs
What is the typical presentation of acute pancreatitis?
- Severe, constant upper abdominal pain, which radiates to back
- Vomiting
- Hypotension - fatigue, lightheadedness etc
