GI and Liver Flashcards
Give 4 functions of the liver.
- Glucose and fat metabolism.
- Detoxification and excretion.
- Protein synthesis e.g. albumin, clotting factors.
- Defence against infection.
Name 3 things that liver function tests measure.
- Serum bilirubin.
- Serum albumin.
- Pro-thrombin time.
Name an enzyme that increases in the serum in cholestatic liver disease (duct and obstructive disease).
Alkaline phosphatase.
What enzymes increase in the serum in hepatocellular liver disease?
Transaminases e.g. AST and ALT.
Name two hepatocellular enzymes.
Transaminases e.g. AST and ALT.
Name a cholestatic enzyme.
Alkaline phosphatase.
What are the potential consequences of hepatocyte regeneration in someone with liver cirrhosis?
Neoplasia and therefore HCC. Hepatocyte regeneration is liable to errors.
Give 3 causes of iron overload.
- Genetic disorders e.g. haemochromatosis.
- Multiple blood transfusions.
- Haemolysis.
- Alcoholic liver disease.
What protein is responsible for controlling iron absorption?
Hepcidin.
Levels of this protein are decreased in haemochromatosis.
Give 3 causes of duct obstruction.
- Gallstones.
- Stricture (narrowing) e.g. malignant, inflammatory.
- Carcinoma.
- Blocked stent.
What can cause peritonitis?
- Bacterial infection due to a perforated organ; spontaneous bacterial peritonitis; infection secondary to peritoneal dialysis.
- Non-infective causes e.g. bile leak; blood from ruptured ectopic pregnancy.
Name a cause of pelvic inflammatory disease.
A complication of chlamydial infection.
Give 4 reasons why liver patients are vulnerable to infection.
- They have impaired reticulo-endothelial function.
- Reduced opsonic activity.
- Leukocyte function is reduced.
- Permeable gut wall.
Give 5 causes of diarrhoeal infection.
- Traveller’s diarrhoea.
- Viral e.g. rotavirus, norovirus.
- Bacterial e.g. E.coli.
- Parasites e.g. helminths.
- Nosocomial e.g. c.diff.
Give 5 causes of non-diarrhoeal infection.
- Gastritis/peptic ulcer disease e.g. h.pylori.
- Acute cholecystitis.
- Peritonitis.
- Typhoid/paratyphoid.
- Amoebic liver disease.
Give 3 ways in which diarrhoea can be prevented.
- Access to clean water.
- Good sanitation.
- Hand hygiene.
What is the diagnostic criteria for traveller’s diarrhoea?
> 3 unformed stools per day and at least one of:
- Abdominal pain.
- Cramps.
- Nausea.
- Vomiting.
It occurs within 3 days of arrival in a new country.
Give 3 causes of traveller’s diarrhoea.
- Enterotoxigenic e.coli (ETEC).
- Campylobacter.
- Norovirus.
Describe the pathophysiology of traveller’s diarrhoea.
Heat labile ETEC modifies Gs and it is in a permanent ‘locked on’ state. Adenylate cyclase is activated and there is increased production of cAMP. This leads to increased secretion of Cl- into the intestinal lumen, H2O follows down as osmotic gradient -> diarrhoea.
Which type of e.coli can cause bloody diarrhoea and has a shiga like toxin?
Enterohaemorrhagic e.coli (EHEC) aka e.coli 0157.
What does EIEC stand for?
Enteroinvasive e.coli.
Which type of e.coli is responsible for causing large volumes of watery diarrhoea?
Enteropathogenic e.coli (EPEC).
What does EAEC stand for?
Enteroaggregative e.coli.
What does DAEC stand for?
Diffusely adherent e.coli.