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Kofi: Pure Clinical Sem 3 > GI: Pancreas, Liver & Gallbladder Disease > Flashcards

GI: Pancreas, Liver & Gallbladder Disease Flashcards

1
Q

Describe red cell breakdown.

A
  • 120 days
  • Occurs extravascularly in macrophages in spleen and liver
  • Bilirubin released by heme breakdown. It is hydrophobic and therefore bound to albumin before being carried to the liver
  • Bilirubin conjugated with glucoronic acid by UDP glucoronyl transferase
  • Conjuaged bilirubin is water soluble and secreted by hepatocyte into bile canaculi
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2
Q

Describe bilirubin transport?

A
  • Conjuagted bilirubin is converted to urobiligoen in the intestine and kidney
  • In the intestine urobilinogen is converted to stercobilin
  • In the kidneys urobilinogen is converted to urobilin which is light yellow
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3
Q

How do we measure liver dysfunction?

A
  • Failure of anabolism (albumin, glycogen, numerous coagulation factors, Haematopoiesis in fetus)
  • Failure to catabolise and excrete (drugs, hormones, haemaglobin, poisons, can take over removal of aged red cells after splenectomy)
  • Markers of hepatocyte damage
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4
Q

What is the results of failure of anabolism?

A
  • Prolonged prothrombin time (inr)
  • Signifies serious liver damage
  • Hypoalbuminaemia reflects severe liver dysfunction
  • Signs of severe liver damage
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5
Q

What is pre-hepatic jaundice?

A

-Too much bilirubin

Caused by haemolytic anaemia for example

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6
Q

What is intra-hepatic jaundice?

A

-Failure of hepatocytes to conjugate and/or secrete most of the bilirubin presented to them. Stasis within the liver is called cholestasis.

Caused by hepatitis, cirrhosis for example

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7
Q

What is post-hepatic jaundice?

A

-Failure of the biliary tree to convert the conjugated bilirubin to the duodenum.

Caused by biliary tree obstruction such as gallstones or carcinoma of the head of pancreas

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8
Q

What is result of increased serum levels of conjugated bilirubin?

A

-Water soluble so will be excreted in the urine and turn the urine dark yellow. Can be measured with a dipstick

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9
Q

What is the result of increased level of urobilinogen?

A

Will not noticeable colour the urine but can be measured with a dipstick

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10
Q

Why does pruritus occur in post-hepatic jaundice?

A

-Inability to secrete bile salts leading to itching

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11
Q

What are the signs of pre-hepatic jaundice?

A
  • Dark stools
  • Normal urine colour
  • Mild jaundice
  • No prurities
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12
Q

What are the signs of intra-hepatic jaundice?

A
  • Moderate jaundice
  • Stools normal
  • Urine is dark
  • No pruritus usually
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13
Q

What are features of post-hepatic jaundice?

A
  • Raised serum bilirubin
  • Decreased urinary urobiliogen
  • Conjuagted bilirubin present in urine
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14
Q

What are features of intra-hepatic jaundice?

A
  • Raised serum biliruibin
  • Normal urinary urobiliogen
  • Conjugated bilirubin present in urine
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15
Q

What are features of pre-hepatic jaundice?

A
  • Raised serum bilirubin
  • Increased urinary urobiliogen
  • No conjugated bilirubin present in urine
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16
Q

What are signs of post-hepatic jaundice?

A
  • Severe jaundice
  • Stools pale
  • Urine is dark
  • Pruritis
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17
Q

What are markers of liver damage?

A
  • ALT
  • AST
  • Alk Phos
  • Gamma GT (alcohol induced so can indicate alcoholism)
18
Q

What are the causes of increased Alk Phos?

A

Bone disease

  • Bone metastases
  • Bone fracture
  • Osteomalacia
  • Hyperparathyroidism
  • Paget’s disease of bone

Liver disease with cholestasis

  • Biliary obstruction
  • Cirrhosis
  • Liver metastases
  • Drugs

*Normally high in growing bone

19
Q

What are causes of Raised ALT?

A

Hepatitis

  • Viral
  • Acute alcohol intake
  • Fatty liver disease
  • Drugs/toxins
20
Q

What are causes of raised Gamma GT?

A
  • Biliary duct obstruction
  • Cirrhosis
  • Liver metastases
  • Drugs
  • Alcoholism
21
Q

What are common liver and bile duct disease?

A
  • Hepatitis
  • Cirrhosis
  • Gallstones and biliary tract obstruction
  • Liver metastases
22
Q

What is pathology underlying hepatitis?

A

-Inflamed and/or necrotic hepatocytes that cannot function normally

23
Q

What are the implications of liver failure?

A
  • Increased susceptibility to infections (bacterial mostly)
  • Increases susceptilibit to toxins and drugs
  • Increased blood ammonia due to failure to clear ammonia via urea cycle
  • Ammonia is produced by colonic bacteria and deamination of amino acids. this can causes hepatic encephalopathy
24
Q

What are symptoms of hepatitis?

A
  • Feeling generally unwell
  • Anorexia
  • Fever
  • Right upper quadrant pain
  • Dark urine
  • Jaundice
25
Q

What are typical blood test findings in acute hepatitis?

A
  • Normal albumin and INR
  • High serum bilirubin
  • Conjugated bilirubin present in the urine
  • Very high serum ALT
  • Normal/Silghtly raised Alk Phos
  • Normal/Silghtly raised Gamma GT
26
Q

What is liver cirrhosis and causes?

A

-Liver fibrosis producing a shrunken hard nodular liver

Caused by alcohol, Viral hepatitis, Fatty liver disease and Idiopathic

27
Q

What are the effects of liver fibrosis?

A
  • Pressure and occlusion of the hepatic sinusoids leads to portal hypertension which leads to portosystemic shunting, including oesophageal varices, diverting nutrient-carrying blood away from the liver.
  • Pressure on the bile canaliculi and therefore reduced ability to excrete toxins, bilirubin.
  • Replacement of hepatocytes by fibrous tissue which leads to reduced albumin and clotting factor production
28
Q

What are the sites of portosystemic anastomoses?

A
  • Anorectal juction
  • Ligamentum teres of falciform ligament
  • Oesophagogastric junction
29
Q

What are symptoms of cirrhosis?

A
  • Fatigue/Weakness
  • Bleeding and bruising early
  • Swollen abdomen
  • Swollen legs
  • Weight loss
  • Jaundice
  • Haematemesis and/or malena
  • Confusion, drowsiness and slurred speech
30
Q

How can cirrhosis be treated?

A
  • Not possible to reverse
  • Treatment aimed at dealing with complications
  • Only cure is liver transplantation
31
Q

What is cholangitis?

A

Life threatening complication of bile duct obstruction as a result of infection in the bile ducts. Commonest bacteria is E.Coli
-Obstruction is common due to to gall stones in common bile duct

32
Q

What is a biliary colic?

A
  • Not a true colic. Pain is constant
  • Pain in the right upper quadrant that radiates to the tip of the right scapula/shoulder due to irritation of diaphragm
  • Often precipitated by eating a fatty meal and can last up to 6 hours
33
Q

What is acute cholecystitis?

A
  • Gallstone obstructs the cystic duct then there is stasis of the gallbladder contents which is an infection risk
  • Infecting organism is E.Coli
34
Q

What are the symptoms of acute cholecystitis?

A
  • Severe gall bladder pain
  • Systemically unwell and toxic
  • Pyrexial
  • Tender over gall bladder
35
Q

What is acute pancreatitis?

A

-Premature activation of pancreatic proteases in the pancreas itself rather than the duodenum. Protease then auto digest the pancreases and retroperitoneum

36
Q

What is chronic pancreatitis?

A
  • Rare and due to repeated low grade pancreatitis that causes pancreatic fibrosis.
  • Due to alcohol abuse
  • Pancreas become calcified and patients suffer severe epigastric and back pain that leads to opiate addiction and not infrequently suicide.
37
Q

What is the aetiology of acute pancreatitis?

A
  • Alcohol alters the balance between proteolytic enzymes and protease inhibitors thus triggering enzyme activation, auto digestion and cell destruction
  • Gallstones blocking the ampulla of vater lead to outflow obstruction with pancreatic duct hypertension and a toxic effect of bile salts contribute to activation of pancreatic proteases.
38
Q

What are symptoms of acute pancreatitis?

A
  • Epigastric pain that goes through the back
  • Vomiting
  • Dehydration
39
Q

How is acute pancreatitis diagnosed and treated?

A

Investigations

  • Raised serum amylase or serum lipase
  • CT scan may be used in moderate/severe cases to look for pancreatic necrosis/pseudocyst. Necrosed pancreas is non-enhancing with contrast

Treatment of acute pancreatitis

  • No specific treatment
  • Analgesis, supportive treatment
  • Fluid resuscitation as patient can sequester litres of fluid in their retropeiritoneum
40
Q

What is clinical presentation of pancreas cancer?

A
  • Anorexia, Malaise, Fatigue
  • Significant weight loss
  • Epigastric and/or back pain
  • Dark urine
  • Pale Stools
  • Pruritis

Kofi: Pure Clinical Sem 3 (44 decks)

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