GI week: Intro to HPB disease Flashcards
4 important things the liver synthesises
- Clotting factors
- Albumin
- Globulins (transporters)
- Acute phase proteins & immune factors (CRP)
What vitamins does the liver store
A, D, K, B12
Which viruses cause acute hepatitis
- Hep A, B, C, E
- CMV
- EBV
What causes pre-hepatic jaundice
- Anaemia
- Excessive blood breakdown
What causes hepatic jaundice
- Gilbert’s syndrome (abnormal liver enzyme essential for bilirubin excretion)
- Hepatitis
- Cirrhosis, fulminant liver failure (cell death)
What causes post-hepatic jaundice
- Intrahepatic obstruction (liver cell swelling due to alcohol/damage)
- Extra-hepatic obstruction (stones, cancer, inflammation, dysfunction in sphincter of odds)
Describe Courvoisier’s law regarding painless jaundice
Painless jaundice + palpable gallbladder = malignancy (pancreas or biliary)
What causes acute pancreatitis
GET SMASHED
Gallstones Ethanol (alcohol) Trauma Steroids Mumps Autoimmune Scorpion venom High: cholesterol, calcium, PTH ERCP Drugs
What is Charcot’s triad for cholangitis
- fever
- jaundice
- RUQ pain
Where might cholecystitis pain be referred to. Why?
R shoulder pain.
Due to irritation of phrenic N
Most common cause of portal hypertension
Liver cirrhosis
What is primary sclerosing cholangitis
Progressive obliterating fibrosis of intra and extrahepatic ducts, eventually leading to cirrhosis
When liver failure results in reduced synthesis, what occurs
- low albumin
- low clotting factors (prolonged clotting time)
When liver failure results in reduced clearance of waste products, what occurs
- jaundice
- encephalopathy
When liver failure results in portal hypertension, what occurs
- ascites
- varices
- splenomegaly
What drugs can cause acute pancreatitis
- sodium valproate
- steroids
- thiazides
- azathioprine
What does the liver excrete
- bilirubin
- cholesterol
- drugs, alcohol, poison
What conditions may lead to increased haemolysis/ anaemia
- Mechanical heart valves
- Sickle cell anaemia
- Thalassaemia
- Autoimmune haemolytic anaemia
- Infection, tumours
- Leukemia
- Lymphoma
Most common types of chronic hepatitis
Hep B and C
Which hepatitis is most commonly spread by unprotected sex
Hep B
Which hepatitis is most commonly spread by IVDU
Hep C
What type of bilirubin is found in urine?
What type(s) of jaundice will this indicate?
Conjugated bilirubin (unconjugated bilirubin is NEVER found in urine)
Will indicate hepatic or post-hepatic jaundice
How does bilirubin get into the urine in hepatic/ post-hepatic jaundice?
Conjugated bilirubin leaks out of hepatocytes, enters blood plasma, goes through kidneys into urine
Why is there increased bilirubin in blood but no bilirubin in urine, for pre-hepatic jaundice?
Increased RBC breakdown leads to increased unconjugated bilirubin.
Unconjugated bilirubin not water soluble thus will not enter urine, will stay in blood
Why is ascending cholangitis a surgical emergency
Infection can spread up bile duct, into liver, then enter systemic circulation
What score is used to assess prognosis in cirrhosis
Child-Pugh score
Components of Child-Pugh score
Total bilirubin (higher is worse)
Serum albumin (lower is worse)
Prothrombin time >6.0 OR INR >2.3
Ascites
Grade of hepatic encephalopathy
BAISE: bilirubin, ascites, INR, swelling, encephalopathy
List the 4 grades of hepatic encephalopathy
- Euphoria/anxiety, shortened attention span, impaired ability to do mathematics
- Lethargy, subtle personality change, inappropriate behaviour, minimal disorientation
- Extreme sleepiness (but responsive to verbal), confusion, gross disorientation
- Coma
What is responsible for the brown colour of stools?
Stercobilin
from conjugated bilirubin
