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R - Yr2 Alimentary (Liam Lennox) > Hepato-biliary Disease > Flashcards

Hepato-biliary Disease Flashcards

1
Q

What is cirrhosis?

A

End Stage Chronic Liver Disease

Diffuse loss of normal liver structure with replacement by nodules of hepatocytes & fibrous tissue

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2
Q

What causes cirrhosis?

A

All sorts:

  • Alcohol
  • Hepatitis B & C
  • Immune conditions
  • Metabolic disorders
  • Obesity (Diabetes Mellitus)
  • Cryptogenic
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3
Q

Name some immune conditions that cause cirrhosis?

A

Auto-immune hepatitis

Primary Biliary Cholangitis

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4
Q

Name some metabolic disorders that cause cirrhosis?

A 
Excess iron (primary haemochromatosis)
Excess copper (Wilson's Disease)
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5
Q

What is cryptogenic Cirrhosis?

A

Cirrhosis of unknown cause

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6
Q

What are the effects of cirrhosis?

A

It can lead to:

  • Weakness/Fatigue
  • Loss of appetite -> Weight Loss
  • Bruising
  • Jaundice
  • Pruritis
  • Nausea -> Vomiting

Complications:

  • Liver Failure
  • Portal Hypertension
  • Increases risk of hepatocellular carcinoma
  • Ascites & ankle oedema
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7
Q

What are the common causes of acute liver injury?

A

Anything causing hepatitis:

  • Viruses
  • Alcohol
  • Drugs

Or Bile Duct Obstruction causing bile build up to &
kill liver cells

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8
Q

What are the possible outcomes of acute liver injury?

A
  • Resolves
  • Liver Failure
  • Chronic hepatitis & cirrhosis
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9
Q

What is alcoholic liver disease?

A

Response to excess alcohol, it disrupts metabolism of fats causing an accumulation in the liver. The liver cells look more like fat droplets than hepatocytes down the microscope.

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10
Q

What are the consequences of alcholic liver disease (acute & Chronic)?

A

Acute -> Inflammation -> Liver cell death -> Liver Failure

Chronic -> Cirrhosis -> Liver Failure

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11
Q

What is Jaundice?

A

An increase in circulating bilirubin due to an altered bilirubin metabolism.

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12
Q

What are the types of jaundice?

A

Pre- hepatic
Hepatic
Post Hepatic

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13
Q

Define the stages of bilirubin metabolism

A

Pre-Hepatic:

  • Haemoglobin -> Haem & Globin in the spleen
  • Haem -> Bilirubin which is released into blood

Hepatic:

  • Hepatocytes take up bilirubin from blood
  • Conjugate it then excrete into the biliary system

Post-Hepatic:

  • Transported in bile to duodenum
  • Bilirubin-conjugate broken down in intestine
  • Some bilirubin eliminated in faeces/urine and some reabsorbed through entero-hepatic circ.
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14
Q

What causes pre-hepatic jaundice?

A

Excess haemoglobin release from RBC’s. Haemolysis.

Often down to infection or genetic conditions

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15
Q

What are the causes of hepatic and obstructive jaundice?

A

Hepatic:

  • Viral Hep
  • Alcoholic Hep
  • Liver Failure
  • Drugs
  • Liver Cancer
  • Wilsons/haemochromatosis
  • PBC/PSC if involving intra-hepatic ducts

Obstructive Cholestasis

  • Primary Biliary Cholangitis
  • Primary Sclerosing Cholangitis
  • Pancreatic cancer
  • Cholangiocarcinoma
  • Gallstones
  • Cholecystitis
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16
Q

What are the types of drug induced cholestasis?

A

Therapeutic vs Recreational

Predictable (dose related) vs Unpredictable (non-dose related)

17
Q

What types of liver tumours are there?

A

Hepatocellular carcinoma - malignancy of hepatocytes
Cholangiocarcinoma - Malignancy of bile duct epithelium
Metastases from other cancers

18
Q

Define Primary Biliary Cholangitis?

A

An auto-immune condition primarily occurin in women
Unknown environmental trigger + genetic predisposition for loss of immune tolerance to self mitochondrial proteins (i.e. production of auto-mitochondrial antibodies)

Leads to chronic granulomatous inflammation of bile ducts -> Loss of intra-hepatic bile ducts -> Cirrhosis

19
Q

Define Primary Sclerosing Cholangitis? (PSC)

A

Progressive cholestasis due to bile duct inflammation & fibrous stricture formation, mainly in men.
Eventually obliterates intra-hepatic bile ducts and leads to cirrhosis

20
Q

How do we test for PSC?

A

pANCA (neutrophil antibodies)

MRCP (MR Cholangiopancreatography)

21
Q

What other conditions are associated with PSC?

A

IBD & Cholangiocarcinoma

22
Q

How do we treat PSC?

A

Biliary Stents or a liver transplant

23
Q

What are the risk factors for cholelithiasis?

A

Obesity & Diabetes

24
Q

What types of gall bladder disease cause post-hepatic jaundice?

A 
Acute or chronic cholecystitis
Often due to:
 - Gall stones
 - Empyema
 - Perforation
 - Biliary Peritonitis
25
Q

What are the effects of a common bile duct obstruction?

A
  • Post-hepatic Jaundice
  • Lack of bile in duodenum -> Pale stools
  • Ascending Cholangitis (when infected bile is proximal to the obstruction)
  • Secondary Biliary Cirrhosis if the obstructions belonged

R - Yr2 Alimentary (Liam Lennox) (37 decks)

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