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Pathology > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

What do raised ALT and AST indicate?

A

Non-specific evidence of liver injury

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2
Q

What does raised LDH indicate?

A

non-specific

could be liver injury, cardiac failure, leukaemia, lymphoma

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3
Q

What does raised GGT indicate?

A

Alcoholic liver injury

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4
Q

What does raised Alk Phos indicate?

A

Biliary obstruction

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5
Q

2 types of bilirubin?

A 
Unconjugated Bilirubin (indirect)
Conjugated Bilirubin (direct)
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6
Q

Where is bilirubin conjugated?

A

In the liver

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7
Q

3 types of jaundice?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

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8
Q

Pre-hepatic causes of jaundice?

A

Haemolysis

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9
Q

How to calculate unconjugated (indirect) bilirubin?

A

Total bilirubin - Conjugated (direct) bilirubin

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10
Q

Intra-hepatic causes of jaundice?

A 
Liver disease (cirrhosis, alcoholic, fatty liver disease, pregnancy)
Intra-hepatic bile duct loss (PBC)
Intra-hepatic bile duct obstruction (mets, cirrhosis, hepatitis)
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11
Q

Post-hepatic causes of jaundice?

A 
Obstruction of extra-hepatic bile ducts:
Gallstones
benign strictures
extrahepatic cholangiocarcinoma
carcinoma head of pancreas
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12
Q

Conjugated bilirubin in the urine manifests as?

A

Pale stools and dark urine

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13
Q

Causes of acute liver injury?

A

alcohol, drugs (paracetamol), viral (Hep A and B), ascending cholangitis due to gallstones, acute fatty liver of pregnancy, Weil’s disease

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14
Q

What is Weil’s disease?

A

bacterial infection also known as leptospirosis

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15
Q

Causes of chronic liver disease?

A

chronic hepatitis, cirrhosis, iron overload (haemochromatosis)

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16
Q

Chronic hepatitis definition?

A

clinical and biochemical evidence of hepatitis lasting more than 6 months

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17
Q

Causes of chronic hepatitis?

A

Viral (Hep B + C), drugs, alcohol, fatty liver disease (NAFLD -> NASH), autoimmune, Wilson’s disease

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18
Q

What does autoimmune hepatitis look like on biopsy?

A

Portal lymphocytes with prominent plasma cells

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19
Q

Why is it important to diagnose autoimmune hepatitis?

A

Rapid progression to cirrhosis may be stopped with steroid use

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20
Q

What is the most common cause of liver cirrhosis?

A

Alcohol

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21
Q

Features of acute alcoholic hepatitis?

A

risk of death or progression to cirrhosis

acute inflammation, hepatocyte necrosis and Mallory’s hyaline

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22
Q

When is Mallory’s hyaline seen on biopsy?

A

In acute alcoholic hepatitis

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23
Q

Risk factors for NAFLD & NASH?

A

obesity, hyperlipidaemia and T2DM

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24
Q

What is hemosiderosis?

A

Deposition of iron in the liver as hemosiderin, turning it brown

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25
Q

Causes of hemosiderosis?

A

Multiple blood transfusions
Alcohol
Primary hereditary haemochromatosis

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26
Q

What gene mutations cause haemochromatosis?

A

C282Y + H63D in the HFE gene

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27
Q

What pattern of inheritance is Haemochromatosis?

A

Autosomal Recessive

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28
Q

What happens in Wilson’s Disease?

A

Copper is deposited in the liver and the basal ganglia of the brain

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29
Q

Symptoms of Wilson’s Disease?

A

chronic hepatitis leading to cirrhosis
progressive neurological disability
Kayser-Fleischer Rings in the eyes

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30
Q

Diagnosis of Wilson’s Disease?

A

low serum caeruloplasmin

inc. copper in liver biopsy

31
Q

Treatment of Wilson’s Disease?

A

chelating agent penicillamine

32
Q

What can cause both cirrhosis and emphysema?

A

Alpha 1 antitrypsin deficiency

33
Q

Causes of liver cirrhosis?

A

Alcohol, Hep B, Hep C, Haemochromatosis, Autoimmune, Biliary Obstruction, NASH, Wilson’s Disease, alpha 1 antitrypsin deficiency

34
Q

Complications of cirrhosis?

A

liver failure, portal hypertension, hepatocellular carcinoma

35
Q

Liver failure definition?

A

red. synthesis of albumin, clotting factors

failure to eliminate hormones, nitrogenous wastes

36
Q

Liver failure consequences?

A 
systemic oedema
bruising and bleeding
ascites
encephalopathy 
renal failure
37
Q

Why does encephalopathy occur in liver failure?

A

Failure to eliminate nitrogenous wastes

38
Q

Failure of the liver to eliminate steroid hormones results in?

A

Secondary hyperaldosteronism

Hyper-oestrogenism (spider naevi, gynaecomastia)

39
Q

Commonest sites that mets to the liver?

A

Colon, pancreas, lung and breast

40
Q

What is the commonest primary tumour of the liver?

A

Hepatocellular Carcinoma

41
Q

What does hepatocellular carcinoma secrete in the blood?

A

Alpha fetoprotein

42
Q

Alpha fetoprotein in the blood indicates?

A

Hepatocellular Carcinoma

43
Q

Where is hepatocellular carcinoma really common?

A

Africa and China

44
Q

Where does a cholangiocarcinoma arise?

A

Within the liver or within the extrahepatic bile ducts

45
Q

Transmission of Hepatitis A?

A

close personal contact
contaminated food/water
blood exposure (rare)

46
Q

What is acute infection of Hep A diagnosed by?

A

Detection of HAV-IgM in serum by EIA

47
Q

What is past infection/immunity of Hep A detected by?

A

Detection of HAV-IgG in serum by EIA

48
Q

Which viral hepatitis can you not have without another?

A

Can’t have Hep D without B

49
Q

Which hepatitis does not become chronic?

A

Hepatitis A

50
Q

Which viral hepatitis have no vaccine?

A

Hep C

Hep E

51
Q

Which hepatitis are largely transmissed by blood to blood contact or sexual transmission?

A

Hep B + Hep D

Hep C

52
Q

What are the 6 ‘F’s of ascites?

A

flatus, fluid, faeces, foetus, fat, filthy big tumour

53
Q

Types of peritonitis?

A

Primary (spontaneous bacterial)

Secondary

54
Q

Symptoms of spontaneous bacterial peritonitis?

A

ascites, fever, abdominal pain, altered mental state

55
Q

Diagnosis of spontaneous bacterial peritonitis?

A

positive ascitic bacterial fluid culture

leukocyte count >250 in ascitic fluid

56
Q

What causes secondary peritonitis?

A

spillage of organisms from GI or GU tracts into the peritoneal cavity
trauma, appendix perforation, perforated ulcer, carcinoma, diverticulitis, ulcerative colitis, cholecystitis, infection

57
Q

Secondary Peritonitis Symptoms?

A 
initially symptoms of primary cause
abdo pain (moderate aggrevated by movement, then severe)
vomiting
fever
unable to pass flatus
58
Q

Causative organisms of secondary peritonitis?

A 
E coli, enterococci, clostridium, Bacteroides
Antibiotic resistant (especially in healthcare setting)
59
Q

Risk factors for liver abscesses?

A

DM, underlying hepatobiliary or pancreatic disease, liver transplant

60
Q

Liver abscess presentation?

A

Fever (90%)
Abdominal symptoms (50-75%)
nausea, vomiting, anorexia, malaise, weight loss

61
Q

Liver abscess microbiology?

A

Streptococcus, E coli, Staph aureus, Candida (immunocompromised), Klebsiella (Asia), Amebiasis (especially in pts with travel history)

62
Q

What causes amebiasis?

A

Entamoeba Histolytica

63
Q

Treatment of amebiasis?

A

Metronidazole

64
Q

Complications of acute pancreatitis?

A

Pancreatic necrosis
Pseudocyst formation
Extra-pancreatic infection (20%)

65
Q

How much of cholecystitis is acalculous?

A

Approx. 10%
Usually in critically ill patients
Associated with high mortality and morbidity

66
Q

Diagnosis of cholecystitis?

A

Murphy’s Sign
Ultrasound
MRCP
CT

67
Q

Complications of cholecystitis?

A 
Gallbladder gangrene (20%)
Fistula
Gallstone ileus
Emphysematous Cholecystitis
Recurrence
Sepsis
68
Q

What is emphysematous cholecystitis?

A

Infection and inflammation of the gallbladder wall with air-creating pathogens (e.g., E coli, clostridium)
surgical emergency

69
Q

What is acute/ascending cholangitis?

A

clinical syndrome characterised by Charcot’s triad that develops as a result of stasis or infection in the biliary tract

70
Q

Causative organisms of cholangitis?

A

E coli
Klebsiella
Enterobacter

71
Q

Diagnosis of cholangitis?

A 
fever/chills
lab evidence of inflammatory response
jaundice
abnormal LFTs
biliary dilation on imaging
72
Q

Clinical features of diverticulitis?

A 
abdominal pain in LLQ
nausea and vomiting
tender mass
change in bowel habit
urinary symptoms
peritoneal guarding, rigidity, rebound tenderness
73
Q

Diverticulitis Complications?

A

Abscess
Obstruction
Fistula
Perforation

74
Q

Diagnosis of diverticulitis?

A

CT scan with contrast

Pathology (13 decks)

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