Hepatobiliary Flashcards
Tumors of liver
Benign
Cavernous hemangioma
Hepatocellular adenoma
Malignant
Primary: hepatoblastoma
Hepatocellular carcinoma
Fibrolamellar carcinoma
Intrahepatic cholangiocarcinoma
Combined hepatocellular cholangiocarcinoma
Non hodkin lymphoma
Secondary
Arising from colon breadt lung pancreas leukemias lymphomas
Define cirrhosis of liver
It may be defined as end stage of chronic liver disease characterised by
1. Bridging fibrous septae in form of delicate bands or broad scars linking portal tracts with one another and portal tracts with terminal hepatic veins
- Parenchymal nodules containing proliferating hepatocytes encircled by fibrosis with diameters varying from very small to large
3.disruption of architecture of entire liver
Causes of liver cirrhosis
Viral hepatitis
Alcoholic liver disease
Non alcolic steatohepatitis
Biliary disease
Pr hemochromatosis
Wilsons disease
a1 antitrypsin def
Drug induced
Syphillis
Complications of liver cirhossis
Portal htn
Hepatic envephalopathy
Hepatic failure
Jaundice
Bleeding from esophageal varices
Hepatocellular carcinoma
Mechanism of ascitis in liver disease
- Splancnic vasodilation
2.percolation of hepatic lymph into peritoneal cavities
3.intestinal fluid leakage - Seconadry hyperaldosteronism
- Hypoalbuminaemia
Portal htn
Increased resistance to portal blood flow
Due to
Pre hepatic cause:
Obstruction of portal vein
Narrowing of portal vein
Massive splenomegaly
Hepatic causes: cirrhosis
Schistosomiasis
Sarcoidosis
Malignancy
Miliary tb
Amyloidosis
Post hepatic
Rt sided heart failure
Constrictive pericarditis
Hepatic vein outflow obstruction
Porto systemic venous shunts
With the rise of portal pressure bypass develop whenever systemic and portal circulation share common capillary beds
Features of psv shunts
1. haemorrhoids
2. esophageal varices causing massive hematamesis
3.perabdominal capput medussae and abdominal wall collaterals
Hepatotropic virus
Hepatitis A-E and G
Non hepatotropic virus
Ebv
Cmv
Adenovirus
Herpes virus
Enterovirus
Rubella
Yellow fever
Other causes of hepatotis
Miliary tb
Malaria
Staphylococcal bacteremia
Candida inf
Salmonella inf
Ameobiasis
Outcomes of hep b inf
90 % cases have conplete recovery
1% develop fulminant hepatitis
And 9% have hbsag in their for atleast 6 months so they are chronic carriers
50% of chronic carriers undergo resolution and the rest is chronic persistant hepatitis
And chronic active hepatitis
Chr active hep gives rise to hcc, liver cirrhosis, hepatic failure
Fulninant hepatitis
When hepatic insufficiency progresses from onset of sumptoms to hepatic encephalopathy within 2- 3 weeks
Routes of hepatotropic virusee
Hep feco oral
Hep b blood borne , sexual trans, perinatal
Hep c blood borne, sexual perinatal
Hep d blood borne and sexual
Hep e fecooral
Serological markers for hep b virus inf
Antigen
Hbsag
Hbeag
Antibody
Anti hbc igM
Anti hbs igM
Anti hbe igM
Define window period
There is a period of several wks when hbsag has disappeared hbsab is not yet detectable
Core ab is present
Signs and symptoms are not present
Diseases of gall bladder
Congenital
1.Agenesis
Double gall bladder
Bilobed gall bladder
2.cholecystitis
Acute and chronic
3.cholelithiasis
Cholesterol stone 90
Pigment stone 10
4.Tumors
Benign: carcinoids, fibroma, neuroma, hemangioma, adenoma,polyp
Malignant: carcinoma of gall baldder
Carcinoid tumor
Gall stones
These are concretion produced by gall bladder due to abnormal composition
Cholesterol stone 80%
Contains more than 50% crystalline cholesterol monohydrate
Pigment stone: contains bilirubin and ca salt
Causes of cholesterol stonr
Advancing age
Female sex hormone
Ocp
Pregnancy
Obesity
Rapid wt loss
Causes of pigment stones
Chr hemolytic syndrome
Biliary infection
Ilial diseases
Ilial bypass
Cystic fibrosis
Pqthogenesis of cholesterol stone
Bile must be supersaturated with cholesterol
Gall bladder hypomotility promotes nucleation
Cholesterol nucleation in bile is accelerated
Mucous hypersecretion in gall bladder traps crystals permitting their aggregation to stones
Complication of gall stone
- Stone in gall bladder
Acute cholecystitis
Chronic cholecystitis - Stone in common bile duct
Obstructive jaundice
3.stone in ampula of vater
Acute pancreatitis
4.stone in intestine
Intestinal obstruction
Diff btw conjugated and unconjugated bilirubin
Unconjugated bilirubin is present in blood of healthy person
Conjugated is not
Unconjugated bilirubin cannot pass in urine as it is not water soluble
Conjugated can
Unconjugated bilirubin is soluble in lipids and causes damage to cns
Conjugated does not
Jaundice
It is the yellow dicolouration of skin and schlera due to excess production of bilirubin
Reduced hepatic uptake
Impaired bilirubin conjugation
Types of jaundice
Hemolytic jaundice
Hepatocellular jaundice
Obstructive jaundice
Liver function tests
1.Serum bilirubin
Normal 0.3- 1 umol/l
Increases in hyperbilirubinemia in all jaundice
Latent jaundice
2 . Serum Alt:
Normal 10-45u/l
Inc in hepatocellular jaundice
3. Serum ast
Normal : 10-35 u/l
Increases in mi and liver disease
4. Serum alp
Nornal: 40 -125u/l
Inc in obs and hepatocellular jaundice , generqlized bone disease, osteomalacia, rickets
5.serum ldh
Normal 100-300 u/l
Inc in mi liver disease renal disease leukemia hemolytic anaemia megaloblastic anaemia
- Serum gamma glutamyl transferase
Nornal males 15-85u/l
Females 5-55u/l
Inc in liver disease
Chronic alcoholism
LFT
Synthetic tests
Serum total protein 6-8gm /dl
Serum albumin 3.5-5 gm/dl
A:G : 1.7-1
Prothrombin time: 12- 16 secs
Excretory
Bilirubin 0.3-1 gm /dl
Urinary bilirubin
Urinary urobilinogen
Stercobilinogen
Bile acid
Bile salt
Enzymes
Serum alt
Serum ast
Serum alp
Serum gamma gt
