Hepatobiliary and Pancreatic Disease Flashcards
What does the liver synthesis and produce?
Synthesis - Albumin, clotting factors, complement, alpha-1 antitrypsin and thrombopoietin.
Produces - Bile through conjugation of bilirubin
What is the function of Kupffer Cells?
Phagocytose old blood cells, bacteria and foreign materials from the bloodstream/gut
What is jaundice?
Yellowing of skin and mucosal surfaces which occurs with bilirubin levels above 40 micromoles per litre. It causes an intense itch due to irritation of nerve endings.
Describe the two forms of bilirubin in jaundice
It can either be unconjugated (water insoluble) or conjugated (water soluble causing dark urine)
Describe the different classes of jaundice
(conjugated or unconjugated).
- Prehepatic - Occurs due to haemolysis and release of bilirubin from RBCs,
- Intrahepatic - Liver disease.
- Post-hepatic - Obstruction of bile outflow resulting in dark urine and pale stools
What are the causes and symptoms/signs of acute liver injury?
Causes - Viral infections, alcohol, adverse drug reactions and biliary obstruction.
Symptoms/signs - Jaundice, malaise, raised bilirubin and transaminases. If progression to liver failure then decreased albumin, ascites, bruising and encephalopathy.
What is steatosis>
Fat deposition
Describe how alcoholic liver injury can occur
Acetaldehyde binds to hepatocytes causing damage which results in an inflammatory reaction which results in fibrosis
Describe features of drug induced liver injury
Can have injury to liver cells (hepatocellular) for example via paracetamol overdose or injury to bile production-secretion cells (cholestatic) Eg, methly testosterone
Describe some features of acute biliary obstruction
Usually due to gallstones, it causes colicky pain and jaundice. It can be complicated by infection of the blocked bile duct causing infective cholangitis
What is chronic hepatitis and what are some causes?
Inflammation of the liver lasting more than 6 months and presents with sustained elevation of transaminases. Causes can be viral, alcohol, drugs or autoimmune
How is chronic hepatitis classified?
Type (aetiology), grade (degree of inflammation) and stage (degree of fibrosis)
What is NAFLD and describe some features
Non-alcoholic fatty liver disease which is associated with metabolic syndrome (DM 2, hypertension ect) Fat deposits in hepatocytes can lead to cirrhosis
Briefly describe autoimmune chronic active hepatitis
Usually presents in mid to late teens with chronic hepatitis caused by inflammatory cells. They may benefit from steroids
Describe the stages of primary biliary cholangitis
- Autoimmune destruction of bile duct epithelium,
- Proliferation of small bile ducts due to damage of the large duct,
- Architectural disturbances causes portal fibrosis,
- Cirrhosis
ALP tends to be more raised with?
Biliary disease rather than liver.
Describe some of the differences between primary biliary cholangitis and primary sclerosing cholangitis
PBD - Increase in IgM and has no obliterative fibrosis of larger bile ducts.
PSC - Associated with IBD (UC), no increase in antibodies, it DOES have obliterative fibrosis of large ducts
What is haemochromatosis and how is it managed?
Iron deposition in the liver causing alteration of architecture leading to fibrosis and then cirrhosis. Patients need regular venesection and testing of iron and ferritin levels
Describe features of alpha-1 antitrypsin deficiency
- Autosomal recessive disorder which results in low levels of alpha-1 antitrypsin. Proteins build up in hepatocytes as hyaline which can lead to cirrhosis
Describe features of Wilson’s Disease
- Autosomal recessive. It is the failure to excrete copper in bile, resulting in a build up of copper in the liver and then cirrhosis. Copper can also deposit in brain tissue causing neurological dysfunction.
What are some causes of cirrhosis?
Alcohol, hepatitis B and C, iron overload, gallstones or autoimmune liver disease
What are the complications of cirrhosis?
Liver failure (Hepatic encephalopathy, hyperoestrogenism and bleeding), Portal hypertension (due to increase in vascular resistance) Hepatocellular carcinoma
Name some different liver tumours
Benign - Adenoma, haemangioma and cysts.
Malignant - Metastasis and hepatocellular carcinoma and cholangiocarcinoma
Name some pathologies of the biliary system
- Congenital malformations (atresia or choledocal cysts),
- Gallstones (cholelithiasis),
- Cholecystitis,
- Cholangiocarcinoma,
- Obstruction
Describe features of gallstones
Risk factors (5 F's); Female, fair, fat, forty, fertile. diabetes melitis) They cam cause cholecystitis, obstructive, jaundice, cholangitis, pancreatitis and cholangiocarcinoma
Describe features of cholecystitis
Acute - Usually caused by gallstones, can become infected and potentially lead to abscess/rupture (symptoms - RUQ pain, fever, N/V)
Chronic - Chronic inflammation with wall thickening
Describe features of cholangiocarcinoma
Arises from bile duct epithelium. Associated with UC. Can cause obstructive jaundice, itch, weight loss and lethargy
Describe features of acute pancreatitis
Causes; Scorpion bite, hypothermia, shock, alcohol, injury, gall stones and mumps. ( I GET SMASHED)
It causes catastrophic metabolic consequences as it decreases calcium and albumin and increases glucose. There is high serum amylase. It can cause massive fluid loss which leads to shock
Describe features of chronic pancreatitis
- Multiple episodes of acute which can cause fibrosis of pancrease which may lead to diabetes mellitus due to reduced production of enzymes
Describe features of pancreatic carcinomas
- Associated with smoking and diabetes mellitus. It causes painless, progressive jaundice with weight loss,
