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MD3002 - GI Disease/Pathology > Hepatobiliary and Pancreatic Disease > Flashcards

Hepatobiliary and Pancreatic Disease Flashcards

(76 cards)

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1
Q

What does the liver synthesise?

A

albumin, clotting factors, complement, -1-antitrypsin, thrombopoietin

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2
Q

What is produced in the liver?

A

bile through conjugation of bilirubin

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3
Q

What does the liver break down?

A

drugs, insulin, ammonia

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4
Q

What is the action of Kupffer cells?

A

phagocytose old blood cells, bacteria and foreign materials from the bloodstream/gut

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5
Q

What is jaundice?

A
  • Yellowing of skin and mucosal surfaces – bilirubin >40mol/L
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6
Q

What can jaundice cause?

A

itch

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7
Q

Unconjugated =

A

water-insoluble

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8
Q

conjugated =

A

water-soluble (can be excreted in urine)

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9
Q

What is the result of excess conjugated bilirubin?

A

dark urine

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10
Q

Describe a prehaptic cause of jaundice

A

haemolysis  release of bilirubin from RBCs

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11
Q

Describe a intrahepatic cause of jaundice

A

liver disease; excess bilirubin in liver and bloodstream

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12
Q

Describe a post hepatic (obstructive) cause of jaundice

A

obstruction of bile outflow –> dark urine and pale stools

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13
Q

What are the main causes of acute liver injury?

A

o Viral Infections o Alcohol o Biliary obstruction (gallstones) o Adverse drug reactions

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14
Q

What are the main symptoms of acute liver injury?

A
  • Jaundice, malaise
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15
Q

What biochemical factors are altered in acute liver injury

A
  • Raised serum bilirubin (location determines the type of bilirubin) and transaminases
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16
Q

What are the main characteristics of acute liver failure?

A

decreased albumin, ascites, bruising, encephalopathy

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17
Q

What zone of liver cells are affected in acute liver injury?

A

Zone 3 = closest to the central vein so have the least oxygen. Less reserve for survival when infected with a toxin

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18
Q

What are the major characteristics of alcoholic liver injury?

A

 Steatosis  Cirrhosis  Acute hepatitis with Mallory’s hyaline

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19
Q

What processes occur in steatosis that lead to fibrosis?

A

Acetaldehyde binds to hepatocytes causing damage ⇒ inflammatory reaction

Inflammation ⇒ fibrosis

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20
Q

What processes pccur in cirrhosis?

A

fibrosis (collagen) + regeneration –> Cirrhosis

Fibrosis tries to heal the area by preventing any further damage so inflammation cannot spread. As a result this area of the liver has no function and is stiffer

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21
Q

Causes of cirrhosis

A
  • Alcohol
  • Hep B + C
  • Iron overload
  • autoimmune liver disease
  • gallstones
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22
Q

What are the main classifications of Cirrhosis?

A
  • Morphological
    • Micronodular – nodules <3mm
    • Macronodular >3mm
    • Mixed
  • Aetiological
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23
Q

What are the three main complications of cirrhosis?

A
  • liver failure
  • portal hypertension
  • hepatocellular carcinoma
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24
Q

What are the common features of liver failure?

A

hepatic encephalopathy (ammonia), build-up of steroid hormones ⇒ hypoestrogenism (palmar erythema and gynaecomastia), bleeding

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25
What are the common features of portal hypertension
increased hepatic vascular resistance, AV shunting – oesophageal varices, haemorrhoids, caput medusae
26
Describe drug induced liver injury
* 10% of all drug reactions involve the liver * Injury to liver cells (hepatocellular) – paracetamol overdose * Injury to bile production/secretion cells (cholestatic) – methyl testosterone * Always take a full drug history from a patient with deranged LFTs
27
What is the most common cause of acute biliary obstruction?
gallstones
28
What are the symptomns of acute biliary obstruction?
causes colicky pain and jaundice
29
What can be the main complication of acute biliary obstruction?
complicated by infection of blocked CBD - cholangitis (medical emergency)
30
What can chronic liver failure follow on from and what can it result in?
* A common clinical problem * Can follow a clinical evident episode of acute liver injury * May have insidious onset without symptoms until later stages * Many forms culminate in cirrhosis
31
What is chronic hepaitis?
* inflammation of the liver lasting more than 6 months * Sustained elevation of transaminases – require liver biopsy to classify cause
32
What are the main causes of chronic hepaitis?
* Viral * Alcohol * Drugs * Autoimmune
33
What are the three main classifications of chronic hepaitis?
Type – aetiology Grade – degree of inflammation Stage – degree of fibrosis
34
What is NASH/NAFLD?
Non-alcoholic steatohepatitis/Non-alcoholic fatty liver disease
35
What are NASH/NAFLD associated with?
Associated with metabolic syndrome (DM II, hypertension, decreased HDL cholesterol, ­increased triglycerides)
36
What can fat deposition in hepatocytes lead to?
cirrhosis
37
Who is autoimmune chronic hepatitis likely to occur in?
Females \> Males Usually present in mid to late teens
38
Describe the main features of autoimmune chronic hepaitis
* Interface hepatitis - hepatocytes at the interface between the bloodstream and the main hepatic substance * Plasma cells and swollen hepatocytes * Fibrosis * ANA, SMA, raised serum IgG and transaminases, anti-LKM (liver-kidney microsomal) * Patients may benefit from steroids
39
Who is primary biliary cholangitis more common in?
Females \> Males (~40-50 years old)
40
What are the stages of primary biliary cholangitis?
* Autoimmune destruction of bile duct epithelium – de3nse lymphocytic infiltration and granulomas * Proliferation of small bile ducts * Architectural disturbance – portal and bridging fibrosis * Cirrhosis
41
What are the main clinical and biochemical features of primary biliary cholangitis?
Jaundice, pruritis, xanthelasmata Raised ALP + IgM, AMA
42
Compare primary biliary cholangitis and primary sclerosing cholangitis: Age/Gender
PBC = \>50years, NOT children, F \> M PSC = Wide age range, M \> F
43
Compare primary biliary cholangitis and primary sclerosing cholangitis: Disease associations
PBC = other autoimmune diseases e.g. Sjorgens, thyroid PSC = IBD; UC
44
Compare primary biliary cholangitis and primary sclerosing cholangitis: Serum immunoglobulins
PBC = increased IgM PSC = no signficant increase
45
Compare primary biliary cholangitis and primary sclerosing cholangitis: Autoantibodies
PBC = AMA, ANA (centromeric) PSC = non-specific, AMA rare
46
Compare primary biliary cholangitis and primary sclerosing cholangitis: Colangiography
PBC = normal extrahepatic and large ducts PSC = stricturing and beading
47
Compare primary biliary cholangitis and primary sclerosing cholangitis: Bile duct injury
PBC = small ducts PSC = large ducts
48
Compare primary biliary cholangitis and primary sclerosing cholangitis: Portal inflammation
PBC = prominent PSC = less prominent
49
Compare primary biliary cholangitis and primary sclerosing cholangitis: Obliterative fibrosis of larger ducts
PBC = absent PSC = characterisitc feature
50
Compare primary biliary cholangitis and primary sclerosing cholangitis: Periportal copper
Present in PBC and PSC
51
What is haemochromatosis?
Iron deposition in the liver causing alteration of architecture ⇒ fibrosis ⇒ cirrhosis
52
AMA =
antimitochondrial antibody
53
ALP =
alkaline phosphatase
54
What are the main types of haemochromatosis?
Primary/secondary Primary = Autosomal recessive – HFE gene Secondary = from repeat blood transfusions
55
What is the treatment for haemochromatosis?
Regular venesection – test iron and ferritin
56
What causes alpha-1 antitrypsin deficiency?
Autosomal recessive disorder Low levels of a-1-antitrypsin in the blood but high levels in the liver
57
What is the pathogenesis of a-1-antitripsin?
* Proteins build up in hepatocytes as hyaline * Can lead to cirrhosis * Associated with emphysema
58
What type of condition is wilson's disease?
autosomal recessive
59
What is the pathophysiology of Wilson's disease?
* Failure of the liver to excrete copper in bile ⇒ build-up of copper in the liver ⇒ cirrhosis * Copper also deposits in brain tissue ⇒ neurological dysfunction * Kayser-Fleischer rings * Low ceruloplasmin
60
What are the main type of developmental/Hamartomas liver tumours?
Cysts Haematomas
61
What are the main type of benign liver tumours?
Incidental finding Adenoma, haemangioma Liver cysts
62
What are the main type of maligant liver tumours?
* Metastases – common (from colon) * Primary * Hepatocellular carcinoma * Cholangiocarcinoma
63
What are the main causes of hepatocellular carcinoma?
* Aflatoxins – fungal origin * Hepatitis B + C viruses * Cirrhosis (any cause)
64
What are the main pathologies assoicated with the biliary system?
* Congenital malformations * Atresia * Choledochal cysts * Gallstones (cholelithiasis) * Cholecystitis * Cholangiocarcinoma * Obstruction
65
Where does cholangiocarcinoma arise from anf what is it associated with?
Arises from bile duct epithelium anywhere in the biliary system (intra- and extra-hepatic) Associated with ulcerative colitis (PSC also at risk)
66
What are the symptoms and clinical complications associated with cholangiocarcinoma?
* Causes obstructive jaundice, itch, weight loss and lethargy * Can lead to rupture of common bile duct or gallbladder – prognosis poor
67
What are the main risk factors for gallstones?
Female, Fair, Fat, Forty, Fertile Diabetes
68
What can gallstones cause?
cholecystitis, obstructive jaundice, cholangitis, pancreatitis, cholangiocarcinoma
69
What are the main features of acute cholescysitis?
* Usually caused by gallstones * Initially sterile then becomes infected * May lead to abscess/rupture * Symptoms * RUQ pain (biliary colic), fever, nausea/vomiting
70
What are the features of chronic cholecystitis?
Invariably related to gallstones Chronic inflammation with wall thickening
71
What is annular pancreas? And what can this cause?
* Embryological malformation - part of the pancreas rotates the wrong way * 2nd part of duodenum * Causes obstruction – polydramnios, low birth weight, poor feeding
72
What are the main features of acute pancreatitis?
* Causes catastrophic metabolic consequences * High serum amylase – diagnostic * Massive fluid losses --\> SHOCK * High mortality rates
73
What are the main causes of acute pancreatitis?
* mumps * gallstones * shock (decreased BP) * hypothermia * alcohol * trauma * scorpion sting
74
What are the biocehmical markers of acute pancreatitis?
decreased calcium and albumin, increased glucose
75
What are the main features of chronic pancreatitis?
* Multiple episodes of acute * Causes fibrosis of pancreas – may lead to diabetes mellitus * Reduced production of enzymes – require supplements (creon)
76
Describe the main features of pancreatic carcinoma
* Adenocarcinoma * Associated with smoking and diabetes mellitus * Presents with painless, progressive jaundice * Weight loss * Poor prognosis * May be operable if small and close to ampulla

MD3002 - GI Disease/Pathology (11 decks)

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