Hepatobiliary and Pancreatic Disease

Question 1

What does the liver synthesis and produce?

Answer 1

Synthesis - Albumin, clotting factors, complement, alpha-1 antitrypsin and thrombopoietin.
Produces - Bile through conjugation of bilirubin

Question 2

What is the function of Kupffer Cells?

Answer 2

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

Question 3

What is jaundice?

Answer 3

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.

Question 4

Describe the two forms of bilirubin in jaundice

Answer 4

It can either be unconjugated (water insoluble) or conjugated (water soluble causing dark urine)

Question 5

Describe the different classes of jaundice

Answer 5

(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

Question 6

What are the causes and symptoms/signs of acute liver injury?

Answer 6

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.

Question 7

What is steatosis>

Answer 7

Fat deposition

Question 8

Describe how alcoholic liver injury can occur

Answer 8

Acetaldehyde binds to hepatocytes causing damage which results in an inflammatory reaction which results in fibrosis

Question 9

Describe features of drug induced liver injury

Answer 9

Can have injury to liver cells (hepatocellular) for example via paracetamol overdose or injury to bile production-secretion cells (cholestatic) Eg, methly testosterone

Question 10

Describe some features of acute biliary obstruction

Answer 10

Usually due to gallstones, it causes colicky pain and jaundice. It can be complicated by infection of the blocked bile duct causing infective cholangitis

Question 11

What is chronic hepatitis and what are some causes?

Answer 11

Inflammation of the liver lasting more than 6 months and presents with sustained elevation of transaminases. Causes can be viral, alcohol, drugs or autoimmune

Question 12

How is chronic hepatitis classified?

Answer 12

Type (aetiology), grade (degree of inflammation) and stage (degree of fibrosis)

Question 13

What is NAFLD and describe some features

Answer 13

Non-alcoholic fatty liver disease which is associated with metabolic syndrome (DM 2, hypertension ect) Fat deposits in hepatocytes can lead to cirrhosis

Question 14

Briefly describe autoimmune chronic active hepatitis

Answer 14

Usually presents in mid to late teens with chronic hepatitis caused by inflammatory cells. They may benefit from steroids

Question 15

Describe the stages of primary biliary cholangitis

Answer 15

• Autoimmune destruction of bile duct epithelium,
• Proliferation of small bile ducts due to damage of the large duct,
• Architectural disturbances causes portal fibrosis,
• Cirrhosis

Question 16

ALP tends to be more raised with?

Answer 16

Biliary disease rather than liver.

Question 17

Describe some of the differences between primary biliary cholangitis and primary sclerosing cholangitis

Answer 17

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

Question 18

What is haemochromatosis and how is it managed?

Answer 18

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

Question 19

Describe features of alpha-1 antitrypsin deficiency

Answer 19

• Autosomal recessive disorder which results in low levels of alpha-1 antitrypsin. Proteins build up in hepatocytes as hyaline which can lead to cirrhosis

Question 20

Describe features of Wilson’s Disease

Answer 20

• 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.

Question 21

What are some causes of cirrhosis?

Answer 21

Alcohol, hepatitis B and C, iron overload, gallstones or autoimmune liver disease

Question 22

What are the complications of cirrhosis?

Answer 22

Liver failure (Hepatic encephalopathy, hyperoestrogenism and bleeding),
Portal hypertension (due to increase in vascular resistance)
Hepatocellular carcinoma

Question 23

Name some different liver tumours

Answer 23

Benign - Adenoma, haemangioma and cysts.

Malignant - Metastasis and hepatocellular carcinoma and cholangiocarcinoma

Question 24

Name some pathologies of the biliary system

Answer 24

• Congenital malformations (atresia or choledocal cysts),
• Gallstones (cholelithiasis),
• Cholecystitis,
• Cholangiocarcinoma,
• Obstruction

Question 25

Describe features of gallstones

Answer 25

Risk factors (5 F's); Female, fair, fat, forty, fertile. diabetes melitis) 
They cam cause cholecystitis, obstructive, jaundice, cholangitis, pancreatitis and cholangiocarcinoma

Question 26

Describe features of cholecystitis

Answer 26

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

Question 27

Describe features of cholangiocarcinoma

Answer 27

Arises from bile duct epithelium. Associated with UC. Can cause obstructive jaundice, itch, weight loss and lethargy

Question 28

Describe features of acute pancreatitis

Answer 28

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

Question 29

Describe features of chronic pancreatitis

Answer 29

• Multiple episodes of acute which can cause fibrosis of pancrease which may lead to diabetes mellitus due to reduced production of enzymes

Question 30

Describe features of pancreatic carcinomas

Answer 30

• Associated with smoking and diabetes mellitus. It causes painless, progressive jaundice with weight loss,