Hepatobiliary and Pancreatic Disease Flashcards
What does the liver synthesise?
- albumin
- clotting factors
- complement
- a-1 antitrypsin
- thrombopoietin
What does the liver produce?
bile through bilirubin conjugation
What do Kupffer cells do?
phagocytose old blood cells, bacteria, and foreign materials from the blood stream/gut
Describe jaundice
- yellowing of skin and mucosal surface
- occurs when bilirubin levels are above 40 micromoles per L
- causes an intense itch due to irritation of nerve endings
What are the types of bilirubin in jaundice and their presentations?
- conjugated (water soluble = dark urine)
- unconjugated (water insoluble)
What are the different types of jaundice?
- pre-hepatic: occurs due to haemolysis and release of bilirubin from RBCs
- intra-hepatic: liver disease
- post-hepatic: obstruction of bile outflow resulting in dark urine and pale stools
What are the causes of acute liver injury?
- viral infections
- alcohol
- adverse drug reactions
- biliary obstruction
What are the effects of acute liver injury?
- jaundice and malaise
- raised bilirubin and transaminases
- if progression to liver failure: decreased albumin, ascites, bruising and encephalopathy
steatosis
fat deposition
Describe how alcohol damages the liver
- acetaldehyde binds to hepatocytes which causes damage
- results in an inflammatory reaction which results in fibrosis
Describe how drugs can damage the liver
- can damage liver cells (hepatocellular)
- can damage bile production-secretion cells (cholestatic)
Describe features of acute biliary obstruction
- usually caused by gallstones
- colicky pain and jaundice
- can be complicated by infection of the blocked bile duct causing infective cholangitis
What is the definition, presentation and causes of chronic hepatitis?
- inflammation of the liver lasting more than 6 months
- presents as sustained elevation of transaminases
- viral, alcohol, drugs, autoimmune causes
How can you classify chronic hepatitis?
- type (aetiology)
- grade (degree of inflammation)
- stage (degree of fibrosis)
What is NAFLD?
- non-alcoholic fatty liver disease
- associated with metabolic syndrome
- fat deposits in hepatocytes which can lead to cirrhosis
Describe the progression of primary biliary cholangitis
- autoimmune destruction of bile duct epithelium
- proliferation of small bile ducts due to damage of large duct
- architectural disturbances causes portal fibrosis
- cirrhosis
What are the differences between primary biliary cholangitis and primary sclerosing cholangitis?
PBC:
- increase in IgM
- no obliterative fibrosis of larger bile ducts
PSC:
- associated with IBD
- no increase in antibodies
- does have obliterative fibrosis of large ducts
What is haemochromatosis and how is it managed?
- iron deposition in liver causing alteration of architecture leading to fibrosis and then cirrhosis
- regular venesection (phlebotomy) and testing of iron and ferritin levels
What is alpha-1 antitrypsin deficiency?
- autosomal recessive disorder resulting in low levels of alpha-1 antitrypsin
- proteins build up in hepatocytes as hyaline which can lead to cirrhosis
What is Wilson’s Disease?
- autosomal recessive disease
- failure to excrete copper in bile resulting in build up of copper in liver and then cirrhosis
- copper can also deposit in brain tissue causing neurological dysfunction
What are causes of cirrhosis?
- alcohol
- hepatitis B and C
- iron overload
- gallstones
- autoimmune liver disease
What are the complications of cirrhosis?
- liver failure (hepatic encephalopathy, hyperoestrogensim, bleeding)
- portal hypertension (increase in vascular resistance)
- hepatocellular caricnoma
What are the different liver tumours?
- benign: adenoma, haemangioma, cysts
- malignant: metastasis and hepatocellular carcinoma, cholangiocarcinoma
What are some pathologies of the biliary system?
- congenital malformation (atresia/choledocal cysts)
- gallstones (cholelithiasis)
- cholecystitis
- cholangiocarcinoma
- obstruction
What are the risk factors and consequences of gallstones?
Risk factors (5 Fs): - female - fair - fat - forty - fertile (diabetes mellitus)
Consequences:
- cholecystitis
- obstructive jaundice
- cholangitis
- pancreatitis
- cholangiocarcinoma
What are the clinical features of cholecystitis?
- acute: gallstones, can become infected and lead to abscess and rupture
- chronic: chronic inflammation with wall thickening
Describe cholangiocarcinoma
- arises from bile duct epithelium
- associated with ulcerative colitis
- can cause obstructive jaundice, itch, weight loss, lethargy
What are the causes and consequences of acute pancreatitis?
Causes:
- scorpion bite
- hypothermia
- shock
- alcohol
- injury
- gallstones
- mumps
Consequences:
- decreases calcium and albumin, increases glucose
- metabolic consequences
- high serum amylase
- massive fluid loss leading to shock
What are the clinical features of chronic pancreatitis?
multiple episodes of acute pancreatitis
- causes fibrosis of pancreas (can lead to diabetes)
- reduces production of enzymes
What are the risk factors and symptoms of pancreatic carcinomas?
- RF: smoking and diabetes
- symptoms: painless progressive jaundice and weight loss
