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MD3002 GI/GU/Renal > Hepatobiliary and Pancreatic Disease > Flashcards

Hepatobiliary and Pancreatic Disease Flashcards

1
Q

What does the liver synthesise?

A
  • albumin
  • clotting factors
  • complement
  • a-1 antitrypsin
  • thrombopoietin
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2
Q

What does the liver produce?

A

bile through bilirubin conjugation

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3
Q

What do Kupffer cells do?

A

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

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4
Q

Describe jaundice

A
  • 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
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5
Q

What are the types of bilirubin in jaundice and their presentations?

A
  • conjugated (water soluble = dark urine)

- unconjugated (water insoluble)

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6
Q

What are the different types of jaundice?

A
  • 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
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7
Q

What are the causes of acute liver injury?

A
  • viral infections
  • alcohol
  • adverse drug reactions
  • biliary obstruction
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8
Q

What are the effects of acute liver injury?

A
  • jaundice and malaise
  • raised bilirubin and transaminases
  • if progression to liver failure: decreased albumin, ascites, bruising and encephalopathy
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9
Q

steatosis

A

fat deposition

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10
Q

Describe how alcohol damages the liver

A
  • acetaldehyde binds to hepatocytes which causes damage

- results in an inflammatory reaction which results in fibrosis

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11
Q

Describe how drugs can damage the liver

A
  • can damage liver cells (hepatocellular)

- can damage bile production-secretion cells (cholestatic)

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12
Q

Describe features of acute biliary obstruction

A
  • usually caused by gallstones
  • colicky pain and jaundice
  • can be complicated by infection of the blocked bile duct causing infective cholangitis
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13
Q

What is the definition, presentation and causes of chronic hepatitis?

A
  • inflammation of the liver lasting more than 6 months
  • presents as sustained elevation of transaminases
  • viral, alcohol, drugs, autoimmune causes
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14
Q

How can you classify chronic hepatitis?

A
  • type (aetiology)
  • grade (degree of inflammation)
  • stage (degree of fibrosis)
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15
Q

What is NAFLD?

A
  • non-alcoholic fatty liver disease
  • associated with metabolic syndrome
  • fat deposits in hepatocytes which can lead to cirrhosis
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16
Q

Describe the progression of primary biliary cholangitis

A
  • autoimmune destruction of bile duct epithelium
  • proliferation of small bile ducts due to damage of large duct
  • architectural disturbances causes portal fibrosis
  • cirrhosis
17
Q

What are the differences between primary biliary cholangitis and primary sclerosing cholangitis?

A

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
18
Q

What is haemochromatosis and how is it managed?

A
  • iron deposition in liver causing alteration of architecture leading to fibrosis and then cirrhosis
  • regular venesection (phlebotomy) and testing of iron and ferritin levels
19
Q

What is alpha-1 antitrypsin deficiency?

A
  • autosomal recessive disorder resulting in low levels of alpha-1 antitrypsin
  • proteins build up in hepatocytes as hyaline which can lead to cirrhosis
20
Q

What is Wilson’s Disease?

A
  • 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
21
Q

What are causes of cirrhosis?

A
  • alcohol
  • hepatitis B and C
  • iron overload
  • gallstones
  • autoimmune liver disease
22
Q

What are the complications of cirrhosis?

A
  • liver failure (hepatic encephalopathy, hyperoestrogensim, bleeding)
  • portal hypertension (increase in vascular resistance)
  • hepatocellular caricnoma
23
Q

What are the different liver tumours?

A
  • benign: adenoma, haemangioma, cysts

- malignant: metastasis and hepatocellular carcinoma, cholangiocarcinoma

24
Q

What are some pathologies of the biliary system?

A
  • congenital malformation (atresia/choledocal cysts)
  • gallstones (cholelithiasis)
  • cholecystitis
  • cholangiocarcinoma
  • obstruction
25
Q

What are the risk factors and consequences of gallstones?

A 
Risk factors (5 Fs):
- female
- fair
- fat
- forty
- fertile
(diabetes mellitus)

Consequences:

  • cholecystitis
  • obstructive jaundice
  • cholangitis
  • pancreatitis
  • cholangiocarcinoma
26
Q

What are the clinical features of cholecystitis?

A
  • acute: gallstones, can become infected and lead to abscess and rupture
  • chronic: chronic inflammation with wall thickening
27
Q

Describe cholangiocarcinoma

A
  • arises from bile duct epithelium
  • associated with ulcerative colitis
  • can cause obstructive jaundice, itch, weight loss, lethargy
28
Q

What are the causes and consequences of acute pancreatitis?

A

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
29
Q

What are the clinical features of chronic pancreatitis?

A

multiple episodes of acute pancreatitis

  • causes fibrosis of pancreas (can lead to diabetes)
  • reduces production of enzymes
30
Q

What are the risk factors and symptoms of pancreatic carcinomas?

A
  • RF: smoking and diabetes

- symptoms: painless progressive jaundice and weight loss

MD3002 GI/GU/Renal (64 decks)

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