Hepatobiliary & Pancreas Flashcards by Jo Nkonge

Summary of Hepatobiliary & Pancreas pathology

Liver pathology
- Jaundice, Hepatitis, Cirrhosis, IEM, HCC

Biliary pathology
- Gall stones, Cholangiocarcinoma

Pancreatic pathology
- A/C Pancreatitis, Pancreatic tumours

Investigations

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What is the most common sign of Liver D?

Jaundice

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Causes of jaundice can be divided into 3 catagories. What are they?

Pre-hepatic (too much bilirubin, unconjugated)
Hepatic (few functioning liver cells)
Post-hepatic (obstruction, conjugated)

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Which type of jaundice will present as yellow eyes + dark urine?

Hepatic jaundice

Chronic Liver D, Acute Liver injury, IEM

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Which type of jaundice would present as yellow eyes + dark urine + pale stools?

Post-hepatic jaundice

Stones, tumours, stricture

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How would pre-hepatic jaundice present?

Haemolytic anaemias, Gilbert’s

Yellow eyes/skin only

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How would you investigate jaundice?

USS (obstructive)
Liver biopsy (no obstruction)
LFTs

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The general presentation of hepatitis is..?

OFTEN ASYMPATOMATIC

Increase liver enzymes
+/- jaundice/malaise/coagulopathy/encephalopathy/death

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The causes of Acute/Chronic Hepatitis & Cirrhosis are all the same but with the latter, the insult persists. What are the causes?

HEP VIRUSES A-E
ALCOHOL
DRUGS
AUTOIMMUNE
Paracetamol
Idiopathic

Chronic: IEM, Biliary, Vascular

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Chronic Hepatitis can be staged A-D. How would you determine stage & cause?

Liver biopsy

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State the effects of alcohol on the liver.

Fatty changes (reverses when stop drinking)
Alcohol steatohepatitis
Cirrhosis

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NAFLD presents the same as…?

What are its risk factors?

Fatty Liver D

CVD risk factors

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The presentation of Fatty Liver D?

Steatosis
Steatohepatitis
Cirrhosis
HCC

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Cirrhosis is the end-point of Chronic liver D and therefore has the same causes. Define Cirrhosis.

= diffuse hepatic fibrosis & conversion of normal architecture –> abnormal nodules

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List specific complications of cirrhosis under the umbrellas of FIBROSIS, LIVER FAILURE, INFECTIONS, HCC.

FIBROSIS - portal HTN, Oesophageal varices
LIVER FAILURE - oedema, bruising, muscle wastng, ascites, jaundice
INECTIONS
HCC

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The 3 IEM that cause liver cirrhosis from abnormal depositions in liver (+other organs) are…?

a-1 Antitrypsin def - a-1 Antitrypsin
Haemochromatosis - Fe2+
Wilson’s D - Cu2+

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Splenomegaly, Oesophageal varices, Piles (peri-anal varices), Ascites are all COMPLICATIONS of what?

Portal HTN

Treat with shunt

Ascites = accumalation fo fluid in the peritoneal cavity causing abdo swelling. T/F?

HCC stands for…?

70% have Cirrhotic liver
In non-cirrhotic patients = mets

Hepatocellular Carcinoma

Risk factors for HCC?

Cirrhosis
Alcohol
M > F
Obesity
Viral Hepatitis

What blood marker is used to diagnose HCC?

a-feroprotein

What is the standard treatment for HCC?

Transplant (cirrhosis is diffuse, HCC can reoccur)

Surgery if non-cirrhotic/small

Gall stones types are: cholesterol, pigmented, mixed. What are the risk factors?

Obesity
Diabetes
F > M

Complications of Gall stones?

OBSTRUCTIONS
Cholecystitis/Cholangitis
Pancreaitis
Gall stone Ileus
Liver abscess
GB carcinoma

Treatment for gall stones?

Cholecystectomy

Cholangiocarcinoma = adenocarcinoma arising from bile ducts. What are the 2 types?

Intra-hepatic Peri-hilar (large ducts, presents early, obstructive jaundice)

The pancreas is comprised of mostly what type of tissue?

EXOCRINE 85% | destroyed 1st in pathology

Acute pancreatitis = MEDICAL EMERGENCY. What are the 2 top causes?

Gall stones* | Alcohol

Is this a presentation of Acute/Chronic pancreatitis? Test? - Severe sudden abdo pain radiating to back - Nausea/vomitting - Grey Turner's, Cullen's sign

Acute pancreatitis Amylase

Chronic Pancreatitis top 2 causes?

Alcohol Smoking (HPT, Infections, Recurrent acute, obstruction)

Intermittent abdo pain, back pain & weight loss, Diarrhoea, Steatorrhoea (FAT malabsorption), Diabetes, are presentation for what?

Chronic Pancreatitis

Investigations for Chronic Pancreatitis?

Direct function tests | -Duodenal aspirates (Secretin, CCK, Lundh tests)

Do Pancreatic adenocarcinomas arise from the exocrine or endocrine component of pancreas? Risk factors?

Exocrine ``` Smoking Alcohol Red meats M > F Hereditary cancers ~10% ```

Presentation of Pancreatic Adenocarcinoma is similar to chronic pancreatitis.

``` Epigastric pain - radiating to back Weight loss Obstructive jaundice Diabetes Courvoiser's sign Trousseau's syndrome ```

Pancreatic neuroendocrine tumours can arise from any endocrine cell. Presentation depends on hormone produced by cell. Typically presents in whom?

20-60yrs MEN1 Von-Hippel Lindau

Blood markers for Hepatocellular damage?

ALT* AST a-feroprotein

Markers for Biliary tract damage?

Conjugated bilirubin ALP y-GT

PIIINP, TIMP-1, Hyaluronic acid are markers for what?

Liver Fibrosis

Increased ALT/AST. Normal ALP is indicative of which type of jaundice?

Hepatic jaundice

Normal ALT/AST. Increased ALP is indicative of which type of jaundice?

Obstructive jaundice

IEM causing jaundice are...?

Gilberts, Crigler-Najjar Dubin-Johnson, Rotor

Indications to do LFTs?

pain,itchy, jaundice, bruising, bruising, risk factors, existing liver D