hepatobilliary and pancreatic disease Flashcards
what is bile made from
bilirubin and bile salts
what does the liver break down
drugs, insulin, ammonia, etc.
what does the liver synthesise
albumin, clotting factors, complement, alpha 1 antitrypsin
what do Kupffer cells do
phagocytose old blood cells, bacteria and foreign materials
what concentration of bilirubin must be present for jaundice to occur
more than 40 micromoles per liter
may cause an itch
what is unconjugated jaundice
water insoluble
what is conjugated jaundice
water soluble so can be excreted in the urine. made in the liver and then joins the bile
what is the cause of prehapatic jaundice
haemolysis leading to increase release of bilirubin
what is intrahepatic jaundice
liver disease leading to excess bilirubin in the blood
what is post hepatic jaundice
obstruction of bile outflow
what are the causes of acute liver injury
viral infections
alcohol
drug reactions
gallstones leading to billiary obstruction
what are the signs of acute liver injury
jaundice, malaise
raised serum bilirubin and transaminase
decreased albumin, ascites, bruising, encephalopathy
what pattern of hepatocyte injury would you see with toxic or haemodynamic liver injury
zonal
what is steatosis
infiltration of liver cells with fat associated with metabolic disturbance
what are Mallory hyalines
an inclusion found in the cytoplasm of liver cells usually due to alchoholic liver disease
how does alcoholic liver disease occur
acetaldehyde binds to hepatocytes causing damage and inflammations
the inflammation leads to fibrosis
what are the two components of cirrhosis
fibrosis and regeneration
what are the causes of cirrhosis
alcohol hepatitis b and c iron overload gallstones autoimmune
what is the morphological classification of cirrhosis
micronodular- less than 3 mm
macronodular
or mixed
what is hepatic encephalopathy
toxins are not removed from the blood which damage the brain
e.g. ammonia
what are some of the complications of cirrhosis
hepatic encephalopathy build up of steroid hormones esp. hyperoestrogenism bleeding (clotting factors) portal hypertension AV shunting
oesophageal varices, caput medusae, haemorrhoids
carcinoma
what can methyl testosterone do
injure bile production (cholestasis)
what is cholangitis
infection of the gallbladder due to obstruction
what is chronic hepatitis
liver inflammation lasting more than 6 months
sustained elevation of transaminases
describe the classification of chronic hepatitis
- Type – aetiology
- Grade – degree of inflammation
- Stage – degree of fibrosis
what are the features of autoimmune chronic active hepatisis
usually in mid to late teens
plasma cells and swollen hepatocytes
fibrosis
raised transaminase
what is biliary cirrhosis
autoimmune destruction of bile duct epithelium proliferation of small bile ducts architectural disturbance fibrosis and cirrhosis lymphocyte infiltration
what is pruritus
severe itching of the skin
what are the symptoms of primary biliary cirrhosis
Jaundice, pruritis, xanthelasmata
what is haemochromatosis
iron deposition in the liver causing alteration of architecture and cirrhosis
autosomal recessive
what is venesection
blood letting to reduce iron or RBCs
what is alpha 1 antitrypsin deficiency
autosomal recessive disorder
proteins build up in hepatocytes
can lead to cirrhosis
what is non alcoholic steatohepatitis (fatty liver disease)
associated with metabolic syndrome
fat deposition in hepatocytes can lead to cirrhosis
what is Wilson’s disease
autosomal recessive disorder
failure of the liver to excrete copper in bile leading to cirrhosis
plus neuro dysfunction
what is Ceruloplasmin
a ferroxidase enzyme that carries copper in the blood
what are Kayser-Fleischer rings
copper deposition around the eye
what type of developmental liver tumours are there
- Cysts
* Hamartomas
what types of benign liver tumours are there
- Adenoma, haemangioma
* Liver cysts
what type of malignant liver tumours are there
- Metastases – common
- Primary –
- Hepatocellular carcinoma
- Cholangiocarcinoma
what are common causes for hepatocellular carcinoma
hepatitis B + C
cirrhosis
aflatoxins
what are common congenital malformations of the billary system
- Atresia
* Choledocal cysts
what are common diseases of the gallbladder
- Gallstones (cholelithiasis)
- Cholecystitis
- Cholangiocarcinoma
- Obstruction
what is cholangiocarcinoma
Arises from bile duct epithelium anywhere in the
biliary system (intra- and extra-hepatic)
• Associated with ulcerative colitis
• Causes obstructive jaundice, itch, weight loss and
lethargy
• Can lead to rupture of common bile duct or
gallbladder – prognosis poor
what are the risk factors for gallstones
- Female, fair, fat, forty, fertile
* Diabetes mellitus
what are the symptoms of cholecystitis
– RUQ pain (biliary colic), fever,
nausea/vomiting
wall thickening
what is an annular pancreas
obstruction around the 2nd part of the duodenum leading to
polyhydramnios, low
birth weight, poor
feeding
what are the features of pancreatitis
• Causes catastrophic metabolic consequences – ↓ calcium, ↓ albumin, ↑ glucose • High serum amylase – diagnostic • Massive fluid losses → SHOCK • High mortality rates
what causes chronic pancreatitis
• Multiple episodes of acute
• Causes fibrosis of pancreas – may lead to
diabetes mellitus
• Reduced production of enzymes – require
supplements (creon)
what are the features of pancreatic andenocarcinoma
• Associated with smoking and diabetes mellitus
• Presents with painless, progressive jaundice
• Weight loss
• Poor prognosis
• May be operable if small and close to
ampulla
what disease is cholangeocarcinoma associated with
UC
what are sustained elevation of transaminases associated with
chronich hepatitis
what are the most common causes of pancreatitis
alcohol and gallstones
also tobacco, trauma, medications, poisons
what test is diagnostic for acute pancreatitis
raised serum amylase
what type of cancer is pancreatic cancer
adenocarcinoma
what increases the risk of pancreatic adenocarcinoma
smoking
DM
what does raised transaminases indicate
chronic hepatitis
what types of hepatitis can lead to hepatocellular carcinoma
B and C
