HPB diseases Flashcards
cells of the liver
hepatocytes - metabolism
Kuppfer cells - inflammatory response
Stellate cells - responsible for fibrosis
the liver ‘digestion’
carbs: storage and release of glucose, formation of glycogen
Lipids: fatty acid metabolism & synthesis of lipoproteins
Protein: synthesis of albumin, transport proteins, proteases, clotting factors, acute phase proteins
bilirubin
bilirubin comes from the breakdown of heamoglobin
unconjugated bilirubin is hydrophobic strongly albumin bound, and is not excreted in the urine
conjugation makes it water soluble so it can then be excreted in urine or bile (giving urine its brown colour)
conjugated bilirubin is metabolised by gut flora to urobilinogen and some is resorbed (EH circulation)
unconjugated hyperbilirubinaemia
increased delivery of hamoglobin - haemolysis e.g haemolytic anaemia
ineffective eryhtropoesis - deficiendy of B12, folate, iron, sideroblastic anaemia
heamatoma - trauma
failure to cinjugate bilirubin - Gilberts
Sideroblastic anaemia
bone marrow produces ringed sideroblast rather than erythrocytes
conjugated hyperbilirubinaemia
acute hepatocellular dysfunction - viral hep, drugs, alcoholic hep, hepatic ischamia/hypoxia
chronic hepatocellular dysfunction
biliary obstruction - stones, carcinoma pancreas, bile duct disease
model of liver disease
acute hepatitis–>chronic hep–>hepatic fibrosis–>cirrhosis
features of acute hepatitis
lethargy jaundice RUQ pain disordered clotting encephalopathy
features of chronic hepatitis
usually none
occasional fatigue and non-specific Sx
often a chance finding
Cirrhosis
fibrotic tissue disrupts hepatic architecture - venous inflow dammed back leading to portal hypertension. hepatocyte function is deregulated
disorganised hepatocyte regeneration - hepatocyte function deregulated, and constant stimulation to regenrate
this leads to nodules of hepatocytes surrounded by fibrosis - cirrhosis
increased risk of hepatoma
metabolic effects of cirrhosis
reduced synthetic capacity (albumin, clotting factors, protein)
reduced clearance of waste products (jaundice, encephelopathy)
portal HTN (ascites, varices, splenomegaly)
further effects of cirrhosis
risk of hepatoma
vascular dilatation in splanchnic bed (abdo viscera), leading to central hypovolaemia, increasing RAS, causing salt and watre retention
fluid retention and vulnerability to renal clampdown
failure of sex hormone metabolism
causes of cirrhosis
alcohol
NAFLD/NASH (non alcoholic steatohepatitis)
autoimmune (PBC, hep)
hereditary (wilson’s, heamachromatosis, alpha-1-antitrypsin deficiency)
chronic viral infection (HBV, HCV)
cryptogenic
alcoholic hepatitis
if Maddrey score >32, 50% mortality at 1 month
pancreatic disease
acute pancreatitis (alcohol, stones, familial, drugs) chronic pancreatitis: pain, exocrine insufficuency, endocrine insufficiency Cancer