INVESTIGATION OF LIVER AND PANCREATIC DISEASE

Question 1

Aminotransferases:

Answer 1

Alanine/ALT Aspartate/AST. Found in the cell and only released by cellular damage. ALT is more specific for liver than AST. AST also found in muscle and red blood cells.
Tumour markers – α-fetoprotein (primary hepatocellular carcinoma

Question 2

Alkaline phosphatase (ALP

Answer 2

Elevated due to increased production by cells lining the bile canaliculi and overflow into blood. Due to cholestasis (intra- or extrahepatic), Infiltrative diseases, Space-occupying lesions (tumours) and Cirrhosis. Multiple sites of production: Liver, Bone, Intestine, Placenta.

Question 3

Gamma glutamyltransferase (γGT)

Answer 3

support a liver source of raised ALP. Elevated due to structural damage
Can be induced by: alcohol, enzyme inducing agents e.g. anti-epileptics, fatty liver e.g. due to alcohol, diabetes or obesity, heart failure, prostatic disease, pancreatic disease (acute & chronic pancreatitis, cancer) and kidney damage (ARF, nephrotic syndrome, rejection).

Question 4

Bilirubin:

Answer 4

Excretory capacity of the liver and free flow of bile.
Measured as: Total, Unconjugated  Pre-hepatic & Hepatic, Conjugated  Post-hepatic (Obstructive) & Hepatic. Jaundice at serum Bilirubin > 40-50 μmol/L.

Question 5

infectious hepatitis in the short and long-term

Answer 5

acute symtoms: atigue, nausea, abdominal pain, darkening of urine, and then develops jaundice
chronic symptoms: no symptoms or only mild nonspecific symptoms such as chronic fatigue

Question 6

pathophysiological consequences of metabolic and toxic insults including paracetamol poisoning and alcohol abuse

Answer 6

CYP45 enzymes

Paracetemol –> shunted to this enzyme meaning mroe NAPQ1 remains = toxic and damages hepatocytes

Question 7

The Pancreas

Answer 7

Elongated, flattened gland lying on posterior abdominal wall. Head lies within duodenal loop. Drains via main pancreatic duct joined to the common bile duct. Opens into duodenum via Sphincter of Oddi. Essential endocrine & exocrine function.

Question 8

Endocrine Secretions

Answer 8

Islets of Langerhans) Insulin, Glucagon, pancreatic Polypeptide

Question 9

Exocrine Secretions

Answer 9

Ductal and acinar cells), Bicarbonate, Digestive enzymes, Trypsin, Chymotrypsin & Elastase, Carboxypeptidases, Amylase, Lipase.

Question 10

ACUTE PANCREATITIS

Answer 10

Acute necrotising liquefaction, inflammatory
Aetiology: Gallstones, Alcohol, Drugs, Hypertriglyceridemia, trauma, infectious.
Rare tumors, autoimmune, Scorpion Toxins!
Symptoms: Severe epigastric pain, sudden onset, radiating to the back
Potential biochemical features: Uraemia , Hypoalbuminemia, Hypocalcaemia, Hyperglycaemia, Metabolic acidosis, Abnormal LFTs
Diagnosis: Amylase or Lipase, Imaging, Clinical History

Question 11

CHRONIC PANCREATITIS

Answer 11

Progressive loss of both islet cells and acinar tissue.
Presentation: Abdominal pain, Malabsorption, Impaired glucose tolerance, Alcohol often an important factor. Malabsorption often presenting feature.
Tests of exocrine function i.e. amylase/lipase of NO value except during acute exacerbations.
Diagnosis and management: imaging, Pancreatic Function test for investigating insufficiency
Direct, Indirect, Miscellaneous: Vitamin D, calcium, FBC, LFTs, glucose, lipids
Pancreatic Function Tests
Direct (Invasive) Tests: Intubation to collect aspirates in the duodenum. Secretin, CCK, Lundh Tests
Indirect (Non-invasive) Tests: Pancreatic enzyme analysis in stools (Elastase), Trypsinogen (IRT) measured in blood in CF screening. Pancreolauryl & NBT-PABA tests.