Investigations of Liver + GI Tract Disease

Question 1

Briefly describe the blood supply to the liver (2)

Answer 1

Hepatic arteries (branch of coeliac artery)
Hepatic portal vein

Question 2

Briefly describe the histology of the liver (2)

Answer 2

Blood vessels divide into liver sinusoids

Highly permeable

Question 3

What are the major functions of the liver? (7)

Answer 3

METABOLISM OF
Carbs - gluconeogenesis, glycogen synthesis, glycogenolysis
Lipids - FA synthesis, ketogenesis, bile acid synthesis, cholesterol synthesis, 25-OH-D3 synthesis
Proteins - plasma protein metabolism + ammonia detoxification
Conjugates bilirubin
Xenobiotics
Hormones - conjugation of steroid hormones, degradation of peptide hormones
Storage of vit A, B12, iron + glycogen

Question 4

What compounds are screened for in a LFT? (7)

Answer 4

Bilirubin + urobilogen

Alkaline phosphatase (ALP) = enzymes that hydrolyse phosphate esters in alkaline conditions
- increased in liver + bone disease + growing kids

Alannine aminotransferase (ALT) + aspartate aminotransferase = transfer amino groups
- increased in liver damage
- wide tissue distribution
AST:ALT ration >2 = alcohol involvement

Gama-glutamyl transferase = increased in chronic liver disease with alcohol consumption

Albumin = decreased in liver disease + inadequate protein intake

PT + INR = measure rates of prothrombin

• INR is the rate of patient PT to control pt
• reduced clotting factor synthesis in liver disease -> INR >1.2

Question 5

Describe the epidemiology of hepatocellular carcinoma. What are the symptoms, diagnosis + treatment? (6)

Answer 5

More common in males
Rel. common in SE Asia, Japan, Pacific Islands, Med
Usually presents in patients with cirrhosis or haemochromastits
Sx = upper ab pain/discomfort, weight loss, ab swelling, nausea, vomitting, constipation, bone pain
Dx = increase a-fetoprotein, increased ALP, decreased albumin + cysts on imaging
Tx = surgical resection, liver transplants, chemo, external irridation

Question 6

What are the major functions of the pancreas? (4)

Answer 6

Alkaline secretion, digestive enzyme secretions (exocrine)

Insulin, glucagon, somatostatin (endocrine)

Question 7

What are the causes of acute pancreatitis, and how is it investigated? (3)

Answer 7

Cx = alcohol, gallstones, carcinoma, post-op, trauma, drugs (diuretics, steroids
Sx = ncreased upper ab pain which radiates to the back
Dx = increased amylase + lipase in blood + urine, diagnose with US, CT

Question 8

What are the causes of gallstones, and how are they investigated? (2)

Answer 8

Can be either cholesterol stones or pigment stones

Ix = increased bilirubin, increased ALP, increased amylase, calcified gallstones in radiograph, US detection

Question 9

Describe the epidemiology of pancreatic carcinoma. What are the risk factors, symptoms and treatment? (6)

Answer 9

2x more common in men than women
80% cases in 60-80yrs group
Risk factors = smoking, alchohol, increased animal fat in diet, coffee, chronic pancreatitis, DMII
CPx = pain, jaundice, weight loss, fatigue, diarrohea, steatorrhoea, hepatomegaly
Ix = imaging, blood tests (ESR, CRP, LFT)
Tx = chemo, radiotherapy