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GI > Lecture 10 - Liver and biliary system pathology > Flashcards

Lecture 10 - Liver and biliary system pathology Flashcards

1
Q

Liver functions

A

Stores:

  • Glycogen
  • Vitamins
  • Copper
  • Iron

Synthesises:

  • Glucose
  • Protein e.g. albumin
  • Bile
  • Lipids and cholesterol
  • Coagulation factors

Metabolism:

  • Bilirubin
  • Ammonia
  • Alcohol
  • Carbohydrates and lipids

Detoxifies drugs

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2
Q

Liver cirrhosis

A

Due to chronic liver injury and inflammation causing fibrosis and hepatocyte necrosis e.g.

  • Alcholoic liver disease
  • Fatty liver
  • HBV
  • Autoimmune hepatitis

Resulting in nodules
Irreversible
Impaired liver function and structure

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3
Q

Alcoholic liver disease

A
  • Increased deposition of triglycerides (weeks)
  • Alcoholic hepatitis (years)
  • Cirrhosis (years) - end stage and irreversible
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4
Q

Steatosis

A

Abnormal retention of lipids within an organ

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5
Q

Microvascular change in alcoholic disease

A 
Steatohepatitis 
Pericentral fibrosis - blue streaks
Neutrophil infiltration 
Cirrhosis 
Hepatocyte ballooning
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6
Q

Macrovascular change in alcoholic disease

A 
Liver appears:
yellow
enlarged - hepatomegaly 
soft 
greasy 
tender
  • Jaundice
  • RUQ pain

Cirrhosis - shrinks liver

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7
Q

Non alcoholic fatty liver disease

NAFLD

A

Alcoholic liver disease without alcohol

Inflammation - non - alcoholic steatohepatitis (NASH)

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8
Q

NAFLD risk factors

A

Obesity
Diabetes
Metabolic syndrome - dyslipidaemia

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9
Q

Hereditary haemochromatosis

A

Increased absorption of iron from the small intestines and excess deposition

Autosomal recessive
Increased ferritin
Risk of developing hepatocellular carcinoma

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10
Q

Wilson’s disease

A

Abnormal copper metabolism

  • reduced secretion of copper from biliary sytem therefore accumulation in tissues

Autosomal recessive
Low caeruloplasmin

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11
Q

Caeruloplasmin

A

Enzyme that aids secretion of copper in blood

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12
Q

Primary biliary cirrhosis

A

+ve anti mitochondrial antibody

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13
Q

Primary sclerosing cholangitis

A

-ve +ve anti mitochondrial antibody

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14
Q

Markers for autoimmune hepatitis

A

Anti-nuclear antibody

Anti smooth muscle antibody

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15
Q

Portal hypertension

A
  1. Fibrotic liver doesn’t expand
  2. Compresses veins entering the liver from the portal venous system
  3. Backflow
  4. Build up of blood in the portal venous system
    increases hydrostatic pressure in the portal venous system
  • Ascites
  • Splenomegaly - build up of pressure in the splenic circulation
  • Oesophageal, umbilical and anorectal varices
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16
Q

Oesophageal varices

A

Haematemesis if ruptured

17
Q

Anorectal varices

A

Painless as above pectinate line

Rarely bleed

18
Q

Umbilical varices

A

Uncommon
Caput medusa
Foetal ligamentum teres links the liver to the umbilicus

19
Q

Hepatorenal syndrome

A

Development of AKI in the presense of cirrhosis

  1. Portal hypertension
  2. Arterial vasodilation (splanchnic) - decrease BP
  3. RAAS activated
  4. Renal artery vasoconstriction decreasing GFR
20
Q

What are gall stones made from?

A

Cholesterol

Bile pigments e.g. bilirubin

21
Q

Gall stones on Xray

A

Radiolucent - dont show up on Xrays

Renal calculi do show up

Do ultrasound

22
Q

Risk factors for gall stones

A 
Diet and lifestyle - overweight
Middle aged
Female
Pregnancy 
Pre-existing liver disease
23
Q

Gall stones symptoms

A

RUQ pain
Colicky pain - on and off
Pain after eating - CCK

NO INFLAMMATION

Temporary obstruction of a gallstone usually in the cystic duct

24
Q

Complications of gallstones

A

Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis

25
Q

Acute cholecystitis

A

Inflammation of the gall bladder
Fever
Thick walled gall bladder on USS
Murphy’s sign +ve

Treatment: cholecystectomy

26
Q

Acute cholangitis

A

Infection of the biliary tree

Presents with:
Inflammation
Charcot’s triad

Treatment:
IV antibiotics
Fluids
Relieve obstruction

27
Q

Charcot’s triad

A

Jaundice
Fever
RUQ abdominal pain

28
Q

Acute pancreatitis

A

Acinar cell injury and necrosis due to blockage of the pancreatic duct

  • Inflammatory response
  • Autodigestion of pacreas

Presents with:

  • Epigastric pain radiating to the back [pancreas is retroperitoneal]
  • vomiting
  • Cullen’s sign
  • Grey Turner’s sign
29
Q

Causes of acute pancreatitis

A

Gall stones
Ethanol and alcohol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP
Drugs
30
Q

Cullen’s sign

A

Bruising on tummy

31
Q

Grey Turner’s sign

A

Bruising on flanks

32
Q

Investigations for acute pancreatitis

A
  • inappropriate release of pancreatic enzymes -amylase and lipase

CT/MRI - identify necrosis

33
Q

Management of acute pancreatitis

A

Depends on severity

  • Fluids
  • Manage gallstones
  • Organ support
34
Q

Cholelithiasis

A

Presense of gall stones

35
Q

Choledocholithiasis

A

Gall stone in the common bile duct

GI (18 decks)

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