liver and bilary system and disease

Question 1

what causes jaundice?

Answer 1

an elevation of bilirubin

Question 2

what is the normal level of bilirubin?

Answer 2

3-7mmol/L

Question 3

what enzymes are raised when the liver is inflamed?

Answer 3

transglutamase enzymes

Question 4

what enzymes are raised in alcohol toxicity in the liver?

Answer 4

cholestatic enzymes

Question 5

what are the 4 types of jaundice?

Answer 5

neonatal, haemolytic, hepatocellular and obstructive

Question 6

what causes neonatal jaundice?

Answer 6

babies are born with low levels of bilirubin transferase which helps to remove bilirubin from the body

Question 7

what is the treatment for neonatal jaundice and why does it work?

Answer 7

exposing babies to UV light, this makes the bilirubin more water soluble so can leave the blood stream

Question 8

what causes haemolytic jaundice?

Answer 8

red blood cells are destroyed which as a byproduct creates bilirubin which accumulates

Question 9

what causes hepatocellular jaundice?

Answer 9

damage to the liver means that although bilirubin is still able to be conjugated, the liver is unable to secrete the conjugated bilirubin

Question 10

what causes obstructive jaundice?

Answer 10

the bile duct is obstructed therefore conjugated bilirubin cannot be passed into the intestine to be secreted so is passed into the blood

Question 11

give 5 common symptoms of jaundice?

Answer 11

yellow skin, yellow eyes, brown urine, pale stools, fever

Question 12

bullet point explain bilirubin metabolism in circulation?

Answer 12

• red blood cells are broken down to release haemoglobin
• globin is metabolised
• haem is converted into bilirubin bound to albumin

Question 13

bullet point explain bilirubin metabolism in the liver?

Answer 13

• bilirubin dissociates from albumin and enters hepatocytes
• bilirubin is conjugated with two glucoronic acids
• bilirubin is secreted into bile and enters the small intestine
• intestinal bacteria convert bilirubin into urobilinogen
• 80% is secreted in faeces and 20% is secreted In urine

Question 14

what is hepatitis?

Answer 14

inflammation of the liver

Question 15

hepatitis A:
- how is it spread?
- incubation period?
- acute or chronic?
- any worse progression?
- symptoms?
- does it give life long immunity?

Answer 15

• faeces and orally
• short incubation period
• acute and self limiting
• no progression
• asymptomatic
• gives life long immunity

Question 16

hepatitis B:
- how is it spread?
- incubation period?
- acute or chronic?
- any worse progression?

Answer 16

• blood and sexual contact
• long incubation period
• chronic
• can progress but most make a full recovery

Question 17

hepatitis C:
- how is it spread?
- acute or chronic?
- any worse progression?
- symptoms?

Answer 17

• blood and sexual contact
• chronic
• most will develop liver disease
• asymptomatic

Question 18

hepatitis E:
- how is it spread?
- acute or chronic?
- any worse progression?
- does it give life long immunity?

Answer 18

• low person to person spread
• acute and self limiting
• no progression
• immunity is not lifelong

Question 19

explain the process of alcohol induced hepatocellular steatosis?

Answer 19

• alcohol dehydrogenase causes an excess of NADH which increases lipid biosynthesis
• assembly and secretion of lipoproteins is impaired
• lipid droplets accumulate at hepatocytes
• the liver becomes large yellow soft and greasy

Question 20

what is cirrhosis?

Answer 20

where hepatocytes are replaced by non functional connective tissue leading to reduced liver function

Question 21

give 3 causes of cirrhosis?

Answer 21

• alcohol
• drugs
• hepatitis

Question 22

give 5 symptoms of cirrhosis?

Answer 22

fluid retention
defects in anticoagulation
peripheral neuropathy
gastric bleeding
jaundice

Question 23

what causes gall stones?

Answer 23

bile is supersaturated with cholesterol, pigments and other substances and there are not enough bile salts

Question 24

give 4 symptoms of gall stones?

Answer 24

epigastric pain
pain that radiates to the back
poor digestion of fatty foods
elevated temperature