Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2.3.5. Gastrointestinal System > Liver and Pancreas Pathology > Flashcards

Liver and Pancreas Pathology Flashcards

1
Q

What is the hepatic portal system?

A

2 consecutive capillary beds

First drain from the gut, second in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the anatomy of the gallbladder connecting the liver and duodenum

A

R and L hepatic duct = common hepatic duct

Cystic duct to gallbladder

Common bile duct + pancreatic duct = ampulla of vater

Join the 2nd portion of duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the functions of the liver?

A

Metabolism

Storage = glycogen, lipoprotein, TGs

Protein prod = albumin, coag factors

Detox = CYP450, decrease drug efficacy

Bile production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Venous drainage of the gut goes where?

A

Portal vein —> liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Briefly outline the structure of the liver

A

Portal vein from gut

Sinusoids to central canal

Hepatocytes

Bile canaliculus to bile duct

Hepatic artery to sinusoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Swelling of hepatocytes results in what?

A

Occlusion of sinusoids and bile canaliculus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What major vessels make up the portal system?

A

Portal vein = carrying nutrients

Hepatic artery = supplying oxygen to the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Outline RBC breakdown

A

Lifespan 120 days

Extravascularly in macrophages in spleen/liver

Bilirubin hydrophobic so needs to be bound to albumin – carried to liver

In liver – conjugated with glycoronic acid by UDP glucuronyl transferse

Conjugated bilirubin = water sol

Secreted by hepatocytes into bile canaculi

Released into duodenum

Converted to urobilinogen

1) bacteria convert to stercobilin - excreted in faeces
2) absorbed back int the bloodstream, goes to kidneys, excreted as urobilin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Broadly speaking how do we measure liver dysfunction

A

Failure of anabolism

Failure to catabolise and excrete

Marks of hepatocyte damage/dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypoalbuminaemia reflects what?

A

Severe liver dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can a prolonged prothrombin time reflect?

A

Significant liver dysfunction = failure to prod coag factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain how jaundice can reflect liver pathology

A

Bilirubin conjugated for removal by the liver

This step is unable to take place when liver damage is present

= bilirubin still present = build up = jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of jaundice?

A

Pre-hepatic = too much bilirubin (haemolytic anaemia)

Intra-hepatic = failure to conjugate and/or secrete bilirubin (hepatitis, cirrhosis)

Post-hepatic = failure of biliary tree to convey the conjugated bilirubin to duodenum (biliary tree obstruction) (itching = pruritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is cholestasis?

A

Decreased bile flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does bilirubin affect the urine?

A

Conjugated = water sol

If serum levels are raised = excreted in urine = dark yellow colour

Can be measured with dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does urobilinogen affect the urine?

A

Will not noticeably colour the urine

Can be measured with a dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is pruritis?

A

Itching

Build up of bile salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Outline the signs and symptoms of pre-hepatic jaundice

A

Mild jaundice

V.dark stools

Urine normal

No pruritis (as able to process bile salts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

On investigation what is seen in pre-hepatic jaundice?

A

Raised serum bilirubin (due to high RBC breakdown)

Increased urinary urobilinogen (due to high bilirubin being delivered to the gut)

No conjugated bilirubin in urine (kidney working fine)

20
Q

Outline the signs and symptoms of intra-hepatic jaundice

A

Moderate jaundice

Normal stools

Dark urine (conjugated bilirubin)

No pruritis (as able to process bile salts)

21
Q

On investigation what is seen in intra-hepatic jaundice?

A

Raised serum bilirubin (liver not working properly)

Normal urinary urobilinogen (kidney convert to urobilin)

Conjugated bilirubin in urine (some conjugated bilirubin not being secreted into the bile, goes to the blood, is water sol so arrears in the urine)

22
Q

Outline the signs and symptoms of post-hepatic jaundice

A

Severe jaundice

Stools pale (low stercobilin in the gut as blocked bile release)

Urine dark (bilirubin)

Pruritis (retention of bile salts)

23
Q

On investigation what is seen in post-hepatic jaundice?

A

Raised serum bilirubin (the liver outlet is blocked, it cant go anywhere so it appears in the blood)

Decreased urinary urobilinogen (not in the gut to go the the kidneys)

Conjugated bilirubin present in urine (water sol, present in the blood, excreted in the urine)

24
Q

What are the markers of hepatocyte damage/dysfunction?

A

ALT = released by damaged hepatocytes

Alk Phos = present in bile duct and bone (high in young people due to high bone turnover)

GGT = present in bile duct and to lesser extent in hepatocytes

25
Q

Name some causes of raised ALT

A

Viral Hep

Acute alcohol intake

Fatty liver disease = can lead to cirrhosis

Drugs/toxins

26
Q

Name some causes of raised Alk Phos

A

Biliary obstruction - Cholestasis

Cirrhosis

Liver mets

Drugs

Bone disease = bone mets, fracture, oestomalacia, hyperparathyroidism, pagets disease

27
Q

Name some causes of raised GGT

A

Biliary duct obstruction

Cirrhosis

Liver mets

Drugs

Alcoholism – induces enzymes

28
Q

What investigation technique is key in identifying liver disease?

A

Ultrasonography

29
Q

How does ammonia effect the liver?

A

Hepatic encephalopathy

30
Q

What are the symptoms of hepatitis?

A

Feels generally unwell

Anorexic

Fever

R upper quad pain

Dark urine

Jaundice

31
Q

What is the important finding on a blood test in acute hepatitis?

A

Very high serum ALT

32
Q

Liver fibrosis leads to what?

A

Occlusion of hepatic sinusoids = portal hypertension

Pressure on bile canaliculi = reduced ability to excrete toxins

Fibrous tissue = reduced albumin and clotting factors

= ascites

33
Q

Name the sites of portosystemic anastomoses

A

Anorectal junction

Ligamentum teres of falciform lig

Oesophagogastric junction

34
Q

What are oesophageal varices?

A

Extremely dilated veins in the lower third of the oesophagus due to portal hypertension

35
Q

What are the symptoms of cirrhosis?

A

Fatigue/weakness

Bleeding = raised INR

Ascites = low albumen, portal hypertension

Swollen legs = hypoproteinaemia

Weight loss

Jaundice

Haematemesis (vomiting blood) and melaena (dark sticky faeces containing partially digested blood)

Confusion, slurred speech

36
Q

What is the treatment for cirrhosis?

A

Not possible to reverse

Treat = dealing with complications

Liver transplantation

37
Q

Describe the causes of biliary tree obstruction

A

Gallstones

Carcinoma of the head of pancreas

38
Q

What is cholangitis?

A

Infection in the bile ducts – e.coli

Life-threatening complication of bile duct obstruction

Charcots triad = fever, R upper quad pain, jaundice

39
Q

What causes gallstones?

A

1/5 = excess bilirubin

4/5 = excess cholesterol

40
Q

What is biliary colic?

A

Pain in the R upper quad – radiates to the tip of right scapula/shoulder

Often precipitated by eating a fatty meal

41
Q

Compare acute and chronic pancreatitis

A

Acute = premature activation of pancreatic proteases (before duodenum)

Chronic = repeated low grade pancreatitis that causes pancreatic fibrosis and calcification

42
Q

What is erythema ab igne?

A

Skin condition caused by long-term exposure to heat

43
Q

Outline the aetiology of acute pancreatitis

A

Alcohol = alters balance between proteolytic enzymes and protease inhibitors – enzyme activation

Gallstones = outflow obstruction, pancreatic duct hypertension, activation of pancreatic proteases

44
Q

What are the symptoms of pancreatitis?

A

Epigastric pain

Vomiting

45
Q

How is acute pancreatitis diagnosed?

A

Raised serum amylase

CT

46
Q

Describe the clinical presentation of pancreatic cancer

A

Anorexia

Significant weight loss

Epigastric and/or back pain

Dark urine

Pale stools

Pruritis

47
Q

What type of pancreatic tumour causes Zollinger-ellison syndrome?

A

gastrin secreting tumour

2.3.5. Gastrointestinal System (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions