Liver and Pancreas Pathology

Question 1

how is bilirubin carried in the blood

Answer 1

by being bound to albumin

Question 2

describe bilirubin conjugation

Answer 2

bilirubin is conjugated with glucornic acid by the enzyme UDP glucuonyl transferase

Question 3

what happens to conjugated bilirubin when it enters the duodenum

Answer 3

it is converted to urobiliogen and then stercobilin

Question 4

what does urine high in conjugated bilirubin look like

Answer 4

dark

Question 5

give some causes of hepatitis

Answer 5

viral, acute alcohol intake, fatty liver disease, drugs

Question 6

give some signs of hepatitis

Answer 6

fatigue, weight loss, right upper quadrant pain, jaundice

Question 7

what colour is the urine in hepatitis

Answer 7

dark

Question 8

what do the blood tests show in hepatitis

Answer 8

normal albumin, high serum bilirubin, conjugated bilirubin in urine, high ALT, normal ALP/Gamma GT

Question 9

how does hepatitis cause haptic encephalopathy

Answer 9

there is an increase in ammonia due to the urea cycle no longer occurring

Question 10

how can you check to look at the anabolism of the liver

Answer 10

look at albumin and coagulation factors

Question 11

how can you check to look at the catabolism of the liver

Answer 11

look at haemoglobin breakdown

Question 12

what can be looked at to see for hepatocyte damage

Answer 12

ALT, ALP, Gamma GT

Question 13

why does ALT increase

Answer 13

due to hepatocyte damage

Question 14

give some examples of reasons why ALT might rise

Answer 14

hepatitis, fatty liver disease, drugs, viral disease

Question 15

when is ALP high

Answer 15

due to bone disease, bile duct obstruction/damage and canalculi damage/obstruction

Question 16

when is Gamma GT raised

Answer 16

due to bile duct obstruction or alcohol

Question 17

what happens in liver cirrhosis

Answer 17

there is fibrosis which causes pressure and occlusion of the sinusoids leading to portal hypertension

Question 18

what is the effect on the venous anatomises in portal hypertension

Answer 18

blood is shunted in the opposite direction in the portal veins, through the anatomises joining with the peripheral veins

Question 19

where are varices due to portal hypertension seen

Answer 19

anorectal junction, in ligametum teres in the falciform ligament, oesophagogastric junction

Question 20

what cases liver cirrhosis

Answer 20

alcohol, hepatitis, fatty liver disease

Question 21

what are symptoms of liver cirrhosis

Answer 21

swollen legs and abdomen (ascites) - due to low albumin 
fatigue 
easily bleeding - low clotting factors 
jaundice - intra-hepatic 
weight loss

Question 22

what will blood tests show in liver cirrhosis

Answer 22

low albumin
prolonged INR
raised bilirubin
raised ALT

Question 23

what is pre-hepatic jaundice

Answer 23

where theres too much bilirubin due to an increase breakdown of RBCs

Question 24

give some causes of pre-hepatic jaundice

Answer 24

haemolytic anaemia, sickle cell anaemia, auto-immune

Question 25

what are the signs of pre-hepatic jaundice

Answer 25

``` yellow tinge raised serum bilirubin dark stool increased urobiligen in the urine no conjugated bilirubin in urine ```

Question 26

what is intra-hepatic jaundice

Answer 26

where there're problems with the liver itself so bilirubin isn't conjugated or secreted

Question 27

what causes intra-hepatic jaundice

Answer 27

hepatitis and cirrhosis

Question 28

what is cholestasis

Answer 28

where there is stasis in the liver

Question 29

in which type of jaundice is cholestasis seen in

Answer 29

intra-hepatic

Question 30

what are the signs of intra-hepatic jaundice

Answer 30

yellow/orange tinge raised serum bilirubin increased conjugated bilirubin in urine making it darker normal stool/ urinary urobiligen

Question 31

what is post-hepatic jaundice

Answer 31

where there is bile duct blockage preventing conjugated bilirubin entering the duodenum

Question 32

what are the signs of post-hepatic jaundice

Answer 32

itching - due to bile salts not being secreted pale stools (no stercobilin) conjugated bilirubin in urine (dark urine) increased serum bilirubin decreased urobiligen in urine

Question 33

what can cause bile duct obstruction

Answer 33

gallstones, pancreatic cancer, liver metastases

Question 34

what are the signs of bile duct obstruction

Answer 34

normal albumin and INR raised serum bilirubin dark urine ALP/Gamma GT raised

Question 35

what is a complication of bile duct obstruction

Answer 35

cholangitis - infection in the bile duct by E.coli due to obstruction