Liver and Pancreas Pathology Flashcards
how is bilirubin carried in the blood
by being bound to albumin
describe bilirubin conjugation
bilirubin is conjugated with glucornic acid by the enzyme UDP glucuonyl transferase
what happens to conjugated bilirubin when it enters the duodenum
it is converted to urobiliogen and then stercobilin
what does urine high in conjugated bilirubin look like
dark
give some causes of hepatitis
viral, acute alcohol intake, fatty liver disease, drugs
give some signs of hepatitis
fatigue, weight loss, right upper quadrant pain, jaundice
what colour is the urine in hepatitis
dark
what do the blood tests show in hepatitis
normal albumin, high serum bilirubin, conjugated bilirubin in urine, high ALT, normal ALP/Gamma GT
how does hepatitis cause haptic encephalopathy
there is an increase in ammonia due to the urea cycle no longer occurring
how can you check to look at the anabolism of the liver
look at albumin and coagulation factors
how can you check to look at the catabolism of the liver
look at haemoglobin breakdown
what can be looked at to see for hepatocyte damage
ALT, ALP, Gamma GT
why does ALT increase
due to hepatocyte damage
give some examples of reasons why ALT might rise
hepatitis, fatty liver disease, drugs, viral disease
when is ALP high
due to bone disease, bile duct obstruction/damage and canalculi damage/obstruction
when is Gamma GT raised
due to bile duct obstruction or alcohol
what happens in liver cirrhosis
there is fibrosis which causes pressure and occlusion of the sinusoids leading to portal hypertension
what is the effect on the venous anatomises in portal hypertension
blood is shunted in the opposite direction in the portal veins, through the anatomises joining with the peripheral veins
where are varices due to portal hypertension seen
anorectal junction, in ligametum teres in the falciform ligament, oesophagogastric junction
what cases liver cirrhosis
alcohol, hepatitis, fatty liver disease
what are symptoms of liver cirrhosis
swollen legs and abdomen (ascites) - due to low albumin fatigue easily bleeding - low clotting factors jaundice - intra-hepatic weight loss
what will blood tests show in liver cirrhosis
low albumin
prolonged INR
raised bilirubin
raised ALT
what is pre-hepatic jaundice
where theres too much bilirubin due to an increase breakdown of RBCs
give some causes of pre-hepatic jaundice
haemolytic anaemia, sickle cell anaemia, auto-immune
what are the signs of pre-hepatic jaundice
yellow tinge raised serum bilirubin dark stool increased urobiligen in the urine no conjugated bilirubin in urine
what is intra-hepatic jaundice
where there’re problems with the liver itself so bilirubin isn’t conjugated or secreted
what causes intra-hepatic jaundice
hepatitis and cirrhosis
what is cholestasis
where there is stasis in the liver
in which type of jaundice is cholestasis seen in
intra-hepatic
what are the signs of intra-hepatic jaundice
yellow/orange tinge
raised serum bilirubin
increased conjugated bilirubin in urine making it darker
normal stool/ urinary urobiligen
what is post-hepatic jaundice
where there is bile duct blockage preventing conjugated bilirubin entering the duodenum
what are the signs of post-hepatic jaundice
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
what can cause bile duct obstruction
gallstones, pancreatic cancer, liver metastases
what are the signs of bile duct obstruction
normal albumin and INR
raised serum bilirubin
dark urine
ALP/Gamma GT raised
what is a complication of bile duct obstruction
cholangitis - infection in the bile duct by E.coli due to obstruction
