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GI > Liver and Pancreas pathology > Flashcards

Liver and Pancreas pathology Flashcards

1
Q

What are the functions of the liver?

A
  • STORAGE (glycogen, vitamins, iron, copper)
  • METABOLISM (bilirubin, ammonia, drugs, alcohol, lipids)
  • SYNTHESIS (glucose, protein, Tipis and cholesterol, bile, albumin, coagulation factors)
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2
Q

What are the vague symptoms a patient with liver pathology may present with?

A
  • nausea
  • vomiting
  • fatigue
  • anorexia
  • abdominal pain
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3
Q

What are some acute causes of liver disease?

A
  • paracetemol oversoe
  • other medication (tetracycline)
  • acute viral infections HEP A/B and EBV
  • acute excessive alcohol intake
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4
Q

What are the factors of acute liver failure?

A

rapid onset

no history of liver disease

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5
Q

What is liver cirrhosis?

A

-typically the end result of a lot of conditions and will develop in response to any chronic liver injury

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6
Q

What are chronic liver injuries?

A
  • fibrosis caused by ongoing inflammation
  • hepatocyte necrosis
  • architectural changes (nodules)

IRREVERSIBLE changes

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7
Q

What is the end result of these irreversible changes?

A

impairment of liver function and distortion of the architecture (can get hepatomegaly or the liver can shrink)

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8
Q

What is the most common causes of liver cirrhosis?

A

alcoholic liver disease

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9
Q

What is alcoholic liver diseases?

A

damage to the liver that occurs after exposure to alochol

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10
Q

What are the 3 main mechanisms by which alcohol can affect the liver?

A

1) fatty changes (weeks) (initially reversible if you avoid alcohol) (will see mallory bodies under microscope
2) alcohol hepatitis (years) (also initially reversible but will get signs of inflammation)
3) irreversible damage (years) (build up of acetylaldehyde) - end stage

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11
Q

What are the key features of cirrhosis under the microscope?

A 
blue streaks (fibrosis)
lots of neutrophils (due to inflammation)
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12
Q

How is alcoholic liver disease diagnosed and what are the symptoms?

A
  • history
  • may be asymptomatic or have general symptoms
  • fatty liver causing hepatomegaly (with cirrhosis it tends to shrink)
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13
Q

What would alcoholic hepatitis present with?

A 
rapid onset jaundice
tender hepatomegaly (pain in RUQ)
nausea
oedema
ascites
splenomegaly
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14
Q

What is HBV and HCV?

A

Hepatitis B and C

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15
Q

How does hepatitis cause cirrhosis?

A

leads to inflammation and necrosis of the hepatocytes

  • the hepatocytes will swell and compress the sinusoids and canaliculi as these have a low pressure inside
  • the hepatic artery will not be compress due to a high pressure inside it
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16
Q

What can the compression of the sinusoids and caniculli cause?

A

can lead to liver failure giving an increased risk of infection, increased susceptibility to toxins and increase blood ammonia due to less urea cycles which all causes hepatic encephalopathy (altering the level of consciousness)

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17
Q

What are the signs of hepatitis?

A

feeling unwell, anorexia RUQ pain dark urine, jaundice

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18
Q

NOTES

A

HEP C has no vaccine but a cure

HEP B has vaccine but no cure

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19
Q

What is NAFLD?

A

non-alcoholic fatty liver disease

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20
Q

What is NAFLD?

A

non-alcoholic fatty liver disease

  • has a similar pathogenesis to alcoholic liver disease but without the alcohol
  • also can be familial
  • there is an accumulation of triglyceride in the hepatocytes causing inflammation to be present
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21
Q

What are some risk factors of NAFLD?

A
  • obesity
  • diabetes
  • dyslipidaemia (metabolic syndrome)
  • familial hyperlipidaemia
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22
Q

How can you treat NAFLD?

A
  • reduce risk factors
  • lifestyle modification
  • oral hypoglycaemic agents
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23
Q

What are 2 rare causes of cirrhosis?

A
  • hereditary haemochromatosis

- wilson’s disease

24
Q

What is hereditary haemochromatosis?

A
  • abnormal iron metabolism
  • increased iron absorption from the SI and excess deposition in the liver
  • autosomal recessive
  • incresed ferritin
25
Q

Why does the increased ferritin not give a clear diagnosis?

A

it is an acute phase protien

26
Q

What are the risks of HH?

A

-risk of developing hepatocellular carcinoma

27
Q

How is HH managed?

A

venesection for life

28
Q

What is wilson’s disease?

A

abnormal copper metabolism

  • reduced secretion of copper from the biliary system causing accumulation in tissues
  • autosomal recessive
29
Q

What would a blood test show with wilson’s disease?

A

low caeruloplasmin (which is normally a way of helping copper to be secreted)

30
Q

What are some other causes of cirrhosis?

A
  • alpha 1 antitrypsin
  • glycogen storage disease
  • budd-chiari
31
Q

What are the complications of cirrhosis?

A

portal hypertension

32
Q

What is portal hypertension and why does it occur?

A

build up of blood in the portal venous system as fibrotic liver doesn’t expand well and compresses veins entering the liver from the portal venous system, causing an increased hydrostatic pressure (ascites) and build up of pressure in the splenic circulation (splenomegaly)

33
Q

What happens with portal hypertension?

A

blood can shunt from the portal system to the systemic venous circulation via anastomoses that are not usually used leading to distension of the veins at the site of the anastomoses –> varicies

34
Q

Where are the clinically important sites of varicies?

A
  • oesophageal - can rupture causing haematemesis
  • anorectal - painless and rarely bleed
  • umbilical - ligamentum trees of the falciform ligament where veins are found inside
35
Q

What are the symptoms of liver cirrhosis?

A

fatigue, bleeding easily, ascites, oedema, jaundice, weight loss

36
Q

What is hepatorenal syndrome?

A

the development of AKI in the presence of cirrhosis

37
Q

How does hepatorenal syndrome come about?

A

-portal hypertension causes arterial vasodilation which activates the RAAS and you then get renal arty vasoconstriction which long term can cause AKI - once liver failure is reversed, kidney function improves

38
Q

What are gallstones made of?

A
  • cholesterol

- bile pigmetns

39
Q

How can you confirm gallstones?

A

do an USS and look for presence and location

-they are radiolucent compared to kidney stones

40
Q

What are the risk factors for gallstones?

A 
diet and lifestyle
age
gender
pregnancy
pre-existing liver disease
41
Q

What are the complications of gallstones?

A
  • biliary colic
  • acute cholecystitis
  • acute ascending cholangitis
  • acute pancreatitis
42
Q

What is biliary colic?

A

the temporary obstructions of a gallstone in the cystic duct

-NO SYMPTOMS OR FEATURES OF INFLAMMATION

43
Q

Where would you have pain with biliary colic?

A

RUQ that can radiate to the tip of the shoulder

-typically onset a few hours after a fatty meal

44
Q

How is biliary colic managed?

A

analgesia

elective cholecystectomy

45
Q

What is acute cholecystitis?

A

inflammation of the gallbladder that develops over hours due to a gallstone being stuck in the cystic duct

46
Q

How does acute cholecystitis present?

A

-Initial presentation very similar to biliary coli but will get inflammatory features seems on US

47
Q

What features on US would you see with AC?

A

-thickened wall of gall bladder due to a more permanent blockage

48
Q

What is murphy’s sign?

A

when you place your hand on the RHS of the abdomen and ask the patient to breath in, the gallbladder will hit your fingers and will be painful so patient will say “ow”

49
Q

How is acute cholecystitis managed?

A
  • conservative firstly

- cholecystectomy

50
Q

What is acute ascending cholangitis?

A

an infection of the biliary tree typically due to impacted common bile duct stone or other obstructive causes
-E-coli is the pathogen

51
Q

What does acute ascending cholangitis present with?

A

“charcot’s triad”

  • pain in RUQ
  • features of inflammation
  • jaundice
52
Q

How is acute ascending cholangitis managed?

A

IV antibiotics, fluids and relieve obstruction

53
Q

What is acute pancreatitis?

A

end result is ‘auto-digestion’ of the pancreas due to acing cell injury and necrosis causing blockage of the pancreatic duct evoking an inflammatory response

54
Q

What are the causes of acute pancreatitis?

A

G - gallstones
E - ethanol (alcohol)
T - Trauma

S - Steroids
M - Mumps
A - autoimmune
S - scorpain bite
H - hyperlipidaemia
E - ERCP
D - Drugs
55
Q

How does acute pancreatitis present?

A

patients has epigastric pain that often radiates to back (as pancreas is retroperitoneal)
-vominitng
-cullens and grey turned sign
(cullens is bruising on tummy and greys is bruising down the sides)

56
Q

How is acute pancreatitis managed?

A

depends on severity but need fluids, management of gallstone and organ support

GI (10 decks)

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