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Medicine > Liver, Biliary Tract and Pancreas > Flashcards

Liver, Biliary Tract and Pancreas Flashcards

1
Q

What are the only two unsaturated fatty acids?

A

Linoleic acid

Linolenic acid

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2
Q

How much does the pancreas secrete daily?

A

1.5L fluid

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3
Q

What are the four lipolytic enzymes?

A

Lipase
Colipase
Phospholipase A2
Cholesterol esterase

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4
Q

What stimulates secretion of secretin?

A

Luminal acid

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5
Q

What does secretin stimulate release of?

A

Bicarbonate

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6
Q

What stimulates secretion of cholecystokinin (CCK)?

A

Proteins and fats

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7
Q

What does release of CCK do?

A

Gallbladder contraction

Stimulates pancreatic enzyme secretion

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8
Q

What does bicarbonate released from the pancreas do?

A

Neutralises gastric acid - intraluminal pH increases from 2 to 6/7

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9
Q

What stops the release of secretin?

A

Neutralisation of acid by bicarbonate

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10
Q

What are the three major types of cells in the pancreas?

A

Duct cells
Acinar cells
Islet cells

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11
Q

What are the most prevalent type of cells in the pancreas?

A

Acinar cells

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12
Q

What do duct cells secrete?

A

Bicarbonate

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13
Q

What do acinar cells secrete?

A

Pancreatic enzymes

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14
Q

What are some causes of acute pancreatitis?

A 
Obstructive
Drug/toxin/metabolic
Infectious
Vascular
Trauma
Idiopathic
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15
Q

Worldwide, what is the leading cause of acute pancreatitis?

A

Gallstones

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16
Q

What is the leading cause of acute pancreatitis in UK?

A

Alcohol

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17
Q

What is the best imaging technique for diagnosing gallstone pancreatitis?

A

Ultrasonography

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18
Q

What blood tests would you do for acute pancreatitis?

A

Serum lipase (more sensitive than amylase)
CRP
FBC, U&E, LFTs, glucose

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19
Q

When would a CT be used in pancreatitis?

A

To determine pancreatic necrosis

Look for tumours, as an unusual cause of pancreatitis

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20
Q

What are the causes of chronic pancreatitis?

A

Hereditary
Tropical
Autoimmune
Cystic fibrosis

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21
Q

What diagnostic marker is used for pancreatic cancer?

A

CA19-9

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22
Q

What type of cancer are most pancreatic cancers?

A

Adenocarcinoma

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23
Q

Where do most pancreatic cancers originate?

A

Main pancreatic duct

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24
Q

What is a definite risk factor for pancreatic cancer?

A

Smoking

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25
Q

What are the effects of pancreatic insufficiency?

A

Malabsorption - leading to diarrhoea and steatorrhoea
Weight loss
Deficiency of fat-soluble vitamins (A, D, E, K)
Diabetes

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26
Q

What are causes of pancreatic insufficiency?

A

Chronic pancreatitis - normally alcohol
Cystic fibrosis - children
Duct obstruction - normally cancer
Pancreatic atrophy - elderly

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27
Q

What test would measure pancreatic exocrine function in faeces?

A

Faecal elastase

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28
Q

When would pancreatic biopsy and cytology be done?

A

For diagnosis of cancer

Autoimmune pancreatitis

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29
Q

What is the presentation of acute pancreatitis?

A

Severe upper abdo pain
Vomiting
Prostration

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30
Q

What is the presentation of pancreatic cancer?

A 
Severe upper abdo pain
Weight loss
Diarrhoea
Jaundice (if CBD obstructed)
Recent onset diabetes
31
Q

What are the most common bile acids?

A

Cholic acid

Chenodeoxycholic acid

32
Q

What are bile acids conjugated with in the liver?

A

Taurine or glycine

33
Q

Where and by how are bile salts absorbed in the GIT?

A

Terminal ileum by active transport

34
Q

What degrades red blood cells?

A

Reticuloendothelial system - spleen and liver

35
Q

What is the first step of the degradation of haem catalysed by?

A

Haem oxygenase

36
Q

What catalyses reduction of biliverdin to bilirubin?

A

Biliverdin reductase

37
Q

How is bilirubin transported to the liver?

A

Non-covalently bound to albumin

38
Q

What catalyses formation of bilirubin diglucuronide?

A

Bilirubin glucuronyltransferase

39
Q

What happens to bilirubin diglucuronide in the intestine?

A

Hydrolysed and reduced by bacteria in gut to urobilinogen

40
Q

What is the most common type of gallstone?

A

Cholesterol

41
Q

What would raised inflammatory markers (ESR & CRP) in the presence of RUQ pain, guarding/tenderness and fever be indicative of?

A

Acute cholecystitis or empyema of gallbladder

42
Q

What is biliary colic?

A

Gallstone lodged in cystic duct/common bile duct

43
Q

How would you treat biliary colic?

A

Conservative - let stones pass

Cholecystectomy

44
Q

What are the functions of bile acids?

A

Excretion route for cholesterol
Emulsify lipids
Form mixed micelles

45
Q

How long must you have hepatitis for it to be considered chronic?

A

6 months or longer

46
Q

Which is the most common viral hepatitis occurring worldwide?

A

Hepatitis A

47
Q

How is hepatitis A spread?

A

Faeco-oral route

48
Q

Who does hepatitis A commonly affect?

A

Children and young adults

49
Q

What is the incubation period of hepatitis A?

A

Up to 2 weeks

50
Q

When is hepatitis A maximally infectious?

A

Just before jaundice appears

51
Q

What does anicteric mean?

A

Absence of jaundice

52
Q

What are the mild symptoms of hepatitis A infection?

A

Nausea
Anorexia
Distaste for cigarettes

53
Q

What symptoms of hepatitis A infection warrant an assessment in hospital?

A

Persistence of nausea or vomiting

Any mental confusion

54
Q

What is the treatment for hepatitis A?

A

Reassurance

55
Q

Will hepatitis A infection progress to chronic liver disease?

A

No

56
Q

What cells does hepatitis B virus infect?

A

Hepatocytes

57
Q

What causes liver damage in hepatitis B infection?

A

Cytotoxic T cells recognising viral antigen on hepatocytes and killing them

58
Q

What is the difference between a Th1 and a Th2 response in hepatitis B infection?

A

Th1 - associated with clearance of the virus

Th2 - linked with development of chronic infection and severe disease

59
Q

When can hepatitis B infection progress to hepatocellular carcinoma?

A

In late stages of integrated disease - where HBV DNA has become integrated with that of host

60
Q

What is the incubation period of acute HBV infection?

A

1-2 months

61
Q

What is a rise in hepatitis B antigens linked with?

A

A rise in ALT

Onset of symptoms

62
Q

What are the symptoms of hepatitis B infection?

A 
Nausea
Vomiting
Anorexia
Fever
Jaundice
Rash
Polyarthritis
63
Q

What is the treatment for acute hepatitis B infection?

A

Symptomatic treatment

64
Q

What infection can occur as a co-infection of HBV?

A

Hepatitis D infection

65
Q

What percentage of acute infection of hepatitis C are asymptomatic?

A

90%

66
Q

After how long can HCV RNA be detected?

A

1-8 weeks after infection

67
Q

What can be used to treat acute cases and chronic disease of hepatitis C?

A

Interferon

68
Q

What will the majority of asymptomatic hepatitic C infected patients go on to develop?

A

Chronic liver disease

69
Q

What can chronic liver disease as a result of hepatitis C infection go on to develop?

A

Cirrhosis within 10-30 years and some of these will develop into hepatocellular carcinoma

70
Q

What are the risk factors for development of fibrosis in hepatitis C infection?

A

Male
High alcohol intake
Fatty liver
Diabetes

71
Q

Chronic hepatitis C is usually asymptomatic. So how is it discovered?

A

Accidentally following routine bloods. Elevation in aminotransferases, usually ALT.

72
Q

What are common symptoms of chronic hepatitis C infection?

A

Fatigue
Nausea
Anorexia
Weight loss

73
Q

How is hepatitis E transmitted?

A

Enterally, usually contaminated water

Medicine (19 decks)

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