Liver, Biliary Tract and Pancreas - Surgery

Question 1

Describe bilirubin metabolism and pathway?

Answer 1

Heam breakdown = UNconjugated bilirubin
Travels to the liver (fat soluable) matabolised into conjugated bilirubin - stored in bile duct
Fatty food eaten - released from GB and microbes covert it into urobilinogen (absorped into blood - pee yellow) and stercobilinogen (poo brown)

Question 2

Name a cause of pre-hepatic jaundice?

Answer 2

Haemolytic anaemia (sickle-cell, thalassaemia, malaria)

Question 3

Name 7 causes of hepatic jaundice?

Answer 3

Hepatitis 
Cirrhosis
ALD
PBC
Gilbert's syndrome
Criggler-Najjar syndrome
Neonatal jaundice

Question 4

Describe physiological jaundice of the newborn and state the Mx?

Answer 4

Newborn hepatocytes haven’t fully developed yet (2-weeks) and RBC life span is shorter - as they are not able to fully convert unconjugated bilirubin into conjugated bilirubin = increased levels = deposits in basal ganglia (fat soluable) = kernicterus
Mx - phototherapy

Question 5

Name two iatrogenic ways of increasing unconjugated bilirubin levels?

Answer 5

Rifampacin
IV contrast
May impair hepatic uptake

Question 6

What is Dubin-Johnson’s syndrome?

Answer 6

AR condition with defect in enzyme that transfers conjugated bilirubin into the bile duct (MRP.2) - therefore this builds up in hepatocytes and goes into the blood = dark urine and pale stools

Question 7

Name four causes of obstructive jaundice?

Answer 7

Gallstone
Head of pancreas tumour (painless jaundice)
Cholangiocarcinoma
Liver fluke