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Y2 - GI > Liver Function And Pathology 2 > Flashcards

Liver Function And Pathology 2 Flashcards

1
Q

What is portal circulation?

A

The network of veins that drain through the liver before reaching the inferior vena cava

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2
Q

What is systemic circulation?

A

Any veins that drain into the IVC NOT VIA THE LIVER

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3
Q

What 3 blood vessels make up the portal vein that leads into the liver?

A

Superior mesenteric vein
Inferior mesenteric vein
Splenic vein

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4
Q

What part of the gut does the Superior Mesenteric vein drain?

A

Ascending colon
Transverse colon (proximal 2/3s)

Small intestine (duodenum, jejenum, ileum)
Caecum

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5
Q

What part of the gut does the Inferior Mesenteric Vein drain?

A

Descending colon
Sigmoid colon
Rectum (via rectal veins)

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6
Q

What does the splenic vein drain?

A

Spleen into liver

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7
Q

What is the flow of blood through the liver?

A

Portal vein (80%) + hepatic artery (20%) through portal triad -> sinusoids -> central vein -> hepatic veins

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8
Q

What is portal hypertension?

What causes it?

A

The build up of blood in the portal venous system leading to high hydrostatic pressure here

Occurs due to the fibrotic changes seen in liver cirrhosis

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9
Q

How does liver Cirrhosis cause portal hypertension?

A

The fibrotic changes in the liver means the liver cant expand as much so blood accumulates in portal system increasing the hydrostatic pressure

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10
Q

What are the 3 main complications of portal hypertension?

A

Ascites

Splenomegaly

Varices

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11
Q

Why does ascites develop with portal hypertension?

A

Build up of blood in portal system leads to increased hydrostatic pressure

Hydrostatic pressure > oncotic pressure in blood leading to fluid remaining in interstitium

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12
Q

Why does Splenomegaly develop with portal hypertension?

A

The build up of blood in the portal system backs up into the splenic vein into the spleen

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13
Q

What are Varices?

A

Dilated/distended veins that develop at sites of Portosystemic anastomosis

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14
Q

What are portosystemic anastomosis?

A

Allow flow of blood from the portal system directly to the systemic circulation bypassing the liver when its difficult for blood to flow through the liver like in liver cirrhosis

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15
Q

Describe the process of the formation of Varices with portal hypertension:

A

The increase in hydrostatic pressure in the portal system/circulation forces blood from the portal circulation directly to the systemic circulation via portosystemic anastomosis

These portosystemic anastomosis dilate/distend due to carry too much blood, they are now called Varices

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16
Q

What are the 3 main locations where Varices can develop when theres portal hypertension?

A

Oesophageal Varices
Anorectal Varices
Umbilical Varices

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17
Q

How do oesophageal Varices develop?

A

Portal hypertension
Normally left gastric vein drains lower oesophagus but the Varices divert blood to the azygous vein instead which drains to the SVC

So distension of the portosystemic anastomoses between the left gastric vein and the azygous vein

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18
Q

Why are oesophageal Varices very dangerous?

A

Very vulnerable to rupture leading to massive haemorrhage (oesophageal mucosa thin)

Needs immediate endoscopic intervention to control bleeding and measures to lower portal hypertension

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19
Q

What blood vessels do anorectal Varices form between?

A

Superior, middle and inferior rectal veins

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20
Q

Why are anorectal Varices normally painless?

A

They are above the Pectineal line

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21
Q

What is the name given to Umbilical Varices?

A

Caput medusae

22
Q

How do umbilical Varices/caput medusae present?

A

Dilated veins radiating from the umbilicus

23
Q

Why can umbilical Varices develop in an adult?

A

There’s still a connection in the adult between the umbilical vein remnant (ligamentum teres) abdominal wall and circulation

24
Q

What are the 2 bile ducts that branch directly from the livers bile ducts coalescing?

A

Left hepatic and right hepatic bile duct

25
Q

What bile duct forms from the left hepatic duct and right hepatic duct joining together?

A

Common hepatic duct

26
Q

What is the name of the bile duct that comes straight off the gall bladder?

A

Cystic duct

27
Q

What is the name of the bileduct which forms as a result of the joining of the common hepatic duct and the cystic duct?

A

Common bile duct

28
Q

What is hepatorenal syndrome?

A

Acute/rapid deterioration of kidney function due to liver cirrhosis causing portal hypertension

The failing liver is causing a failing kidney

29
Q

What is the thought pathological mechanism of Heptorenal syndrome?

A

Portal hypertension leads to splanchinc (abdominal vein) vasodilation

This leads to body perceiving systemic BP has dropped so it activates the RAAS to compensate

Renal artery constriction occurs lead to reduced kidney perfusion and therefore reduced kidney function

30
Q

What other duct joins the Common Bile Duct?

A

Pancreatic duct

31
Q

What is the point at which the common bile duct drains into the duodenum called?

A

Ampulla of Vater

32
Q

What controls the release of secretions through the common bile duct into the duodenum through the Ampulla of Vater?

A

Sphincter of Oddi

33
Q

What are gallstones made of?

Why can they form?

A

Cholesterol
Bile pigments

Form since the gall bladder concentrates bile by removing water when it’s storing it

34
Q

How can gallstones and renal stones be distinguished on an X-ray and why?

A

Renal stones show up white whereas gallstones not visible

Renal stones have a Ca2+ component

35
Q

What are the risk factors for gallstone development?

A

Diet
Lifestyle
Woman
Pregnancy

36
Q

What are 4 complications that can be caused by gallstones?

A

Biliary colic
Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis

37
Q

What is biliary colic?

A

When theres sudden onset RUQ pain a couple of hours after eating a meal due to temporary blockage of the cystic duct by a gallstone

NO INFLAMMATION

38
Q

What hormone is released following a meal which would cause the pain in biliary colic and why?

A

Cholecystokinin (CCK)

This stimulates the gallbladder to contract which is what moves the gallstone blocking the duct

39
Q

How is biliary colic treated?

A

Analgesia
Cholecystectomy (removal of gall bladder

40
Q

What is acute cholecystitis?

A

When the gallstone is permanently impacted into the wall of the cystic duct permanently blocking it

41
Q

How does acute cholecystitis present?

A

RUQ pain
Fever
INFLAMMATION (evidence of it)

42
Q

How is acute cholecystitis treated?

A

Antibiotics
Analgesia
Cholecystectomy

43
Q

What examination can be done to help diagnose acute cholecystitis?

Explain how it works:

A

Murphys sign

Put hand on patients right side of abdomen
Get them to inhale, liver and gall bladder will sink below ribs, as it touches your hand patient will have a sharp painful inhalation showing gall bladder tenderness

44
Q

What is acute ascending cholangitis?

A

An infection of the billary tree which is caused by a gallstone blocking the common bile duct

45
Q

What leads to infection causing acute ascending cholangitis?

A

The stone blocks the common bile duct which completely blocks bile flow causing stasis of bile which leads to infection behind the stone

46
Q

What does acute ascending cholangitis present with?

What are the presence of these 3 symptoms referred to as?

A

RUQ pain
Inflammation
Jaundice

All 3 = Charcots triad

47
Q

How is acute ascending cholangitis treated?

A

Antibiotics
Fluids
Surgery

48
Q

What is acute pancreatitis?

A

Gallstone blocks the common bile duct at point which major pancreatic duct joins it or more distal to this

49
Q

Describe the pathological process of acute pancreatitis caused by a gallstone:

A

Gallstone blocks the common bile duct at point which major pancreatic duct joins it or more distal to this

Leads to inc pressure in pancreatic duct so the protease enzymes become activated leading to auto digestion of the pancreas, this causes a MASSIVE INFLAMMTORY response
(Acinar cells damaged and pancreatic necrosis)

50
Q

How does acute pancreatitis present?

A

Epigastric pain that radiates to the back

Vomiting

Elevated plasma pancreatic amylase and lipase levels

Cullens and Grey turners (rare)

Y2 - GI (35 decks)

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