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ESA3 GI > Liver/Pancreas Pathologies > Flashcards

Liver/Pancreas Pathologies Flashcards

1
Q

What is produced by the liver ?

A

Albumin
Glycogen
Coagulation factors
Bile

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2
Q

What is catabolised in the liver ?

A 
Drugs (CYP450)
Hormones
Haemoglobin
Toxins(CYP450)
Can take over removal of RBC after splenectomy
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3
Q

How can you test for liver dysfunction (not integrity ) ?

A
  • Plasma Albumin = hypoalbuminaemia

- Coagulation factors = prolonged INR (international normalised ratio) or Prothrombin time

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4
Q

What is the normal lifespan of RBC ?

A

120 days

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5
Q

What are the products of RBC breakdown and what happens to them ?

A
  • Haemoglobin broken down in globin and heme
  • Globin is broken down in aaback to plasma
  • Heme gives iron which goes to plasma and Bilirubin which enters bilirubin metabolism
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6
Q

Briefly describe the bilirubin metabolism

A

Unconjugated bilirubin released from heme > is hydrophobic so binds to Albumin and carried to liver > conjugated to glucoronic acid by UDP glucuronyl transferase > conjugated bilirubin secreted in bile > converted to urobilinogen in gut > 90% to stercobilin in faeces , 10% reabsorbed and converted to urobilin in kidney

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7
Q

How can you test for abnormalities of bilirubin production or secretion ?

A

Test for plasma bilirubin levels
Urinary urobilinogen (dipstick)
Urinary conjugated bilirubin (dark urine or dipstick)

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8
Q

What is jaundice ? What are the different types ?

A

Raised plasma bilirubin , deposit in tissue ,give yellow colour (conjunctiva)

Pre-hepatic, intra-hepatic, post-hepatic

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9
Q

What causes pre-hepatic jaundice ?

A

Excessive haemolysis : Sickle cell disease, autoimmune disease

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10
Q

What signs are seen in pre-hepatic jaundice ? What would be the result of investigations ?

A
  • Mild-jaundice
  • Very dark stools
  • Normal urine
  • Raised plasma bilirubin
  • increased urinary urobilinogen
  • no urinary conjugated bilirubin
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11
Q

What causes intra-hepatic jaundice ?

A

Failure of hepatocyte so to conjugate and / or secrete bilirubin (decreased secretion to gut )
Eg: hepatitis , cirrhosis , Cholangitis ,drugs

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12
Q

What are the signs of intra-hepatic jaundice and investigation results ?

A
  • moderate jaundice
  • normals stools
  • Dark urine
  • Raised serum bilirubin
  • Presence of conjugated bilirubin in urine
  • Normal Urobilinogen in urine
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13
Q

What causes post-hepatic jaundice ?

A

Failure of the biliary tree to bring bilirubin to gut

Eg: biliary tree obstruction (gallstones) , carcinoma…

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14
Q

How do you call bile stuck in the liver ?

A

Cholestasis

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15
Q

What signs and investigation are present in post-hepatic jaundice ?

A
  • Severe jaundice (green)
  • Pale stools
  • Dark urine
  • Pruritis (itching)
  • Raised plasma bilirubin
  • Decreased urine urobilinogen
  • Presence of conjugated bilirubin in Urine
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16
Q

What causes Pruritis in post-hepatic jaundice ?

A

Cholestasis cause deposition of bile salt in skin

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17
Q

Do you expect patient with post-hepatic jaundice to have xanthelasma ? Why ?

A

Yes , raised plasma cholesterol due to decreased secretion of bile salt in gut

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18
Q

What markers are used to assess liver damage ?

A

ALT : alanine aminotransferase

Alkaline Phosphatase

Gamma GT

19
Q

Damage to what causes raised ALT ? In which conditions would you expect to see raised ALT ?

A

Inflammed or damaged hepatocytes release ALT

Seen in Hepatitis due to Viral infection (A,B,C) , Acute alcohol intake , Fatty liver disease, Drugs/toxins

20
Q

Where is Alkaline Phosphatase present ?

A
  • Liver canaliculi
  • Bile ducts
  • Bones
21
Q

In which conditions would you expect to see raised AlkPhos ?

A
  • Bile duct/liver disease with cholestasis : biliary obstruction , cirrhosis (compression of canaliculi ) , liver metastases, drugs
  • Bone disease : bone metastases, fracture, osteomalacia,hyperparathyroidism, Paget’s disease of the bone
22
Q

What is Paget’s disease of the bone ?

A

Due to change in balance between activity of bone cells : remodelling

Causes bones to be enlarged , distorted, porous

23
Q

When is Gamma GT produced ?

A
  • Present in bile duct cells , a little in hepatocytes

- Production is induced by alcohol

24
Q

When do you expect gamma GT to be increased ?

A
  • Biliary duct obstruction, cholestasis
  • Cirrhosis
  • Liver metastasis
  • Drugs

-Alcoholism

25
Q

What are the symptoms of hepatitis ?

A
  • Generally unwell
  • Anorexia
  • Jaundice
  • Fever
  • Right upper quadrant pain
  • Dark urine
26
Q

What would the blood and urine test look like I acute hepatitis ?

A
  • Raised serum bilirubin
  • conjugated bilirubin in Urine
  • Very high ALT
  • Normal albumin and INR
  • Normal AlkPhos and GammaGT
27
Q

What causes hepatic encephalopathy ? Which condition ?

A

Ammonia

Liver failure : can’t complete urea cycle

28
Q

What is liver cirrhosis ?

A

Progressive disease in which healthy liver tissue is replaced with scar tissue (fibrosis)

29
Q

What are the main causes of liver cirrhosis ?

A

Alcohol
Viral hepatitis
Fatty liver disease
Idiopathic

30
Q

What are the symptoms of cirrhosis ?

A
  • Fatigue
  • Bleeding and bruising(prolonged INR)
  • Ascites
  • Oedema (legs)
  • Jaundice
  • Weight loss (can’t absorb nutrients )
  • confusion,slurred speech : hepatic encephalopathy
31
Q

What are the typical test results in cirrhosis ?

A

May be normal

  • low albumin
  • prolonged INR
  • raised bilirubin
  • may have increased ALT
  • AlkPhos normal
  • GammaGT may be high if due to alcoholism
32
Q

What are the consequences of cirrhosis on bloodflow ?

A
  • Portal hypertension (leading to oesophageal varices, haemorrhoids, Caput medusa (bleeding in ligamentum teres)
  • No nutrients absorption
  • Obstruction Of bile duct
33
Q

What are the 2 main causes officially duct obstruction?

A
  • Gallstone

- Carcinomaof head of pancreas

34
Q

What lab results would you see in biliary duct obstruction ?

A
  • normal ALT,INR,Albumin
  • Very high bilirubin
  • conjugated bilirubin in Urine
  • AlkPhos and GammaGT raised
35
Q

What is cholangitis ?

A

Infection (E coli)of the bile duct, ascending infection can reach the liver. Usually due to gallstone blocking common bile duct

36
Q

What are the symptoms of cholangitis ?

A

Charcot’s triad :
Right upper quadrant pain
Fever
Jaundice

37
Q

When does acute cholecystitis happen and what are the symptoms ?

A

Gallstone obstruct cystic duct , Stasis in gallbladder : infection usually E. coli

Symptoms : pyrexia, tender over gallbladder , toxic (generally unwell)

38
Q

What is the aetiology of acute pancreatitis ?

A

Premature activation of pancreatic protease in the pancreas rather than duodenum : auto digest pancreas and peritoneum

39
Q

What causes the activation of proteases in acute pancreatitis ?

A

Alcohol : alters balance between proteolytic enzymes and protease inhibitors

Gallstones : outflow obstruction leads to pancreatic duct hypertension and toxic effect of bile salts contribute to activation of proteases

40
Q

When does chronic pancreatitis occur and what are the consequences ?

A

Due to repeated low grade pancreatitis : causes fibrosis of pancreas , pancreas becomes calcified

Often due to alcohol abuse

41
Q

Where is the pain located in pancreatitis ? Other symptoms ?

A

Epigastric and back pain

Vomiting

42
Q

What would be the lab results in acute pancreatitis ?

A

Raised serum amylase and lipase

Ct scan also used to see calcification, pseudocyst…

43
Q

How is acute pancreatitis treated ?

A

No specific treatment

Supportive treatment : analgesic , Fluid resuscitation

44
Q

What are the signs and symptoms of pancreatic cancer ?

A

Anorexia,weight loss, fatigue

Epigastric and or back pain

Dark urine,pale stools, pruritis : if common bile duct obstruction or metastasis to liver

ESA3 GI (9 decks)

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