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GI > Liver Problems > Flashcards

Liver Problems Flashcards

0
Q

What is alcoholic hepatitis?

A

Inflammation of hepatocytes caused by alcohol

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1
Q

How does fatty liver occur?

A

Alcohol metabolism does NAD+ -> NADH
Increased NADH induces fatty acid synthesis
Decreased NAD+, get decreased fatty acid oxidation, accumulation of fatty acids in the liver
Glycerol -> TAGs
Accumulate -> fatty liver

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2
Q

Pathology of cirrhosis

A

Liver cell necrosis
Modular regeneration and fibrosis
Increased resistance to blood flow and reduced liver function

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3
Q

Complications of cirrhosis?

A 
Hepatocellular carcinoma
Liver failure
Encephalopathy
Wernicke-Korsakoff syndrome
Dementia
Epilepsy
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4
Q

Causes of liver cirrhosis?

A 
Alcohol
Wilson's disease
α-1 antitrypsin deficiency
Biliary cirrhosis
Haemochromatosis
Hep B/C
Autoimmune hepatitis
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5
Q

Clinical features of liver cirrhosis?

A 
Liver dysfunction
Jaundice
Anaemia
Bruising
Palmar erythema
Duputren's contracture
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6
Q

What is Wilson’s disease?

A

When the body cannot excrete copper effectively in the bile

Copper builds up in hepatocytes, spills into bloodstream and is deposited in other organs, often the brain

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7
Q

Lab results for cirrhosis?

A 
Normal/raised ALT and AST
Raised alkaline phosphatase
Raised bilirubin
Decreased albumin
Deranged clotting
Decreased sodium
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8
Q

Management of cirrhosis?

A

Stop drinking
Treat complications
Transplant

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9
Q

What is portal hypertension?

A

When portal venous pressure is >20 mmHg

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10
Q

What can portal hypertension be caused by?

A

Obstruction of portal vein

  • congenital
  • thrombosis
  • extrinsic compression

Obstruction of flow within liver

  • cirrhosis
  • hepatoportal sclerosis
  • schistosomiasis
  • sarcoidosis
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11
Q

What can portal hypertension lead to?

A

Ascites
Splenomegaly
Oesophageal varices, haemorrhoids and caput medusae

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12
Q

How does portal hypertension lead to ascites?

A

High pressure in portal venous system means blood is backed up in abdomen
Increased hydrostatic pressure in the abdomen
Less fluid reabsorbed into blood vessels at the end of the capillary beds

Reduced oncotic pressure in the vessels - lack of plasma proteins

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13
Q

How can portal hypertension lead to splenomegaly?

A

Increased blood pressure in the spleen

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14
Q

Where are the porto-systemic anastamoses?

A

Oesophageal branch of left gastric vein and oesophageal tributaries of azygous system

Superior rectal branch of inferior mesenteric vein (portal) and inferior rectal veins

Para umbilical and retroperitoneal veins of posterior abdominal wall or diaphragm

Colic/splenic/portal and retroperitoneal veins of posterior abdominal wall or diaphragm

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15
Q

Risk factors for gall stones?

A 
Female
Age
Obesity then rapid weight loss
Multiparity
Diet
Developed countries
Drugs (the pill)
Ileal disease or resection
Haemolytic disease
16
Q

How are bile acids concentrated in the gall bladder?

A

Sodium and water transport across the gall bladder epithelium

17
Q

Symptoms of acute pancreatitis?

A 
Oedema
Haemorrhage
Severe pain
Vomiting
Dehydration
Shock
Ecchymosis
Ileus
Necrosis?
18
Q

Investigation results of pancreatitis?

A 
Raised blood amylase
Glycaemia
Raised alkaline phosphatase
Raised bilirubin
Low calcium
19
Q

Treatment of pancreatitis?

A

Just supportive

20
Q

Causes of acute pancreatitis?

A

Gall stones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP/iatrogenic
Drugs
21
Q

Pathogenesis of acute pancreatitis?

A 
Duct obstruction causes juice and bile reflux causes acinar damage
Enzymes are released
-proteases cause tissue destruction
-lipases cause fat necrosis
-elastase cause blood vessel destruction
22
Q

What happens in chronic pancreatitis?

A

A result of chronic inflammation
Causes fibrosis and calcification
Parenchymal destruction and duct stenosis

23
Q

Signs and symptoms of chronic pancreatitis?

A 
Pain
Malabsorption -> Steatorrhoea
Albumin
Weight loss
Jaundice
24
Q

Causes of chronic pancreatitis?

A

Chronic alcoholism
Cystic fibrosis
Biliary disease
Genetic

25
Q

What type of cancer are most pancreatic cancers?

A

90% are ductal adenocarcinomas

26
Q

Presentation of pancreatic carcinoma?

A

Initially no symptoms, then get lots

  • obstructive jaundice
  • pain
  • vomiting
  • diabetes
  • malabsorption

GI (21 decks)

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