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Gastrointestinal System > Pancreas and liver pathology > Flashcards

Pancreas and liver pathology Flashcards

1
Q

What are the functions of the liver?

A 
Metabolism
Storage 
Detoxification
Bile production
Absorbs from intestinal tract to be metabolised
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2
Q

What is the pressure system like in sinusoids?

A

Low pressure so not much pressure needed to block

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3
Q

What is the pressure like in hepatic artery?

A

High

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4
Q

What is the life span of a red blood cell?

A

120 days

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5
Q

Where are red blood cell broken down?

A

Occurs extravascularly in macrophages in the spleen (mainly) and liver

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6
Q

How can bilirubin get to the liver?

A

Hydrophobic so must be bound to albumin

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7
Q

How is bilirubin made water soluble?

A

Water soluble

Conjugated with glucoronic acid by UDP glucuronyl transferase in the liver

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8
Q

Where is water soluble conjugated bilirubin excreted?

A

Secreted by hepatocytes into bile canaculi

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9
Q

What is conjugated bilirubin made into?

A

Urobilinogen to stercobilin or urobilin

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10
Q

How do we measure liver dysfunction?

A

Failure of anabolism
Failure of catabolise and excrete
Markers of hepatocyte damage

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11
Q

If anabolism is damaged what will you measure?

A

Albumin

Numerous coagulation factors

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12
Q

What is hypoalbuniaemia?

A

reflects severe liver dysfunction

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13
Q

What does failure to produce coagulation factors result in?

A

prolonged prothrombin time (INR)

Significant liver dysfunction

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14
Q

What is measured in catabolism breakdown?

A

Haemoglobin

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15
Q

What is pre hepatic jaundice?

A

Too much bilirubin

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16
Q

What is intra-hepatic jaundice?

A

Failure of hepatocytes to conjugate and or secrete bilirubin

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17
Q

What is post- hepatic jaundice?

A

Failure of biliary tree to convey the conjugated bilirubin to duodenum

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18
Q

What colour will conjugated bilirubin make urine?

A

Dark yellow

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19
Q

How can you detect excess urobiliogen in the urine?

A

dipstick

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20
Q

What are the signs of pre-hepatic jaundice

A

•Mild jaundice (lemon tinge)•
Stools may be very dark
•Urine colournormal
•No pruritis

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21
Q

What are the clinical findings of pre-hepatic jaundice?

A

Raised serum bilirubin
•Increased urinary urobiliogen
•No conjugated bilirubin present in urine

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22
Q

What are the symptoms of intra-hepatic jaundice?

A

Moderate jaundice
•Stools normal
•Urine dark
•No pruritis usually

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23
Q

What are the clinical findings of intra-hepatic jaundice?

A

Raisedserum bilirubin
•Normal urinary urobiliogen
•Conjugated bilirubin present in urine

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24
Q

What are the symptoms of post hepatic jaundice?

A

Severe jaundice (green tinge)
Stool pale
urine dark
pruritis

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25
Q

What are the clinical findings of post hepatic jaundice?

A

Raised serum bilirubin
Decreased urinary urobilogen
Conjugate bilirubin present in urine

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26
Q

What are the markers of hepatocyte damage or dysfunction?

A

ALT
Alk Phos
Gamma GT

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27
Q

When is ALT high in blood?

A

inflamed or damaged hepatocytes

hepatitis e.g. viral, acute alcohol intake, fatty liver disease and drugs/ toxins

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28
Q

When is ALK phos high?

A

Bone or liver disease

(biliary obstruction) normally higher in growing bone

29
Q

When is Gamma GT high?

A

Bile duct obstruction

Induced by alcohol- alcoholics

30
Q

Why is ultrasonography a key investigation in the investigation of liver disease?

A 
Very sensitive in detecting biliary obstruction
Can detect:
hepatic fibrosis e.g. cirrhosis
Fatty infiltration of the liver
Portal hypertension
Ascites
Gallstones in the gallbladder
Liver metastases
31
Q

What are some common liver and bile duct diseases?

A

Hepatitis
Cirrhosis
Gallstones and biliary tract obstruction
Liver metastases

32
Q

What are some causes of hepatitis?

A

Viral, acute alcohol intake, Fatty liver disease and drugs

33
Q

What is hepatitis?

A

Inflammed or necrotic hepatocytes that cannot function normally

34
Q

If you have hepatitis B what may you go on to get?

A

Cirrhosis

hepatocellular cancer

35
Q

What does liver failure give you increased susceptibility to?

A

Infections like bacteria

Drugs and toxins

36
Q

In liver failure there is increased ammonia, why?

A

due to failure to clear ammonia which causes hepatic encephalopathy

37
Q

What are symptoms of hepatitis?

A

unwell feeling, anorexia, fever, right upper quadrant pain, dark urine, jaundice

38
Q

What would your blood tests show in hepatitis?

A

normal albumin and INR, high serum bilirubin, conjugated bilirubin in urine, HIGH SERUM ALT, normal or slightly raised ALK phos and gamma GT

39
Q

What is liver cirrhosis?

A

Liver fibrosis producing a shrunken hard nodular liver

40
Q

What does liver cirrhosis lead to?

A

Leads to pressure and occlusion of sinusoids which leads to portal hypertension which leads to portosystemic shunting which diverts nutrient carrying blood away from the liver

41
Q

What will an increased pressure on bile canaliculi cause?

A

Reduced ability to excrete toxins and bilirubin

42
Q

What causes cirrhosis?

A

Alcohol, viral hepatotis, fatty liver disease, idiopathic

43
Q

What will replacement of hepatocytes by fibrosis tissue cause a reduction in?

A

albumin and clotting factors

44
Q

Where are the sites of porto systemic anastomoses?

A

Anorectic junction, ligametnum teres of falciform ligament, oesphagogastric junction

45
Q

What are the symptoms of cirrhosis?

A

Fatigue, weakness, bleeding, bruising, swollen abdomen and legs, weight loss, jaundice, hematemesis and or melena, confusion, drowsiness, slurred speech

46
Q

What will the blood tests results of

A

May all be normal

May have low albumin, raised bilirubin, slight rise of enzymes

47
Q

What is the treatment of cirrhosis?

A

Not possible to reverse, deals with complications, only cure is liver transplant

48
Q

What is caput medusa?

A

Blood flows the wrong way

49
Q

What is treatment of cirrhosis?

A

Deal with complications
Not possible to reverse
Only cure is liver transplant

50
Q

What are the causes of bile duct obstruction?

A

Gallstone Migrating from the gallbladder into common bile duct or carcinoma of the head of pancreas

51
Q

What would you find in bile duct obstruction lab findings?

A

Hepatocyte anabolism (serum albumin and INR), hepatocyte inflammation or necrosis e.g. serum ALT normal or raised, Serum blirubin very high, conjugated bilirubin in urine, bile duct cell dysfunction raised- ALKphos and Gamma GT

52
Q

What is cholangitis?

A

Infection of the bile duct- life threatening complication of bile duct obstruction e.g. ecoli

53
Q

Where and why do gallstones develop?

A

Gallbladder due to chemical imbalances of excess cholesterol or bilirubin

54
Q

What is binary cholic?

A

not a true colic- pain in the right upper quadratn that radiates to right scapula and shoulder, after eating a fatty meal and lasts around 6 hours

55
Q

What os acute cholecystitis?

A

Gallstone obstruction the cystic duct then stasis of gallbladder contents- infection risk- ecoli
Severe gall bladder pain and very unwell pyrexial, tender over gallblader

56
Q

What systems can get metastases?

A

Organs that drain into the portal vein and hepatic artery

57
Q

How does the liver get cancer?

A

Lodge in the filter

58
Q

What are the lab findings of metastases?

A

Raised serum bilirubin, Conjugated bilirubin present in urine, raised ALK phos, ALT and Gamma GT may be slightly raised, serum albumin and INR normal

59
Q

What is acute pancreatitis?

A

Common
Due to premature activation of pancreatic proteases in the pancreas rather than duodenum
Proteases then autodigest the pancreas and the retroperitoneum

60
Q

What are the causes of acute pancreatitis?

A

Alcohol as alters balance between Proteolytic enzymes and protease inhibitors so triggers enzymes activation, auto digestion and cell destruction
Gallstones as outflow obstruction with pancreatic duct hypertension and toxic effect of bile salts activate pancreatic proteases

61
Q

What are symptoms of acute pancreatitis?

A

Epigastric pain that goes to the back

Vomiting

62
Q

How would you diagnose acute pancreatitis?

A

Raised serum amylase or serum lipase, CT scan can see pancreatic necrosis and psydeocyst

63
Q

What is the treatment for acute pancreatitis?

A

Not specific
Supportive and fluid resuscitation
Anigesic

64
Q

What is chronic pancreatitis?

A

Rare and due to repeated low grade pancreatitis that causes pancreatic fibrosis
Due to alcohol abuse
Pancreases becomes calcified and patients suffer severe epigastric and back pain
This leads to opiate addiction
Exocrine and endocrine gland fails due to fibrosis

65
Q

What is carcinoma of the pancreas usually and where is it?

A

Ductal adenocarcinoma

Head of the pancreas

66
Q

what is the survival rate after 5 years of pancreas cancer?

A

3%

67
Q

What is the clinical presentation of pancreatitis?

A 
Anorexia, malaise, fatigue
Significant weight loss
Epigastric and or back pain
Dark urine
Pale stools
Pruritus
68
Q

What are the common causes of jaundice?

A 
– Hepatitis (vviral,, drugs,, acute alcohol intake)) 
– Common bile duct stones 
– Carcinoma of the head of the pancreas 
– Liver metastases 
– Late stages of cirrhosis

Gastrointestinal System (16 decks)

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