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GI: SEM 3 > S7) Liver and Pancreatic Pathology > Flashcards

S7) Liver and Pancreatic Pathology Flashcards

1
Q

Describe the anatomical relationship of the liver with the gallbladder and duodenum

A
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2
Q

Outline the transport and metabolism of bilirubin

A
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3
Q

Identify 3 ways in which we can measure liver dysfunction

A
  • Failure of anabolism
  • Failure of catabolism and excretion
  • Markers of hepatocyte damage/dysfunction
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4
Q

Identify 4 things produced by the liver (anabolism)

A
  • Albumin
  • Glycogen
  • Coagulation factors
  • Haematopoiesis (in foetus / adult with bone marrow failure)
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5
Q

In terms of anabolism, identify 2 indicators of poor liver function

A
  • Hypoalbuminaemia due to failure to produce albumin
  • Prolonged prothrombin time (PT/INR) due to failure to produce coagulation factors
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6
Q

Identify 5 things broken down by the liver (catabolism)

A
  • Drugs
  • Hormones
  • Haemoglobin
  • Poisons
  • Aged RBCs (after splenectomy)
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7
Q

Identify and describe 3 abnormalities of bilirubin production/excretion

A
  • Pre-hepatic jaundice: too much bilirubin e.g. haemolytic anemia
  • Intra-hepatic jaundice: failure of hepatocytes to conjugate and/or secrete bilirubin e.g hepatitis, cirrhosis
  • Post-hepatic jaundice: failure of the biliary tree to convey conjugated bilirubin to duodenum e.g. biliary tree obstruction
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8
Q

How can excess bilirubin be measured?

A

Conjugated bilirubin is water soluble so when elevated, serum levels can be measured with a dipstick (dark yellow)

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9
Q

Identify 3 signs of pre-hepatic jaundice

A
  • Raised serum bilirubin
  • Increased urinary urobilinogen
  • No conjugated bilirubin present in urine
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10
Q

Identify 4 symptoms of pre-hepatic jaundice

A
  • Mild jaundice (lemon tinge)
  • Stools may be very dark
  • Normal urine colour
  • No pruritis
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11
Q

Identify 3 signs of intra-hepatic jaundice

A
  • Raised serum bilirubin
  • Normal urinary urobiliogen
  • Conjugated bilirubin present in urine
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12
Q

Identify 4 symptoms of intra-hepatic jaundice

A
  • Moderate jaundice
  • Stools normal
  • Urine dark
  • No pruritis usually
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13
Q

Identify 3 signs of post-hepatic jaundice

A
  • Raised serum bilirubin
  • Decreased urinary urobilinogen
  • Conjugated bilirubin present in urine
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14
Q

Identify 4 symptoms of post-hepatic jaundice

A
  • Severe jaundice (green tinge!)
  • Stools pale
  • Urine dark
  • Pruritis
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15
Q

Identify 3 enzyme markers of hepatocyte damage/dysfunction

A
  • Alanine aminotransferase (ALT) is released by inflamed/damaged hepatocytes
  • Alkaline phosphatase (Alk Phos) is present in the liver canaliculi, bile ducts and bone
  • Gamma-glutamyl transferase (Gamma GT) is present in bile duct cells
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16
Q

A raised ALT is due to hepatitis.

Identify 4 causes of hepatitis

A
  • Viral (A, B, C etc.)
  • Acute alcohol intake
  • Fatty liver disease
  • Drugs/toxins
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17
Q

Identify 2 main causes of a raised Alk Phos

A
  • Bile duct/liver disease with cholestasis
  • Bone disease
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18
Q

Identify 4 conditions which lead to bile duct/liver disease presenting with a raised Alk Phos

A
  • Biliary obstruction
  • Cirrhosis
  • Liver metastases
  • Drugs
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19
Q

Identify 4 conditions which lead to bone disease presenting with a raised Alk Phos

A
  • Bone metastases/fracture
  • Osteomalacia
  • Hyperparathyroidism
  • Paget’s disease of bone
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20
Q

Identify 5 causes of a raised Gamma GT

A
  • Biliary duct obstruction/cholestasis
  • Cirrhosis
  • Liver metastases
  • Drugs
  • Alcoholism
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21
Q

Identify 4 common liver and bile duct diseases

A
  • Hepatitis
  • Cirrhosis
  • Gallstones and biliary tract obstruction
  • Liver metastases
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22
Q

How does liver failure present?

A
  • Increased susceptibility to infections
  • Increased susceptibility to toxins and drugs
  • Increased blood ammonia (failure to clear ammonia via urea cycle)
23
Q

Identify 6 symptoms of hepatitis

A
  • Malaise
  • Anorexia
  • Fever
  • Right upper quadrant pain
  • Dark urine
  • Jaundice
24
Q

What are the typical blood test findings in acute hepatitis?

A
  • Normal albumin and INR
  • High serum bilirubin
  • Very high serum ALT
  • Normal/slightly raised Alk Phos
  • Normal/slightly raised Gamma GT
25
Q

What is cirrhosis?

A

Cirrhosis is a condition caused by liver fibrosis, producing a shrunken hard nodular liver

26
Q

Identify 3 consequences of liver fibrosis

A
  • Portal hypertension due to pressure and occlusion of the hepatic sinusoids
  • Reduced excretion due to pressure on the bile canaliculi

- Reduced albumin and clotting factor production due to replacement of hepatocytes by fibrous tissue

27
Q

Identify 4 main causes of liver cirrhosis

A
  • Alcohol
  • Consequence of viral hepatitis (B,C)
  • Fatty liver disease
  • Idiopathic
28
Q

Identify 3 sites of portosystemic anastomoses

A
  • Anorectal junction
  • Ligamentum teres of falciform ligament
  • Oesophagogastric junction
29
Q

In two steps, explain how oesophageal varices results from liver cirrhosis

A
  • Pressure and occlusion of the hepatic sinusoids leads to portal hypertension
  • Portal hypertension leads to portosystemic shunting, including oesophageal varices
30
Q

Identify 5 symptoms of cirrhosis

A
  • Fatigue/weakness
  • Ascites
  • Swollen legs (hypoproteinaemia)
  • Weight loss
  • Jaundice
31
Q

What are the typical blood test findings for cirrhosis?

A
  • May all be normal
  • May show a low albumin and/or prolonged INR
  • May show a raised bilirubin
  • May be a slight rise in ALT (if ongoing inflammation)
  • May be very mild raise in Alk Phos (if cholestasis)
  • May show a raised Gamma GT (if alcoholism)
32
Q

What is the treatment of cirrhosis?

A
  • Fibrosis is irreversible so a liver transplant is needed
  • Treatment is aimed at managing the complications
33
Q

What are the 2 main causes of gall bladder obstruction?

A
  • Gallstone migration from the gallbladder into common bile duct
  • Carcinoma of the head of pancreas
34
Q

What are the typical laboratory findings in post-hepatic/obstructive jaundice?

A
  • Normal serum albumin and INR
  • Normal/slightly raised serum ALT
  • Very high serum bilirubin
  • Conjugated bilirubin present in the urine
  • Raised Alk phos and Gamma GT
35
Q

What is cholangitis?

A

Cholangitis is an infection in the bile ducts and a life-threatening complication of bile duct obstruction, commonly caused by E. Coli

36
Q

Why do gallstones develop?

A

Gallstones develop in the gallbladder due to chemical imbalances in the bile

37
Q

Biliary colic is not true colic.

What is it?

A
  • Biliary colic is pain in the right upper quadrant that radiates to the tip of the right scapula/right shouder
  • It is often precipitated by eating a fatty meal and lasts up to 6 hours
38
Q

What is acute cholecystitis?

A

Acute cholecystitis is inflammation of the gallbladder, occurring when a gallstone blocks the cystic duct and commonly caused by E.coli

39
Q

Apart from severe gallbladder pain, how does a patient with acute cholecystitis present?

A
  • Systemically unwell
  • Pyrexia
  • Tenderness over the gallbladder
40
Q

Why is the liver a common site for metastases?

A

The liver is designed to filter the blood entering it and cancer cells can lodge in the filter

41
Q

What are the laboratory findings in liver metastases?

A
  • Raised serum bilirubin
  • Conjugated bilirubin present in the urine
  • Raised Alk Phos
  • Slightly raised ALT and Gamma GT
  • Normal serum albumin and INR
42
Q

What are the two forms of pancreatitis?

A
  • Acute
  • Chronic
43
Q

What is acute pancreatitis?

A

- Acute pancreatitis is a common condition arising from the premature activation of pancreatic proteases in the pancreas itself rather than in the duodenum

  • These proteases then autodigest the pancreas and the retroperitoneum
44
Q

Identify and describe the 2 main causes of acute pancreatitis

A
  • Alcohol alters the balance between proteolytic enzymes and protease inhibitors, thus triggering enzyme activation
  • Gallstone obstruction causes pancreatic duct hypertension and the toxic effect of bile salts contribute to enzyme activation (biliary acute pancreatitis)
45
Q

What is chronic pancreatitis?

A

- Chronic pancreatitis is rare condition caused by alcohol abuse where repeated low grade pancreatitis causes pancreatic fibrosis

  • The pancreas becomes calcified and patients suffer severe epigastric and back pain that leads to opiate addiction and not infrequently suicide
46
Q

State 2 symptoms of acute pancreatitis

A
  • Epigastric pain that goes through to the back
  • Vomiting
47
Q

How can the diagnosis of acute pancreatitis be confirmed?

A
  • Raised serum amylase / serum lipase
  • CT scan used to look for pancreatic necrosis/pseudocyst
48
Q

Describe the treatment of acute pancreatitis

A
  • Analgesia
  • Supportive treatment
  • Fluid resuscitation
49
Q

What is pancreatic cancer?

A
  • Pancreatic carcinoma is a condition resulting from the uncontrolled cell growth in the pancreas which metastasises to the rest of the body
  • Nearly all are ductal adenocarcinomas and most are in the head of the pancreas
50
Q

Describe the clinical presentation of pancreatic carcinoma

A
  • Anorexia, malaise, fatigue
  • Significant weight loss
  • Epigastric and/or back pain
  • Dark urine
  • Pale stools
  • Pruritis
51
Q

what are the 3 functions of the liver?

A
  1. storage: glycogen, vitamins, iron, copper
  2. synthesis: glucose, lipids/cholesterol, bile, clotting factors, albumin
  3. metabolic: bilirubin, ammonia, drugs, alcohol, carbs, lipid
52
Q

how do you test for synthetic function of the liver?

A

test levels of clotting factor and albumin

53
Q

what is the difference between the portal and systemic circulation?

A
  • portal circulation: network of veins that drain via liver into IVC
  • systemic circulation: venous network that doesn’t go through liver but drains directly into IVC
54
Q

what 3 veins make up the portal vein?

A
  1. superior mesenteric vein: drains ascending colon
  2. inferior mesenteric vein: drains descending colon
  3. splenic vein: IMV drains into splenic vein and join together with SMV to make the portal vein

GI: SEM 3 (1 decks)

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