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Semester 3 - Gastrointestinal > Session 7 - Jaundice, Hepatic Portal tension and pancreatitis > Flashcards

Session 7 - Jaundice, Hepatic Portal tension and pancreatitis Flashcards

1
Q

How does the liver generate aminoacids?

A

Transamination

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2
Q

What three things are we looking for in a liver function test?

A
  • Hepatocellular damage
    • Cholestasis of bile ducts
    • Level of synthetic function
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3
Q

What can be detected in hepatocellular damage?

A

• Aminotransferases

○ ALT/AST

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4
Q

What can be detected in Cholestasis?

A
  • Bilirubin - Unable to excrete bilrubing, plasma concentration rises
    • Alkaline phosphatase - Enzymes in cells lining liveres biliary ducts. Plasma levels rise with an obstruction.
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5
Q

What can be detected to determine the synthetic function of the liver?

A
  • Albumin - Levels reduced in chronic liver disease

* Prothrombin time (clotting) - Measures clotting tendency of blood

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6
Q

What is jaundice?

A

• Damaged hepatocytes have a reduced capacity to excrete bilirubin

Bilirubin accumulated in blood, giving jaundice

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7
Q

What does hyperbilirubinaemia result in?

A

• A yellowish pigmentation of the skin, conjunctival membranes over the sclera and other mucus membranes

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8
Q

At what point is jaundice clinically detectable?

A

• >40umol/l of bilibrubin in blood

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9
Q

What are three types of jaundice we must learn to distinguish between?

A
  • Pre-hepatic
    • Hepatic
    • Post hepatic
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10
Q

What occurs in pre-hepatic jaundice?

A

• Excessive Bilirubin Production, usually due to an increased breakdown of red blood cells (haemolysis)
○ Liver unable to cope with excess bilirubin

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11
Q

What would the labfindings be in a test for pre-hepatics jaundice?

A
  • Unconjugated hyperbilirubinaemia
    • Reticulocytosis
    • Anaemia
    • Increased LDH
    • Decreased Haptoglobin
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12
Q

What is haptoglobin?

A

• Molecule which binds haemoglobin, marking it for destruction

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13
Q

Give three causes of pre-hepatic jaundice

A
  • Inherited
    • Congenital hyperbilirubinaemias
    • Acquired
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14
Q

What three traits can be inherited which may cause pre-hepatic jaundice?

A
  • Red cell membrane defects (spherocytosis)
    • Haemoglobin abnormalities (sickle cell)
    • Metabolic defects
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15
Q

Give the main type of congenital hyperbilirubinaemias

A

• Gilbert’s syndrome - 10% population

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16
Q

Give six acquired causes of pre-hepatic jaundice

A
  • Immune
    • Mechanical ß E.g. RBC’s running across metal heart valves
    • Acquired membrane defects
    • Infections
    • Drugs
    • Burns
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17
Q

What occurs in hepatic jaundice?

A

• Reduced capacity of liver cells to secrete conjugated bilirubin into the blood

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18
Q

What would the labfindings be in a test for hepatics jaundice?

A
  • Mixed unconjugated and conjugated hyperbilirubinaemia
    • Increased Liver enzymes (ALT/AST)

Abnormal Clotting

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19
Q

Give five causes of hepatic jaundice

A
  • Congenital
    • Hepatic inflammation
    • Drugs
    • Cirrhosis

Hepatic tumours

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20
Q

Give a main cause of congenital hepatic jaundice

A

• Gilbert’s syndrome

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21
Q

Give 5 main causes of hepatic inflammation as a cause of hepatic jaundice

A
  • Viral (Hepatitis A, B, C and E, Epstein Barr Virus (EBV))
    • Autoimune hepatitis
    • Alcohol
    • Haemochromotosis
    • Wilson’s disease
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22
Q

Give a drug which causes hepatic jaundice

A

• Paracetamol

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23
Q

Give three main causes of cirrhosis as a cause of hepatic jaundice

A
  • Alcohol
    • Chronic hepatitis
    • Metabolic disorders
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24
Q

Give two main causes of hepatic tumours

A

• Hepatocellular carcinoma

Metastases

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25
Q

What is post-hepatic jaundice caused by?

A

• Obstruction to drainage of bile, causing a back up of bile acids into the liver. Can be intrahepatic or extrahepatic. The passage of conjugated bilirubin is blocked.

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26
Q

What lab findings would expect to see in post-hepatic jaundice?

A
  • Conjugated hyperbilirubinaemia
    • Bilirubin in urine (dark)
    • Increase Canalicular enzymes (ALP)
    • -/Increase liver enzymes (ALT/AST)
27
Q

What are the two main categories of causes of post-hepatic jaundice?

A
  • Intrahepatic

* Extrahepatic

28
Q

Give four intrahepatic causes of post-hepatic jaundice

A
  • Hepatitis
    • Drugs
    • Cirrhosis
    • Primary biliary colic
29
Q

Give four extrahepatic causes of post-hepatic jaundice

A
  • Gallstones/Biliary stricture
    • Carcinoma
    • Pancreatitis
    • Sclerosing Chloangitis
30
Q

Give five types of carcinoma which can cause post-hepatic jaundice

A
  • Head of pancreas
    • Ampulla
    • Bile duct
    • Porta hepatis lymph nodes
    • Liver metastases
31
Q

What is sclerosing cholangitis?

A

Scarring of bileducts inside and outside the liver

32
Q

Give the cause and bilirubin status of pre-hepatic jaundice

A
  • Excessive bilrubin production

* Unconjugated hyperbilirubinaemia

33
Q

Give the cause and bilirubin status of hepatic jaundice

A
  • Reduced capacity to conjugate/excrete bilirubin

* Mixed unconjugated and conjugated hyperbilirubinaemia

34
Q

Give the cause and bilirubin status of post-hepatic jaundice

A
  • Obstruction to biliary system
    • Conjugated hyperbilirubinaemia
    • Bilirubin in urine (dark)

None in faeces

35
Q

Give three symptoms of alcoholic liver disease

A
  • Fatty liver
    • Alcoholic Hepatitis

Cirrhosis

36
Q

Outline how a fatty liver develps

A

• Alcohol metabolism generates NADH from NAD+
○ Increase NADH induces fatty acid synthesis
○ Decrease NAD+ results in decrease fatty acid oxidation
• Accumulation of fatty acids in the liver
○ Glycerol converted to TAGs
• TAGs accumulate, causing fatty liver

37
Q

What occurs in alcoholic hepatitis?

A

• Inflammation of hepatocytes

38
Q

What is cirrhosis?

A

• Liver cell necrosis followed by nodular regeneration and fibrosis, resulting in increased resistance to blood flow and deranged liver function.

39
Q

Give 6 complications of alcoholic liver disease

A
  • Hepatocellular carcinoma
    • Liver failure
    • Wernicke-Korsakoff syndrome
    • Encephalopathy
    • Dementia
    • Epilepsy
40
Q

Give 7 causes of cirrhosis of the liver

A
  • Alcohol
    • Wilson’s Disease
    • a1-antitrypsin deficiency
    • Biliary cirrhosis
    • Haemochromotosis
    • Hepatitis B or C
    • Autoimmune hepatitis
41
Q

Give 6 features of liver cirrhosis

A
  • Liver dysfunction
    • Jaundice
    • Anaemia
    • Bruising
    • Palmar erythema
    • Dupuytren’s contracture
42
Q

What would you expect to see on a liver function test which indicated cirrhosis?

A
    • / é ALT/AST
      • é ALP
      • é Bilirubin
      • ê Albumin
      • Deranged clotting
43
Q

How can cirrhosis be managed?

A
  • Stop drinking
    • Treating complications

Transplantation

44
Q

What is portal hypertension defined as?

A

• Portal venous pressure >20mmHg.

45
Q

What are two things which can cause portal hypertension?

A
  • Obstruction of the portal vein

* Obstruction of flow within the liver

46
Q

Give three causes of obstruction of the portal vein

A
  • Congenital
    • Thrombosis
    • Extrinsic compression
47
Q

Give three causes of obstruction of flow within the liver

A
  • Cirrhosis
    • Hepatoportal sclerosis
    • Schistomiasis
    • Sacroidosis
48
Q

Give three of the major effects of portal hypertension

A
  • Ascites
    • Splenomegaly
    • Porto-systemic anastomoses
49
Q

How is ascites caused in portal hypertension?

A
  • High pressure in the portal venous system means blood is backed up into the abdomen
    • Increase in hydrostatic pressure in the abdomen means less fluid is reabsorbed into blood vessels at end of capillary beds
    • If the liver is damaged, reduced oncotic pressure inside the vessels due to lack of plasma proteins also emphasised effects
50
Q

How is splenomegaly caused?

A

• Increased BP in the spleen

51
Q

What are the porto-systemic anastamoses, and how can they be an issue

A

• Increased pressure causes vessels to dilate, protrude into lumen, rupture/ulcerate and haemorrhage

52
Q

What are three main results of porto-systemic anastamoses because of portal hypertension?

A
  • Oesophageal varices
    • Rectal varices
    • Caput medusa
53
Q

Outline four different portal to systemic shunts and what they cause

A

• Left gastric -> Azygous/Oesohageal
○ Oesophageal varices
• Superior rectal -> Inferior rectal
○ Rectal varices
• Paraumbilical -> Small epigastric of abdominal wall
○ Caput medusa
• Colic/splenic/portal -> Retroperitoneal veins of posterior abdominal wall or diaphragm
○ Portal veins at this point on posterior aspect of bare area of the liver

54
Q

Where are bile acids stored before they are needed?

A

• Gall bladder

55
Q

What needs to happen to reduce volume that needs to be stored?

A

Bile acids are concentrated by the transport of salt and water across the gall bladder epithelium

56
Q

What is the risk with the dehydration of bile acids in the gall bladder?

A

• Precipitation, leading to gall stone

57
Q

Why is pain from gall stones worse after eating?

A

• Cholecystokinin released, causing gall bladder to contract

58
Q

What is pancreatitis?

A

• Inflammatory process caused by the effects of enzymes released from pancreatic acini

59
Q

Give four symptoms of acute pancreatitis

A
  • Oedema, Haemorrhage, Necrosis
    • Severe pain, vomiting, dehydration, Shock
    • Increase Amylase, Glycaemia, ALP/Bilirubin
    • Decrease Ca2+
60
Q

Give 6 symptoms of chronic pancreatitis?

A
  • Fibrosis, Calcification
    • Pain, Malabsorption (Steatorrhoea, ê albumin, weight loss)

Jaundice

61
Q

Give 10 causes of pancreatitis

A
  • Gallstones (Block Pancreatic duct/Amuplla of Vater)
    • Ethanol (Hyper-stimulation of pancreatic secretions)
    • Trauma
    • Steroids
    • Mumps
    • Autoimmune
    • Scorpion bite
    • Hyperlipidaemia
    • ERCP/Iatrogenic
    • Drugs
62
Q

What is the most common cause on pancreatic carcinoma?

A

90% Ductal adenocarcinomas

63
Q

What are the main symptoms of pancreatic carcinoma?

A
  • Obstructive jaundice
    • Pain
    • Vomiting
    • Malabsorption

diabetes

Semester 3 - Gastrointestinal (28 decks)

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