Session 7 - Liver And Pancreas Pathology Flashcards
Where are red cells broken down?
In the spleen
What happens when a red cell is broken down?
Bilirubin is released from haem breakdown
Bilirubin is hydrophobic and binds albumin to be carried to the liver
In the liver bilirubin is conjugated - which is water soluble nd is secreted by hepatocytes into the bile canaliculli
What products of the liver can you measure to check liver function?
Albumin
Prothrombin time - coagulation factors
What are the types of jaundice ?
Give an example of each?
Pre-hepatic: haemolytic anaemia
Intra-hepatic: cirrhosis
Post-hepatic: biliary tree blockage
What skin condition would post-hepatic jaundice cause?
Pruritis - itching
what are the symptoms of pre-hepatic jaundice ?
Mild jaundice
Dark stools
Urine - normal colour
No pruritis
What happens to the levels of
- Serum bilirubin
- Urinary urobiliogen
- Urinary conjugated bilirubin
In PRE-HEPATIC JAUNDICE
- Serum bilirubin is raised
- Urinary urobiliogen is raised
- No conjugated bilirubin in the urine
Symptoms of intra-hepatic jaundice?
MOderate jaundice
Normal stools
Dark urine
No pruritis
What would be seen on the blood test of a patient with intra-hepatic jaundice?
- serum bilirubin
- urinary urobiliogen
- Conjugated bilirubin in urine
Raised serum bilirubin
Normal urinary urobiliogen
Presence of conjugated bilirubin in urine
(Why? Conjugated bilirubin does not go into the bile duct - into blood instead)
what are the symptoms of post-hepatic jaundice?
Pale stools
Dark urine
Itching
Severe jaundice
what would be the blood results of a patient with post-hepatic jaundice?
- Serum bilirubin
- Urinary urobiliogen
- Conjugated bilirubin in urine?
- Serum bilirubin raised
- Urinary urobiliogen - decreased
- Presence of conjugated bilirubin in urine
What does ALT stand for ?
Alanine aminotrasferase
When is ALT released?
It is released by damaged or inflamed hepatocytes
When may Alkaline phosphatase be raised?
Liver disease - especially cholestasis or biliary obstruction
Bone disease
What is raised gamma-glutamyl transferase a marker of?
Bile duct obstruction
Specifically induced by alcohol
Causes of raised ALT?
Hepatitis
- viral
- alcohol intake
- fatty liver disease
- toxins
Causes of raised Alk Phosphate?
Bile duct obstruction
Liver Mets
Bone disease
- bone mets, fracture
- hyperparathyroidism
- Paget’s disease
what are the causes of a raised gamma-GT?
Alcohol
Liver mets
Cirrhosis
Biliary duct obstruction
What blood results would you find in someone with acute hepatitis ?
VERY HIGH ALT High serum bilirubin Normal Gamma GT Normal ALP/alk phos Normal albumin Normal INR
What does the liver look like if there is cirrhosis?
Shrunken, hard and fibrotic
What signs/symptoms are there of portal hypertension ?
Caput medusa
Haemorrhoids
Oesophageal varices
Ascites
Symptoms of Cirrhosis
Fatigue Bleeding and bruising easily Jaundice Ascites Swollen legs (hypoproteinaemia)
How is liver cirrhosis treated?
Liver transplant
what are the 2 main causes of biliary tree obstruction?
Gall stone
Carcinoma of the head of the pancreas
