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
What is cholangitis?
Infection in the bile ducts
What is the most common bacterial agent which causes cholangitis?
E. Coli
What are the symptoms of cholangitis?
Charcots triad
RUQ pain
Jaundice
Fever
What is biliary colic?
A constant pain which lasts up to 6 hours
In the RUQ - may radiate to the tip of the right scapula / shoulder
What is cholecystitis?
Infection of the gall bladder - due to a gall stone obstructing the cystic duct.
What symptoms would someone with cheolecystitis present with?
RUQ pain
Systemically unwell
Fever
What is the cardinal sign in the blood test of a pateint with liver cancer?
Raised Alk Phos.
How do you diagnose acute pancreatitis?
Serum amylase or serum lipase
