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Gastrointestinal > Session 7 - Part II > Flashcards

Session 7 - Part II Flashcards

1
Q

What are some of the main causes of liver failure?

A 
Hepatits
Alcohol
Drugs eg Paracetamol
Industrial solvents
Mushroom poisoning
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2
Q

How does Jaundice occur?

A

Bilirubin (A bile pigment from haemoglobin breakdown) is usually conjugated in the liver. If the liver is damaged it cannot conjugate the bilirubin to excrete it, it will build up in the blood leading to jaundice

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3
Q

Where is Insulin broken down?

A

In the Liver

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4
Q

What is Albumin essential for?

A

Maintaining oncotic pressure in the blood

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5
Q

What coagulation factors does the liver produce?

A

I - Fribrinogen
II - Prothrombin
Others too

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6
Q

What is Thrombopoietin?

A

A glycoprotein hormone that regulates the production of platelets by bone marrow

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7
Q

What does ALT/AST in the blood suggest?

A

Hepatocellular damage because ruptured membranes leak aminotransferases into the blood stream

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8
Q

What has an increased concentration in the blood of a patient with Cholestasis (Bile ducts)

A

Bilirubin – Unable to excrete bilirubin, plasma concentration rises
Alkaline Phosphatase – Enzyme in cells lining the liver’s biliary ducts. Plasma levels rise with an obstruction.

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9
Q

How can you measure synthetic functioning of the Liver?

A 
Albumin – Levels reduced in chronic liver disease
Prothrombin time (Clotting) – Measures the clotting tendency of blood (Longer would be less prothrombin)
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10
Q

Where do you get yellowing in jaundice?

A

Skin
Scleae of eyes
Conjunctival membranes of eyes

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11
Q

At what concentration is jaundice detectable?

A

> 40micromol/L (Normal range <22micromol/L)

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12
Q

What is pre-heaptic jaundice?

A

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

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13
Q

What are the lab findings in pre-hepatic jaundice?

A

Unconjugated hyperbilirubinaemia
Anaemia
Increased LDH

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14
Q

What are some of the inherited causes of pre-hepatic jaundice?

A

Red cell membrane defects
Haemoglobin abnormalities
Gilbert’s syndrome (Congenital Hyperbilirubinaemias)

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15
Q

What are some of the aquired causes of pre-hepatic jaundice?

A

Immune
Infections
Drugs

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16
Q

Define hepatic jaundice

A

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

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17
Q

What are the lab findings in hepatic jaundice?

A

Mixed unconjugated and conjugated hyperbilirubinaemia
Increased Liver enzymes (ALT/AST)
Abnormal Clotting

18
Q

What are some of the causes of hepatic jaundice?

A

Congenital (Gilbert’s syndrome)
Hepatic inflammation/Cirrhosis (Alcohol, Viruses eg Hepatitis)
Drugs (Paracetamol)
Hepatic tumours (Hepatocellular carcinoma, metastases)

19
Q

Define post hepatic jaundice

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.

20
Q

What are the lab findings in post hepatic jaundice?

A

Conjugated hyperbilirubinaemia
Bilirubin in urine (dark)
Increased Canalicular enzymes (ALP)
Increased liver enzymes (ALT/AST)

21
Q

What are some of the intrahepatic causes of post hepatic jaundice?

A

Hepatitis
Drugs
Cirrhosis
Primary biliary colic

22
Q

What is Biliary Colic?

A

Pain associated with Gallstones

23
Q

What are some of the extrahepatic causes of post hepatic jaundice?

A

Gallstones/Biliary stricture
Carcinoma (Head of pancreas, Ampulla, Bile duct, lymph nodes, Liver metastases)
Pancreatitis
Sclerosing cholangitis (Inflammation and scarring of bile ducts)

24
Q

What are some of the causes of Cirrhosis?

A 
Alcohol
Wilson’s Disease
alpha1-antitrypsin deficiency
Hepatitis B or C
Autoimmune hepatitis
25
Q

What are some of the clinical features of Cirrhosis?

A 
Liver dysfunction
Jaundice
Anaemia
Bruising
Palmar erythema
Dupuytren’s contracture (In the hands)
26
Q

What are some of the findings with Cirrhosis?

A 
Increased ALT/AST
Increased ALP
Increased Bilirubin
Decreased Albumin
Deranged clotting
27
Q

What is Portal Hypertension classified as?

A

Portal venous pressure > 20mmHg

28
Q

What can cause Portal Hypertension?

A

Obstruction of the portal vein (Congenital, thrombosis or extrinsic compression)
Obstruction of flow within the liver (Cirrhosis, Schistosomiasis - caused by parasites, sarcoidosis)

29
Q

How can Portal Hypertension cause Ascites?

A

Blood is backed up into the abdomen.
Increase in hydrostatic pressure in the abdomen means less fluid is reabsorbed into blood vessels - will collect in abdomen
If the liver is damaged, reduced oncotic pressure due to lack of plasma proteins

30
Q

What can cause Oesophageal varices?

A

Portal Hypertension causes blood to back up into these anastomoses. Causing the vessel to dilate and haemorrhage.
Patient will vomit blood
Left Gastric –> Azygous/Oesophageal (Is the anastomoses)

31
Q

What can cause Rectal varices?

A

Portal Hypertension causes blood to back up into these anastomoses. Causing the vessel to dilate and haemorrhage.
Superior rectal –> Inferior rectal (Is the anastomoses)

32
Q

What can cause Caput Medusae?

A

Portal Hypertension causes blood to back up into these anastomoses. Causing the vessel to dilate around the umbillicus and be very tender
Paraumbilical –> Small epigastric of abdominal wall (Is the anatomoses)

33
Q

How do Gall stones develop?

A

Bile acids return to liver between meals (secreted by canaliculi cell walls before they are next needed) Stored in the gall bladder until needed.
To reduce the volume, bile acids are concentrated by the transport of salt and water across the gall bladder epithelium.
Concentration process increases the risks of precipitation (leading to Gall Stones.)

34
Q

Why can the pain from Gall stones be worse after eating?

A

Secretion of Cholecystokinin (CCK) will cause the gall bladder to contract.

35
Q

What are the majority of Pancreatic canrcinomas?

A

Ductal Adenocarcinomas

Asymptomatic

36
Q

When symptoms of Pancreatic cancer occur, what are they?

A 
Obstructive jaundice
Pain
Vomiting
Malabsorption
Diabetes
37
Q

What are the causes of Pancreatitis?

A 
GET SMASHED
Gallstones (Block Pancreatic duct/Amuplla of Vater)
Ethanol (Hyper-stimulation of pancreatic secretions)
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP/Iatrogenic
Drugs
38
Q

What is Pancreatitis?

A

Inflammatory process, caused by the effects of enzymes released from pancreatic Acini.

39
Q

What are the signs of Acute Pancreatitis?

A

Oedema, Haemorrhage, Necrosis
Severe pain, vomiting, dehydration, Shock
Increased Amylase, Glycaemia, ALP/Bilirubin
Decreased Ca2+

40
Q

What are the signs of Chronic Pancreatitis?

A

Fibrosis, Calcification
Pain, Malabsorption (Steatorrhoea, decreased albumin, weight loss)
Jaundice

Gastrointestinal (13 decks)

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