Topic 4 part 2 - disorders of accessory organs of Digestive System

Question 1

What are the essential roles of the Liver?

Answer 1

• production of bile salts
• elimination of bilirubin
• metabolism of steroids hormones
• metabolism of drugs
• carbs / fat / protein metabolism
• storage of minerals & vitamins
• Filtration of blood & removal of bacteria

Question 2

Define: Jaundice

Answer 2

accumulation of bilirubin in the blood. a symptom of a liver disorder. (bilirubin = the catabolic product of RBC breakdown after life span).

Question 3

Define: Cholestasis:

Answer 3

disruption in bile flow due to Cholelithiasis (gallstones). Bile = yellowy/green secretion that breaks down fats in response to CCK ( a fatty meal).

Question 4

Define: Cholelithiasis

Answer 4

Gallstones (within the gall bladder - the place that stores bile). 2 types:

• Cholesterol stones: not necessarily made from excess cholesterol in the blood circ.
• Bilirubin stones:

Question 5

Define: Cholecystitis

Answer 5

Inflammation of the Gallbladder (acute or chronic) caused by cholelithiasis (gallstones)

Question 6

What is the GallBladder?

Answer 6

the sac / place that stores bile.

Question 7

What is bile?

Answer 7

Bile = yellowy/green secretion that breaks down fats in response to CCK ( a fatty meal).

Question 8

Define: Steatosis

Answer 8

fat accumulation in the Liver / Hepatocytes (cells of the liver).

Question 9

Define: Ascites

Answer 9

the accumulation of fluid in the peritoneal cavity. Late stage manifestation of cirrhosis / portal hypertension.
Contributing Factors: failure of liver to metabolise aldosterone (hormone that increases water reabsorption) therefore increses hydrostatic pressure.

Question 10

What is the Peritoneum/Peritoneal?

Answer 10

the extensive serous membrane that lines the entire abdominal wall of the M/F body. It extends to suspend the small intestine.

Question 11

How is Liver Function assessed?

Answer 11

1. Biochemical:
   - ALT (alanine aminotransferase) = indicates a breakdown of liver cells (hepatocytes)
   - Serum Albumin = HyperAlbumin / increased albumin indicates the Liver is unable to breakdown of____.
   - Serum Bilirubin = measures Liver excretory function.
2. Imaging: angiography, ultra-sound, CT scan
3. Liver biopsy

Question 12

What is intr-hepatic biliary disease?

Answer 12

caused by a disruption of the flow of bile through the liver (i.e. cholestasis), 3 types:

1. Primary Biliary Cirrhosis: an autoimmune disease = that inflames / scar’s small intrahepatic biliary ducts.
2. Primary Sclerosing Cholangitis: Chronic inflammation of hepatic bile ducts.
3. Secondary Biliary Cirrhosis: prolonged obstruction due to “Cholelithiasis” (gall stones).

Question 13

Define Hepatitis?

Answer 13

inflammation of the Liver.

Caused by: hepatotropic Viruses - Hep A,B,C,D,E. HepC is most common.

Question 14

Describe Hepatitis - common clinical features

Answer 14

jaundice, nausea & vomiting, diarrhoea & constipation, fever & malaise, myalgia, fatigue & weakness, anaemia.

Question 15

Outline Hepatitis - aetiologies

Answer 15

1. Auto-immune disorders
2. Reaction to toxins & drugs
3. Infections: Bacteria or Viral
4. Non-infectious causes: biliary obstruction / cirrhosis

Question 16

What is Portal Hypertension?

Answer 16

the portal vein pressure of 22mmHg or more.

normal pressure of blood flow to the liver = 5-10mmHg

Question 17

What is the Portal Blood Supply?

Answer 17

the loop of arteries & veins that supply blood to the intestines to transport nutrients absorbed from food in the stomach (i.e. digestion) to the liver.

Question 18

Describe the effects Portal Hypertension has on fluid:

Answer 18

“Ascites”: increased pressurein the peritoneal capillaries leads to water movement out into the peritoneal cavity.

Question 19

Describe the effects Portal Hypertension has on blood flow:

Answer 19

“hepatic encephalopathy”: a disease of the brain caused by reduced liver function = occurs as a result of accumulation of neuro-toxic metabolites: “Ammonia” - a waste product usually converted into urea & excreted: Ammonia accumulates in blood & causes neurological damage.

Question 20

Describe the effects Portal Hypertension has on blood:

Answer 20

“Anaemia”: a decrease in haemoglobin in the blood to levels below normal range.

Question 21

What is Cirrhosis of the liver?

Answer 21

end stage liver disease where functional hepatic tissue is replaced by fibrous tissue - which disrupts vascular & biliary flow leading to alteration of the liver.

Question 22

A diverticulum is the term used to describe

Answer 22

an outpouching of the gastrointestinal wall

Question 23

Oesophageal diverticulum is described best by which statement?

Answer 23

It is an outpouching of the oesophageal wall through the muscularis layer.

Question 24

Which of the following statements is true of the CTZ?

Answer 24

D. Toxins in the CSF or blood will stimulate CTZ receptors causing a vomiting response

Question 25

Which of the following is NOT a test of liver function:

Answer 25

C. Serum creatinine

Question 26

Which of the following does NOT cause chronic gastritis:

Answer 26

D. Long term high protein diets

Question 27

Achalasia is a disorder caused by which of the following?

Answer 27

B. Lower oesophageal sphincter fails to relax upon swallowing

Question 28

Fatty liver is also called:

Answer 28

A. Steatosis

Question 29

An inflammatory bowel disease primarily affecting the ileum and proximal colon is?

Answer 29

B. ulcerative colitis

Question 30

Which of the following is not an effect of portal hypertension?

Answer 30

Steatosis

Question 31

Which of the following mechanisms causing intrahepatic biliary disease describes primary sclerosing cholangitis?

Answer 31

Chronic inflammation of hepatic bile ducts.