v. Gastroenterology

Question 1

L73: What is the hepatobiliary system?

Answer 1

The liver, gall bladder and bile ducts working together to make bile

Question 2

L73: What is jaundice?

Answer 2

The accumulation of bilirubin in the skin, due to excess bilirubin in circulation

Question 3

L73: What might patients suffering from jaundice c/o?

Answer 3

• Pigmentation;

- Itch.

Question 4

L73: What is bilirubin?

Answer 4

A metabolic product of haem

Question 5

L73: Where can you typically first notice someone might have jaundice?

Answer 5

Sclera of the eyes

Question 6

L73: Where does conjugation of bilirubin occur?

Answer 6

In the liver

Question 7

L73: Why is bilirubin conjugated in the liver?

Answer 7

To make it soluble in water so that it can be excreted from the body

Question 8

L73: What are the three types of jaundice?

Answer 8

• Pre-haptic;
• Haptic;
• Post-haptic.

Question 9

L73: Where does pre-hepatic jaundice problems originate? Give examples.

Answer 9

• Before liver metabolism;
• In the bloodstream;
• Excessive quantities of rbc breakdown products;
• Haemolytic anaemia, post-transfusion, neonatal.

Question 10

L73: Explain why haemolytic anaemia can lead to jaundice?

Answer 10

• rbc broken down quicker than they should be;
• Saturation of haem breakdown products in the blood being sent to the liver;
• b/s bilirubin increase.

Question 11

L73: Explain how post-transfusion jaundice happens?

Answer 11

• Bad match;
• Immune system attacks rbc;
• Excessive haem breakdown products;
• b/s bilirubin increase.

Question 12

L73: Explain how neonatal jaundice happens?

Answer 12

• Mix of maternal and baby blood;
• Baby’s immune system attacks rbc;
• Excess of haem breakdown products to liver;
• b/s bilirubin increase.

Question 13

L73: What is Gilbert’s disease?

Answer 13

• Decreased bilirubin uptake by liver cells;
• Due to loss of number or function of hepatocytes;
• Reduced amount of bilirubin passing into bile ducts;
• Bilirubin accumulation in blood;
• Jaundice.

Question 14

L73: What causes hepatic jaundice, broadly speaking?

Answer 14

‘Liver failure’ (due to cirrhosis or drug induced dysfunction), preventing metabolism of RBC breakdown products

Question 15

L73: What type of jaundice is Primary Biliary Sclerosis (PBC) and what causes it?

Answer 15

• Post-hepatic jaundice;
• Auto-immune;
• Non-functioning bile ducts in the liver (due to scarring and blocking);
• Obstruction to bile outflow;
• Bilirubin (c + nc) flows back into blood;
• b/s bilirubin increase.

Question 16

L73: What are other causes of post-hepatic jaundice?

Answer 16

• Gall stones;

- Tumours blocking ducts (e.g. pancreatic, chlolangiocarcinoma [bile duct cancer]).

Question 17

L73: What clinical observations can give information to the cause of jaundice and why?

Answer 17

Stools/ urine colour - colour indicates concentration and conjugation of bilirubin excreted

Question 18

L73: What does pale stools and dark urine indicate with jaundice?

Answer 18

• Post-hepatic (obstructive) jaundice;

- Bilirubin isn’t being passed to intestines.

Question 19

L73: What does dark stools and dark urine (‘normal’) indicate with jaundice?

Answer 19

• Pre-hepatic (haemolytic) jaundice;

- Build up on nc bilirubin in blood.

Question 20

L73: What does pale stools and pale urine indicate with jaundice?

Answer 20

• Hepatic jaundice;

- Problem with liver as failing to conjugate.

Question 21

L73: Why can gall stones cause jaundice?

Answer 21

Can block biliary tree

Question 22

L73: What symptoms are associated with gall stones?

Answer 22

• Inflammation of proximal tissues - tenderness;
• Abdominal pain that gets worse with fatty foods (gall bladder tries to secrete excess bile to emulsify fats);
• Pain in shoulder tip (C 3-5).

Question 23

L73: What does a pt with pancreatitis likely to have a history of?

Answer 23

Alcoholism

Question 24

L73: What do pts with pancreatitis/ CF need supplements of?

Answer 24

Pancreatic enzymes

Question 25

L73: What other disease can chronic pancreatitis lead to?

Answer 25

Diabetes (type II)

Question 26

L73: What medication prevents the build up of bile acid and that lifestyle factor can help this?

Answer 26

• Ursodeoxycholic acid;

- Low kcal and low cholesterol diet.

Question 27

L73: What is kernicterus?

Answer 27

Brain damage to a neonate caused from the build up of bilirubin in the brain, with jaundice

Question 28

L73: What is cirrhosis of the liver?

Answer 28

Repeated healing and scarring of hepatocytes

Question 29

L73: What can cause cirrhosis of the liver?

Answer 29

• Alcohol;
• PBC;
• Excess iron stores;
• Hep B and C;
• Autoimmune chronic hepatitis;
• CF.

Question 30

L73: What are common signs and symptoms of cirrhosis of the liver?

Answer 30

• (none!);
• Acute bleeds e.g. oesophageal varices (due to portal hypertension);
• Jaundice;
• Oedema (of abdomen) and ascites;
• Spider naevi.