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GI > Week 7 - Liver and pancreatic disease > Flashcards

Week 7 - Liver and pancreatic disease Flashcards

1
Q

What LFT do you measure to look for cholestasis?

A
  • Bilirubin

- Alkaline phosphatase

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2
Q

What LFT do you measure for synthetic function?

A
  • Albumin

- Prothrombin time

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3
Q

What is jaundice?

A

-Yellow pigmentation of the skin and eyes

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4
Q

Explain pre-hepatic jaundice

A
  • Jaundice from haemolytic causes eg excessive haemolysis

- > Liver is unable to cope with excessive bilirubin and you get unconjugated hyperbilirubinaemia and reticulocytosis

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5
Q

Give some causes of pre-hepatic jaundice

A
  • Inherited -> red cell membrane defects
  • Congenital -> Gilbert’s syndrome
  • Aquired -> Infection
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6
Q

Explain hepatic jaundice

A
  • Deranged hepatocellular function whereby hepatocytes cannot extrete bilirubin
  • Conjugated and unconjugated hyperbilirubinaemia
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7
Q

Explain LFTs in hepatic jaundice

A
  • Both AST and ALT raised to reflect liver damage

- Abnormal prothrombin time

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8
Q

Give some causes of hepatic jaundice

A
  • Hepatitis (Any eg alcoholic, viral, autoimune)
  • Drugs (paracetamol)
  • Cirrhosis
  • Hepatic tumours
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9
Q

Explain post-hepatic jaundice

A

-Caused by obstruction of the billiary tree preventing conjugated hyperbilirubinaemia as passageway blocked

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10
Q

Explain the LFTs found in post-hepatic jaundice

A
  • Normal or slightly high AST/ALT due to mild liver damage from pressure
  • High ALP
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11
Q

Give some causes of post-hepatic jaundice

A

-Hepatitis, primary biliary cirrhosis, gallstones, stricture, pancreatic tumour

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12
Q

What is a cholangiocarcinoma?

A

-Carcinoma of the bile duct

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13
Q

What is hepatitis?

A

-Inflammation of the liver in which you get acute hepatocyte breakdown with synthetic failure

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14
Q

List some causes of hepatitis

A
  • Viral (A,B,C,d)
  • Autoimmune
  • Drugs
  • Hereditary
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15
Q

What LFT do you measure for hepatocellular damage?

A
  • ALT/AST

- g-glutamyl transpeptidse (g-GT)

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16
Q

Describe the progression of alcoholic liver disease

A
  • Fatty liver
  • Alcoholic hepatitis
  • Cirrhosis
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17
Q

Describe some complications which ca arise from alcoholic liver disease

A
  • Hepatocellular carcinoma
  • Liver failure
  • Wenicke-Korsakoff syndrome
  • Encephalopathy
  • Dementia
  • Epilepsy
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18
Q

Name 2 conditions which can cause confusion and CNS disturbances as a result of alcohol abuse

A
  • Wernicke-Korsakoff syndrome

- Hepatic encephalopathy

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19
Q

What causes wernicke-korsakoff?

A

-Thiamine deficiency

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20
Q

What is liver cirrhosis?

A

-Liver cell necrosis followed by nodular regeneration and fibrosis resulting in increased resistance to blood flow and deranged liver function

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21
Q

Name some causes of liver cirrhosis

A
  • Hepatitis B and C
  • Alcohol
  • Billiary cirrhosis
  • Autoimmune hepatitis
  • Haemochromocytosis
  • Wilsons disease
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22
Q

What are the clinical features of cirrhosis?

A
  • Jaundice
  • Anaemia
  • Bruising
  • Palmar erythema
  • Dupuytrens contracture
  • Portal hypertension
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23
Q

What is palmar erythema?

A

-reddening of palms over thenar and hypothenar eminences

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24
Q

What is Dupuytren’s contracture?

A

-Fixed forward curvature of one or more fingers

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25
Q

What do LFTs show in cirrhosis?

A
  • Elevated AST/ALT
  • Elevated ALP
  • Elevated Bilirubin
  • Low Albumin
  • Deranged clottinf
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26
Q

How is liver cirrhosis managed?

A
  • Stop alcohol intake
  • Treat complications
  • Transplant
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27
Q

What is primary biliary cirrhosis?

A

-Chronic destruction of bile ducts leading to jaundice, pruritis and xanthalasma

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28
Q

What is hereditary haemochromotosis?

A

-An autosomal recessive condition in which abnormal iron transport results in ion deposition in various organs including heart, pancreas, liver and skin

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29
Q

What is wilson’s disease?

A

-Autosomal recessive condition resulting in disordered copper transport leading to deposition in liver (cirrhosis), basal ganglia (tremor) and kidney(tubular degeneration)

30
Q

What is portal hypertension?

A

-Increase in portal venous pressure by >20mmHg

31
Q

Name some intrahepatic causes of portal hypertension

A
  • Cirrhosis
  • Hepatoportal sclerosis
  • Sarcoidosis
  • Schostosomaisis
32
Q

Describe the porto-systemic anastomoses

A
  • Oesophageal vein and azygous system
  • Superior rectal vein and inferior rectal veins
  • Portal veins and veins of ant. abdominal wall
33
Q

What are the clinical manifestations of portal hypertension?

A
  • Ascites
  • Splenomegaly
  • Spider naevi
  • Caput medusae
  • Osophageal/rectal varices
34
Q

What are spider naevi?

A

-Swollen blood vessels underneath the skin in the distribution of SVC

35
Q

What is fulminant hepatic failure?

A

-Increased metabolic demand which causes acute and/or sever decompensation of hepatic function causing hepatic encephalopathy within 2 months of diagnosis

36
Q

Give some causes of fulminant hepatic failure

A
  • Hepatitis A, D and E
  • Drugs (paracetamol/ecstasy)
  • Wilson’s disease
  • Alcohol
  • Pregnancy
37
Q

Gove some features of fulminant hepatic failure

A
  • Jaundice
  • Encephalopathy
  • Hypoglycaemia
38
Q

What is hepatic encephalopathy?

A

-Reversible neuropsychiatric deficit which results from a decreased ability to remove ammonia from the blood

39
Q

What can precipitate hepatic encephalopathy?

A
  • Sepsis/infection
  • Diuretics
  • Alcohol withdrawal
  • GI bleed
40
Q

What are the clinical features of hepatic encephalopathy?

A
  • Flapping tremor
  • Personality change
  • Intellectual deterioration
41
Q

What is cholelithiasis?

A

-Gallstones

42
Q

State some risk factors of gallstones

A
  • Female
  • Increasing age
  • Obesity
  • Diet
  • Drugs
43
Q

Describe the stones which can occur in gallstones

A
  • Cholesterol stones
  • Pigment stones
  • Mixed
44
Q

What is biliary colic?

A

-Intermittent pain caused by contraction of the gall bladder in attempt to move the stone

45
Q

What is cholecystitis? How does it present?

A
  • Inflammation of the gallbladder caused by gallstones leading to oedema and mucosal ulceration
  • Often presents with pain and SIRS/sepsis
46
Q

What is mucocoele?

A

-Mucus secretion causing painful distension of the gall bladder

47
Q

Name 3 complications of gallstones

A
  • Ascending cholangitis
  • Obstructuve jaundice
  • Acute pancreatitis
48
Q

What is gallstone ileus?

A

-Gallstone erodes through mucosa of gallbladder and through into duodenum -> can move and obstruct ileus

49
Q

What is charcot’s triad and what does it represent?

A
  • RUQ pain, jaundice and fever

- Ascending cholangitis

50
Q

What is pancreatitis?

A

-Inflammation of the pancreas caused by effects of enzymes released from pancreatic acini

51
Q

What are the causes of acute pancreatitis?

A
  • Gallstones
  • Ethanol
  • Trauma
  • Scorpion bite
  • Mumps
  • Autoimmune
  • Steroids
  • Hyperlipidaemia
  • ERCP
  • Drugs
52
Q

What damage do protease, lipase and elastase cause in pancreatitis?

A
  • Protease destroys tissue
  • Lipase causes fat necrosis
  • Elastase causes blood vessel destruction
53
Q

What are the clinical manifestations of pancreatitis?

A
  • Severe pain
  • Vomiting
  • Dehydration
  • SIRS
54
Q

What is chronic pancreatitis?

A

-Parenchymal destruction, fibrosis, loss of acini and duct stenosis

55
Q

What are the clinical features of chronic pancreatitis?

A
  • Pain
  • Malabsorption (steatorrhoea, wt loss)
  • DM
  • Jaundice
56
Q

What are most pancreatic carcinomas?

A

-Ductal adenocarcinoma

57
Q

What is the prognosis like for pancreatic carcinomas?

A

-Very poor (account for 5% of all ca deaths)

58
Q

What are the risk factors for pancreatic carcinomas?

A
  • Smoking
  • Beta napthylamine
  • Familial
59
Q

What are the clinical features of pancreatic carcinoma?

A
  • Initially asymptomatic

- Pain, vomiting, malabsorption, diabetes

60
Q

What is shifting dullness indicative of?

A

-Ascites

61
Q

Why does ascites form in cirrhosis?

A
  • Portal hypertension causes a rise in systemic venous pressure
  • Liver damage causes a reduced synthetic function and thus reduced albumin production
  • Together low oncotic pressure and high hydrostatic pressure cause fluid to move out of the peritoneal capillaries into the peritoneal space
62
Q

How can oesophageal varices present?

A

-Haematemesis

63
Q

Where does oesophageal venous system meet the systemic circulation?

A

-Oesophageal branch of left gastric vein and azygous system

64
Q

Name 3 disease processes which would increase the breakdown of RBCs

A
  • Haemolytic anaemia
  • Malaria
  • Sickle cell anaemia
65
Q

What is the function of UDP-glucuronyl transferase?

A

-Conjugate bilirubin with glucaronic acid

66
Q

Why do people present with pale stools and dark urine in jaundice?

A
  • Pale stools because no bilirubin is reaching the GI tract -> normally bilirubin converted to stercobilin which gives faeces their colour
  • Dark urine as bilirubin is in the urine
67
Q

What would be present in a blood test if pancreatitis was present?

A

-Amylase

68
Q

Why is ALT more specific than AST?

A
  • ALT is located only in hepatocytes

- AST is also present in myocardium

69
Q

Which LFT is specific of alcoholic liver disease?

A

-g-GT

70
Q

What does an ALT:AST ratio less than 1 indicate?

A

-Viral hepatitis

71
Q

What does an AST:ALT>2 indicate?

A

-Alcoholic disease

GI (16 decks)

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