Case 3 Pathophysiology

Question 1

Name the three types of hyperbilirubinaemia

Answer 1

1) pre-hepatic :
2) hepatic :
3) post-hepatic :

Question 2

What occurs in prehepatic hyperbilirubinaemia

Answer 2

1) Increased bilirubin levels in comparison to how much liver can conjugate
2) build up of UNCONJUGATED bilirubin
3) normal liver function

Question 3

What occurs in hepatic hyperbilirubinaemia

Answer 3

1) Liver damage
2) decreased uptake of unconjugated bilirubin
3) decreased conjugation
4) build up of UNCONJUGATED/CONJGATED bilirubin

Question 4

What occurs in post- hepatic hyperbilirubinaemia

Answer 4

1) obstruction in bile ducts

2) build up of CONJUGATED bilirubin

Question 5

What are normal bilirubin levels?

Answer 5

2-20 ymol/l

Question 6

To be clinically relevant (i.e. Classed as huperbilirubinaemia), bilirubin concentration has to be in what in comparison to normal

Answer 6

Twice normal

Question 7

A 76 year old patient has been diagnosed with cancer of the head of pancreas which is obstructing his bile ducts. His stools are pale and his urine appears dark. Why is his urine dark?

Answer 7

• Patient will have dark urine (as ducts are blocked, conjugated bilirubin leaks from hepatocytes to enter bloodstream.. This conjugated bilirubin in plasma and in urin

Question 8

The same patient with pancreatic cancer complains that his skin is itchy and he appears to have yellow skin discolouration, particularly at his sclera. Explain why he has yellow skin discolouration? Itchy skin?

Answer 8

Skin discolouration -

1) Increased levels of bilirubin, which has a HIGH AFFINITY FOR ELASTIN FIBRES in CONNECTIVE TISSUE
2) Sclera affected because it has high content of elastin

Skin itchy-
1) BILE SALTS (made from bile acids. Taurine and glycine)

Question 9

What type of viral hepatitis is transmitted via faeco-oral route?

Answer 9

Hepatitis A

Question 10

What are the markers for hepatitis A?

Answer 10

Anti- HAV IgG - indicates past infection

Anti- HAV IgM - indicated acute recent infection

Question 11

What types of hepatitis can develop into chronic hepatitis?

Answer 11

Hep B and Hep C

Question 12

A young man visits you with fears he may have contracted Hepatitis B. He was severely ill a few months ago after having unprotected sex on a night out. As the patient is unsure of his vaccination history, and his NHS record is missing, you run some serology tests and observe the results as
HBsAg-negative
anti-HBc-positive
anti-HBs-positive
What is the best guess at the indication of these results given the rough history?

Answer 12

No infection currently. 
Previously infected but has resolved. 
Immunised. 
********** 
A negative HBsAg result indicates no infection, while a positive indication of anti-HBc and anti-HBs indicates that antigens have been produced in response to previous exposure to Hepatitis B virus. If only anti-HBc were produced, this would indicate a current infection and other serology measurements, such as IgM anti-HBc would be needed to more definitely determine the level of infection.

Question 13

Remember!! Most common causes of pancreatitis?

Answer 13

ALCOHOL

GALLSTONES

Question 14

What is the term used for the action of the lower oesophageal sphincter opening before as the upper oesophageal sphincter relaxes?

Answer 14

Receptive relaxation