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MD3002 > hepatobilliary and pancreatic disease > Flashcards

hepatobilliary and pancreatic disease Flashcards

1
Q

what is bile made from

A

bilirubin and bile salts

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2
Q

what does the liver break down

A

drugs, insulin, ammonia, etc.

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3
Q

what does the liver synthesise

A

albumin, clotting factors, complement, alpha 1 antitrypsin

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4
Q

what do Kupffer cells do

A

phagocytose old blood cells, bacteria and foreign materials

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5
Q

what concentration of bilirubin must be present for jaundice to occur

A

more than 40 micromoles per liter

may cause an itch

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6
Q

what is unconjugated jaundice

A

water insoluble

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7
Q

what is conjugated jaundice

A

water soluble so can be excreted in the urine. made in the liver and then joins the bile

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8
Q

what is the cause of prehapatic jaundice

A

haemolysis leading to increase release of bilirubin

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9
Q

what is intrahepatic jaundice

A

liver disease leading to excess bilirubin in the blood

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10
Q

what is post hepatic jaundice

A

obstruction of bile outflow

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11
Q

what are the causes of acute liver injury

A

viral infections
alcohol
drug reactions
gallstones leading to billiary obstruction

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12
Q

what are the signs of acute liver injury

A

jaundice, malaise
raised serum bilirubin and transaminase
decreased albumin, ascites, bruising, encephalopathy

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13
Q

what pattern of hepatocyte injury would you see with toxic or haemodynamic liver injury

A

zonal

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14
Q

what is steatosis

A

infiltration of liver cells with fat associated with metabolic disturbance

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15
Q

what are Mallory hyalines

A

an inclusion found in the cytoplasm of liver cells usually due to alchoholic liver disease

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16
Q

how does alcoholic liver disease occur

A

acetaldehyde binds to hepatocytes causing damage and inflammations
the inflammation leads to fibrosis

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17
Q

what are the two components of cirrhosis

A

fibrosis and regeneration

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18
Q

what are the causes of cirrhosis

A 
alcohol
hepatitis b and c 
iron overload
gallstones
autoimmune
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19
Q

what is the morphological classification of cirrhosis

A

micronodular- less than 3 mm
macronodular
or mixed

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20
Q

what is hepatic encephalopathy

A

toxins are not removed from the blood which damage the brain
e.g. ammonia

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21
Q

what are some of the complications of cirrhosis

A 
hepatic encephalopathy
build up of steroid hormones esp. hyperoestrogenism
bleeding (clotting factors)
portal hypertension 
AV shunting

oesophageal varices, caput medusae, haemorrhoids

carcinoma

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22
Q

what can methyl testosterone do

A

injure bile production (cholestasis)

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23
Q

what is cholangitis

A

infection of the gallbladder due to obstruction

24
Q

what is chronic hepatitis

A

liver inflammation lasting more than 6 months

sustained elevation of transaminases

25
Q

describe the classification of chronic hepatitis

A
  • Type – aetiology
  • Grade – degree of inflammation
  • Stage – degree of fibrosis
26
Q

what are the features of autoimmune chronic active hepatisis

A

usually in mid to late teens
plasma cells and swollen hepatocytes
fibrosis
raised transaminase

27
Q

what is biliary cirrhosis

A 
autoimmune destruction of bile duct epithelium 
proliferation of small bile ducts 
architectural disturbance
fibrosis and cirrhosis 
lymphocyte infiltration
28
Q

what is pruritus

A

severe itching of the skin

29
Q

what are the symptoms of primary biliary cirrhosis

A

Jaundice, pruritis, xanthelasmata

30
Q

what is haemochromatosis

A

iron deposition in the liver causing alteration of architecture and cirrhosis
autosomal recessive

31
Q

what is venesection

A

blood letting to reduce iron or RBCs

32
Q

what is alpha 1 antitrypsin deficiency

A

autosomal recessive disorder
proteins build up in hepatocytes
can lead to cirrhosis

33
Q

what is non alcoholic steatohepatitis (fatty liver disease)

A

associated with metabolic syndrome

fat deposition in hepatocytes can lead to cirrhosis

34
Q

what is Wilson’s disease

A

autosomal recessive disorder
failure of the liver to excrete copper in bile leading to cirrhosis
plus neuro dysfunction

35
Q

what is Ceruloplasmin

A

a ferroxidase enzyme that carries copper in the blood

36
Q

what are Kayser-Fleischer rings

A

copper deposition around the eye

37
Q

what type of developmental liver tumours are there

A
  • Cysts

* Hamartomas

38
Q

what types of benign liver tumours are there

A
  • Adenoma, haemangioma

* Liver cysts

39
Q

what type of malignant liver tumours are there

A
  • Metastases – common
  • Primary –
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
40
Q

what are common causes for hepatocellular carcinoma

A

hepatitis B + C
cirrhosis
aflatoxins

41
Q

what are common congenital malformations of the billary system

A
  • Atresia

* Choledocal cysts

42
Q

what are common diseases of the gallbladder

A
  • Gallstones (cholelithiasis)
  • Cholecystitis
  • Cholangiocarcinoma
  • Obstruction
43
Q

what is cholangiocarcinoma

A

Arises from bile duct epithelium anywhere in the
biliary system (intra- and extra-hepatic)
• Associated with ulcerative colitis
• Causes obstructive jaundice, itch, weight loss and
lethargy
• Can lead to rupture of common bile duct or
gallbladder – prognosis poor

44
Q

what are the risk factors for gallstones

A
  • Female, fair, fat, forty, fertile

* Diabetes mellitus

45
Q

what are the symptoms of cholecystitis

A

– RUQ pain (biliary colic), fever,
nausea/vomiting

wall thickening

46
Q

what is an annular pancreas

A

obstruction around the 2nd part of the duodenum leading to
polyhydramnios, low
birth weight, poor
feeding

47
Q

what are the features of pancreatitis

A 
• Causes	catastrophic	metabolic	consequences	–
↓	calcium,	↓	albumin,	↑	glucose
• High	serum	amylase – diagnostic
• Massive	fluid	losses	→ SHOCK
• High	mortality rates
48
Q

what causes chronic pancreatitis

A

• Multiple episodes of acute
• Causes fibrosis of pancreas – may lead to
diabetes mellitus
• Reduced production of enzymes – require
supplements (creon)

49
Q

what are the features of pancreatic andenocarcinoma

A

• Associated with smoking and diabetes mellitus
• Presents with painless, progressive jaundice
• Weight loss
• Poor prognosis
• May be operable if small and close to
ampulla

50
Q

what disease is cholangeocarcinoma associated with

A

UC

51
Q

what are sustained elevation of transaminases associated with

A

chronich hepatitis

52
Q

what are the most common causes of pancreatitis

A

alcohol and gallstones

also tobacco, trauma, medications, poisons

53
Q

what test is diagnostic for acute pancreatitis

A

raised serum amylase

54
Q

what type of cancer is pancreatic cancer

A

adenocarcinoma

55
Q

what increases the risk of pancreatic adenocarcinoma

A

smoking

DM

56
Q

what does raised transaminases indicate

A

chronic hepatitis

57
Q

what types of hepatitis can lead to hepatocellular carcinoma

A

B and C

MD3002 (56 decks)

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