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Clinical Pathology > Hepatobiliary & Pancreas > Flashcards

Hepatobiliary & Pancreas Flashcards

1
Q

Summary of Hepatobiliary & Pancreas pathology

A

Liver pathology
- Jaundice, Hepatitis, Cirrhosis, IEM, HCC

Biliary pathology
- Gall stones, Cholangiocarcinoma

Pancreatic pathology
- A/C Pancreatitis, Pancreatic tumours

Investigations

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2
Q

What is the most common sign of Liver D?

A

Jaundice

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3
Q

Causes of jaundice can be divided into 3 catagories. What are they?

A

Pre-hepatic (too much bilirubin, unconjugated)
Hepatic (few functioning liver cells)
Post-hepatic (obstruction, conjugated)

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4
Q

Which type of jaundice will present as yellow eyes + dark urine?

A

Hepatic jaundice

Chronic Liver D, Acute Liver injury, IEM

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5
Q

Which type of jaundice would present as yellow eyes + dark urine + pale stools?

A

Post-hepatic jaundice

Stones, tumours, stricture

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6
Q

How would pre-hepatic jaundice present?

Haemolytic anaemias, Gilbert’s

A

Yellow eyes/skin only

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7
Q

How would you investigate jaundice?

A 
USS (obstructive)
Liver biopsy (no obstruction)
LFTs
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8
Q

The general presentation of hepatitis is..?

A

OFTEN ASYMPATOMATIC

Increase liver enzymes
+/- jaundice/malaise/coagulopathy/encephalopathy/death

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9
Q

The causes of Acute/Chronic Hepatitis & Cirrhosis are all the same but with the latter, the insult persists. What are the causes?

A 
HEP VIRUSES A-E
ALCOHOL
DRUGS
AUTOIMMUNE
Paracetamol
Idiopathic

Chronic: IEM, Biliary, Vascular

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10
Q

Chronic Hepatitis can be staged A-D. How would you determine stage & cause?

A

Liver biopsy

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11
Q

State the effects of alcohol on the liver.

A

Fatty changes (reverses when stop drinking)
Alcohol steatohepatitis
Cirrhosis

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12
Q

NAFLD presents the same as…?

What are its risk factors?

A

Fatty Liver D

CVD risk factors

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13
Q

The presentation of Fatty Liver D?

A

Steatosis
Steatohepatitis
Cirrhosis
HCC

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14
Q

Cirrhosis is the end-point of Chronic liver D and therefore has the same causes. Define Cirrhosis.

A

= diffuse hepatic fibrosis & conversion of normal architecture –> abnormal nodules

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15
Q

List specific complications of cirrhosis under the umbrellas of FIBROSIS, LIVER FAILURE, INFECTIONS, HCC.

A

FIBROSIS - portal HTN, Oesophageal varices
LIVER FAILURE - oedema, bruising, muscle wastng, ascites, jaundice
INECTIONS
HCC

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16
Q

The 3 IEM that cause liver cirrhosis from abnormal depositions in liver (+other organs) are…?

A

a-1 Antitrypsin def - a-1 Antitrypsin
Haemochromatosis - Fe2+
Wilson’s D - Cu2+

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17
Q

Splenomegaly, Oesophageal varices, Piles (peri-anal varices), Ascites are all COMPLICATIONS of what?

A

Portal HTN

Treat with shunt

18
Q

Ascites = accumalation fo fluid in the peritoneal cavity causing abdo swelling. T/F?

A

T

19
Q

HCC stands for…?

70% have Cirrhotic liver
In non-cirrhotic patients = mets

A

Hepatocellular Carcinoma

20
Q

Risk factors for HCC?

A 
Cirrhosis
Alcohol
M > F
Obesity
Viral Hepatitis
21
Q

What blood marker is used to diagnose HCC?

A

a-feroprotein

22
Q

What is the standard treatment for HCC?

A

Transplant (cirrhosis is diffuse, HCC can reoccur)

Surgery if non-cirrhotic/small

23
Q

Gall stones types are: cholesterol, pigmented, mixed. What are the risk factors?

A

Obesity
Diabetes
F > M

24
Q

Complications of Gall stones?

A 
OBSTRUCTIONS
Cholecystitis/Cholangitis
Pancreaitis
Gall stone Ileus
Liver abscess
GB carcinoma
25
Q

Treatment for gall stones?

A

Cholecystectomy

26
Q

Cholangiocarcinoma = adenocarcinoma arising from bile ducts. What are the 2 types?

A

Intra-hepatic

Peri-hilar (large ducts, presents early, obstructive jaundice)

27
Q

The pancreas is comprised of mostly what type of tissue?

A

EXOCRINE 85%

destroyed 1st in pathology

28
Q

Acute pancreatitis = MEDICAL EMERGENCY. What are the 2 top causes?

A

Gall stones*

Alcohol

29
Q

Is this a presentation of Acute/Chronic pancreatitis? Test?

  • Severe sudden abdo pain radiating to back
  • Nausea/vomitting
  • Grey Turner’s, Cullen’s sign
A

Acute pancreatitis

Amylase

30
Q

Chronic Pancreatitis top 2 causes?

A

Alcohol
Smoking

(HPT, Infections, Recurrent acute, obstruction)

31
Q

Intermittent abdo pain, back pain & weight loss, Diarrhoea, Steatorrhoea (FAT malabsorption), Diabetes, are presentation for what?

A

Chronic Pancreatitis

32
Q

Investigations for Chronic Pancreatitis?

A

Direct function tests

-Duodenal aspirates (Secretin, CCK, Lundh tests)

33
Q

Do Pancreatic adenocarcinomas arise from the exocrine or endocrine component of pancreas?
Risk factors?

A

Exocrine

Smoking
Alcohol
Red meats
M > F
Hereditary cancers ~10%
34
Q

Presentation of Pancreatic Adenocarcinoma is similar to chronic pancreatitis.

A 
Epigastric pain - radiating to back
Weight loss
Obstructive jaundice
Diabetes
Courvoiser's sign
Trousseau's syndrome
35
Q

Pancreatic neuroendocrine tumours can arise from any endocrine cell. Presentation depends on hormone produced by cell.
Typically presents in whom?

A

20-60yrs
MEN1
Von-Hippel Lindau

36
Q

Blood markers for Hepatocellular damage?

A

ALT*
AST
a-feroprotein

37
Q

Markers for Biliary tract damage?

A

Conjugated bilirubin
ALP
y-GT

38
Q

PIIINP, TIMP-1, Hyaluronic acid are markers for what?

A

Liver Fibrosis

39
Q

Increased ALT/AST. Normal ALP is indicative of which type of jaundice?

A

Hepatic jaundice

40
Q

Normal ALT/AST. Increased ALP is indicative of which type of jaundice?

A

Obstructive jaundice

41
Q

IEM causing jaundice are…?

A

Gilberts, Crigler-Najjar

Dubin-Johnson, Rotor

42
Q

Indications to do LFTs?

A

pain,itchy, jaundice, bruising, bruising, risk factors, existing liver D

Clinical Pathology (13 decks)

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