HPB diseases

Question 1

cells of the liver

Answer 1

hepatocytes - metabolism
Kuppfer cells - inflammatory response
Stellate cells - responsible for fibrosis

Question 2

the liver ‘digestion’

Answer 2

carbs: storage and release of glucose, formation of glycogen
Lipids: fatty acid metabolism & synthesis of lipoproteins
Protein: synthesis of albumin, transport proteins, proteases, clotting factors, acute phase proteins

Question 3

bilirubin

Answer 3

bilirubin comes from the breakdown of heamoglobin
unconjugated bilirubin is hydrophobic strongly albumin bound, and is not excreted in the urine
conjugation makes it water soluble so it can then be excreted in urine or bile (giving urine its brown colour)
conjugated bilirubin is metabolised by gut flora to urobilinogen and some is resorbed (EH circulation)

Question 4

unconjugated hyperbilirubinaemia

Answer 4

increased delivery of hamoglobin - haemolysis e.g haemolytic anaemia
ineffective eryhtropoesis - deficiendy of B12, folate, iron, sideroblastic anaemia
heamatoma - trauma
failure to cinjugate bilirubin - Gilberts

Question 5

Sideroblastic anaemia

Answer 5

bone marrow produces ringed sideroblast rather than erythrocytes

Question 6

conjugated hyperbilirubinaemia

Answer 6

acute hepatocellular dysfunction - viral hep, drugs, alcoholic hep, hepatic ischamia/hypoxia
chronic hepatocellular dysfunction
biliary obstruction - stones, carcinoma pancreas, bile duct disease

Question 7

model of liver disease

Answer 7

acute hepatitis–>chronic hep–>hepatic fibrosis–>cirrhosis

Question 8

features of acute hepatitis

Answer 8

lethargy
jaundice
RUQ pain
disordered clotting
encephalopathy

Question 9

features of chronic hepatitis

Answer 9

usually none
occasional fatigue and non-specific Sx
often a chance finding

Question 10

Cirrhosis

Answer 10

fibrotic tissue disrupts hepatic architecture - venous inflow dammed back leading to portal hypertension. hepatocyte function is deregulated
disorganised hepatocyte regeneration - hepatocyte function deregulated, and constant stimulation to regenrate
this leads to nodules of hepatocytes surrounded by fibrosis - cirrhosis
increased risk of hepatoma

Question 11

metabolic effects of cirrhosis

Answer 11

reduced synthetic capacity (albumin, clotting factors, protein)
reduced clearance of waste products (jaundice, encephelopathy)
portal HTN (ascites, varices, splenomegaly)

Question 12

further effects of cirrhosis

Answer 12

risk of hepatoma
vascular dilatation in splanchnic bed (abdo viscera), leading to central hypovolaemia, increasing RAS, causing salt and watre retention
fluid retention and vulnerability to renal clampdown
failure of sex hormone metabolism

Question 13

causes of cirrhosis

Answer 13

alcohol
NAFLD/NASH (non alcoholic steatohepatitis)
autoimmune (PBC, hep)
hereditary (wilson’s, heamachromatosis, alpha-1-antitrypsin deficiency)
chronic viral infection (HBV, HCV)
cryptogenic

Question 14

alcoholic hepatitis

Answer 14

if Maddrey score >32, 50% mortality at 1 month

Question 15

pancreatic disease

Answer 15

acute pancreatitis (alcohol, stones, familial, drugs)
chronic pancreatitis: pain, exocrine insufficuency, endocrine insufficiency
Cancer