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1st year GI > liver > Flashcards

liver Flashcards

1
Q

what vessels supply blood to the liver

A
  • hepatic artery - branch of the coeliac axis (25%)

- portal vein - drains most of the GI tract and spleen (75%)

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2
Q

what is the network between hepatocytes

A

bile canaliculi which join to form thin bile ductules near the portal tract which in turn enter bile ducts in the portal tracts

  • the hepatic ducts join at the porta hepatitis to form the common hepatic duct
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3
Q

what connects the gall bladder to the lower end of the common hepatic duct

A

cystic duct

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4
Q

what does the gallbladder store

A

It lies under the right lobe of the liver and stores and concentrates hepatic bile - it has a capacity of 50ml

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5
Q

what forms the central bile duct

A

cystic and hepatic ducts, narrowing at its distal end to pass into the duodenum

  • the CBD and pancreatic duct open into the 2nd part of the duodenum through a common channel at the ampulla of vater
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6
Q

where is the liver found

A

the right hyporchondrium

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7
Q

how many segments make up the liver

A

8 - each segment has its own portal pedicle, permitting individual resection at surgery

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8
Q

what are sinusoids

A

low pressure vascular channels that receive blood from terminal branches of the hepatic artery and portal vein at the periphery of lobules and deliver it into central veins.

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9
Q

what is the caudate lobe

A

independent part of the liver, supplied by the right and left hepatic artery and portal vein. Blood from the caudate lobe drains directly into the vena cava

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10
Q

what is the acinus

A

the functional hepatic unit which consists of parynchyma supplied by teh smallest portal tracts containing portal vein radicals, hepatic arterioles and bile ductules

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11
Q

what is jaundice

A

Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment.

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12
Q

when is jaundice detectable clinically

A

when serum bilirubin is over 50 umol/L

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13
Q

what can jaundice be divided into

A
  • haemolytic jaundice
  • congenital hyperbilirubinaemia
  • cholestatic jaundice
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14
Q

what is haemolytic jaundice

A

Increased bilirubin load for the liver cells due to increased breakdown of RBCs

  • usually mild jaundice
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15
Q

what causes haemolytic jaundice

A

Haemolytic anaemia

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16
Q

clinical features of haemolytic jaundice

A
  • jaundice
  • splenomegaly
  • gallstones
  • leg ulcers
17
Q

what is congenital hyperbilirubinaemia

A

defects in conjugation

18
Q

what is unconjugated bilirubin

A

not water soluble and therefore doesn’t pass into the urine

Acholuric jaundice = Jaundice without bile pigments in the urine.

19
Q

what are unconjugated types of jaundice

A
  • Gilberts syndrome

- Crigler-Najjar syndrome

20
Q

what are conjugated types of jaundice

A
  • Dubin-Johnson and Rotors syndromes
  • Benign recurrent intrahepatic cholestasis
  • Progressive familial intrahepatic cholestasis syndromes
21
Q

what is cholestatic jaundice (acquired)

A

cholestatic, or obstructive, jaundice, occurs when essentially normal liver cells are unable to transport bilirubin either through the hepatic-bile capillary membrane, because of damage in that area, or through the biliary tract, because of anatomical obstructions such as gallstones or cancer.

22
Q

what is extra hepatic cholestasis

A

due to a large duct obstruction of bile flow at ant point in the biliary tract distal to the bile canaliculi

23
Q

what is intra hepatic cholestasis

A

occurs because of the failure of bile secretion, which may be caused by intrinsic defects in bile secretion of inflammation in the intrahepatic ducts

24
Q

what causes extra hepatic cholestasis

A
  • common duct stones
  • Carcinoma in the bile duct, head of pancreas or ampulla
  • Biliary stricture
  • Sclerosing cholangitis
  • Pancreatic pseudocyst
25
Q

what causes intra hepatic cholestasis

A
  • viral hepatitis
  • drugs
  • alcohol
  • cirrhosis
  • autoimmune cholangitis
26
Q

what are the signs and symptoms of extra and intra hepatic cholestasis

A
  • jaundice
  • pale stools
  • dark urine
  • serum bilirubin is conjugated
27
Q

what are the 2 most useful tests for jaundice

A
  • viral markers ( for HAV, HBV, HCV )
  • ultrasound - to exclude an extra hepatic obstruction and to diagnose any features comparable with chronic liver disease
28
Q

what is acute liver failure

A

acute liver injury with encephalopathy and deranged coagulation (INR>1.5) in a patient with a previously normal liver

29
Q

what causes acute liver failure

A
  • viruses
  • drugs eg paracetamol, antibiotics, antidepressants
  • toxins
  • hepatic failure in pregnancy
  • vascular causes
  • metabolic causes
  • malignancies
30
Q

what are clinical features of acute liver failure

A
  • jaundice
  • small liver
  • signs of hepatic encephalopathy
  • Fetor hepaticus
  • fever
  • vomitting
  • hypotension
  • hypoglycaemia
  • spascitiy
  • cerebral oedema
31
Q

what investigations should be carried out for acute liver failure

A
  • routine tests
  • there is hyperbilirubunaemia, high serum aminotransferases and low levels of coagulation factors . Aminotransferases are not useful indicators of the course of the disease as they tend to fall along with the albumin with progressive liver damage
  • an electroencephalogram is sometimes helpful in grading encepathology
  • ultrasound will define size of liver and may indicate underlying liver pathology
32
Q

management of acute liver failure

A
  • no specific treatment
  • supportive therapy
  • 20% mannitol if increased intracranial pressure
  • suspected infection = antibiotics
  • transplant
33
Q

what is autoimmune hepatitis

A

Inflammatory liver disease of unknown cause characterized by suppressor T cell defects with autoantibodies directed against hepatocyte surface antigens. Type 2: children and young adults, type 1: adults

34
Q

signs and symptoms of autoimmune hepatitis

A

Most present with autoimmune signs: fever, malaise, urticarial rash, polyarthritis, pleurisy, pulmonary infiltration or glomerulonephritis. Also may present with signs of chronic liver disease

35
Q

what are investigation findings for autoimmune hepatitis

A

Raised AST, ALT, serum bilirubin and Alk Phos, hyper gammaglobulinaemia (esp IgG), positive autoantibodies

36
Q

how to manage autoimmune hepatitis

A
  • prednisolone daily for at least 2 weeks followed by a slow reduction to a maintenance dose
  • Azathrhioprine should be added as a steroid sparing agent

1st year GI (16 decks)

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