GI 8 - The Liver, Gallbladder + Pancreas Flashcards Preview

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Flashcards in GI 8 - The Liver, Gallbladder + Pancreas Deck (29):
1

In which cells can AST be found?

- Hepatocytes
- Cardiac cells
- Skeletal muscle cells
- Brain cells

2

What can cause raised AST levels?

- Viral hepatitis
- Toxic hepatitis
- Ischaemic hepatitis
- Cirrhosis
- Infection
- Myocardial infarction
- Muscular dystrophy
- Haemolytic anaemia

3

Which of AST and ALT are specific to hepatocytes?

ALT

4

What can cause raised ALP?

- Biliary obstruction
- Bone metastases
- Hyperparathyroidism

5

What is the most sensitive serum marker of Liver damage? What is its main drawback?

GGT: gamma-glutamyltransferase
Not specific to Liver damage - present elsewhere in body

6

What changes in albumin levels and prothrombin time would you expect to see in liver failure? Why?

Reduced albumen
Increased prothrombin time

Liver synthesises albumin and clotting factors

7

Which clotting factors are not synthesised by the Liver?

- Factor VIII
- vWF

8

If AST:ALT levels = 1, what is the most common explanation?

Ischaemic hepatitis

9

If AST:ALT < 1, what are the most common explanations?

Viral hepatitis
Toxic hepatitis
Paracetamol OD

10

If AST:ALT > 2.5, what is the most common explanation?

Alcoholic hepatitis

11

List some symptoms of liver cirrhosis:

- Jaundice
- Ascites
- Palmar erythema
- Fatigue/lethargy
- Pale conjunctiva
- Caput medusae
- Oedema
- Mental/personality changes
- Asterixis

12

What is the simple test for hepatic encephalopathy?

Draw a 5-pointed star
- If positive will be unable to draw it

13

Name the 3 main sites of porto-systemic anastamoses affected by portal hypertension:

- Oesophagus
- Anorectal junction
- Skin of abdomen (caput medusae)

14

What is the function of the gallbladder?

- Stores bile
- Concentrated bile (removes salt + H2O)
- Releases bile when CCK present

15

What stimulates the release of bile from the gallbladder?

- Chyme enters duodenum, stimulates release of CCK
- CCK causes contraction of gallbladder, and relaxation of the sphincter of Oddi

16

What structure controls the release of bile and pancreatic secretions into the duodenum?

Sphincter of Oddi

17

What are the 3 types of gallstones? Which is most common?

1) Yellow = cholesterol
2) Black = pigments
3) Mixed = most common

18

What is Cholelithiasis?

Presence of gallstones in gallbladder

19

Who is most at risk of developing gallstones?

- Female (esp. if had children/on OCP)
- Over forty
- Overweight
- Crohn's/IBS
- Cirrhosis
- Cholangitis
- Cholestasis
- Family history
- Ceftriaxone

20

Which main LFT indicates the presence of gallstones?

ALP: Alkaline phosphatase

21

Which pigments can produce gallstones?

- Bilirubin
- Calcium bilirubinate

22

How long is the pancreas? Is it peritoneal or retroperitoneal?

~ 14 cm
Retroperitoneal

23

Name the part of the pancreas which stretches towards the spleen:

Uncinate process

24

What is the blood supply to the pancreas?

Branches of both:
Coeliac trunk = superior pancreaticoduodenal artery and branches of splenic artery
SMA = inferior pancreaticoduodenal artery

25

What percentage of pancreatic secretions are exocrine and endocrine?

Exocrine ~ 98%
Endocrine ~ 2%

26

Name some components of pancreatic exocrine secretions:

- Trypsinogen
- Chemotrypsinogen
- Pancreatic amylase
- Pancreatic lipase
- Cholesterol esterase

27

What endocrine hormones are produced by the pancreas? Which cells release which hormones?

Alpha cells = Glucagon
Beta cells = Insulin
Delta cells = Somatostatin
Gamma cells = Pancreatic polypeptide

28

What can cause acute pancreatitis?

- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion bite
- Hyperlipidaemia
- ERCP
- Drugs

29

What is the typical presentation of acute pancreatitis?

- Severe, constant upper abdominal pain, which radiates to back
- Vomiting
- Hypotension - fatigue, lightheadedness etc