Flashcards in GI: Diseases of liver, biliary tree and pancreas Deck (16):
List the functions of the liver
- detoxification, metabolism of drugs/ toxins
- energy metabolism
- storage of glycogen (buffers blood sugar)
- protein synthesis, albumin and clotting factors
- produces bile
List the functions of the pancreas
Endocrine - produces insulin and glucagon
Exocrine - produces digestive enzymes
List the functions of the gall bladder
- stores and concentrates bile
- excretes bile pigments
Explain why a diseased liver would cause:
Poor blood clotting
Poor blood clotting - insufficient clotting factors synthesised, bleed easily
Skin irritation - bile salts circulating and depositing on the skin can cause itching
Ascites - not enough albumin produced so low oncotic pressure
Outline the steps involved in excretion of bilirubin
Bilirubin bound to albumin which carries it to the liver
It is then conjugated to make it soluble, and joins with bile pigments and bile salts
This then drains into the biliary tree and is converted to urobilinogen in the duodenum
Urobilinogen and sterobilinogen make poo brown
What is pre-hepatic jaundice?
The liver is normal but overworked so cannot conjugate fast enough!
There is increased bilirubin load to the liver eg haemolytic anaemia, the unconjugated bilirubin remains in blood circulation
What is hepatic jaundice?
There is injury/damage to the liver so decreased rate of conjugation.
What is post-hepatic jaundice?
There is obstruction to bile drainage into the duodenum eg gallstones in common bile duct, pancreatic cancer, hepatocyte swelling.
The bilirubin in conjugated and refluxes into the circulation but doesnt make it into the stool - steathorrhoea.
What are the liver function tests?
Give an indication of liver damage rather than function
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) - in hepaTocytes
Alkaline phosphatase (ALP) - in the cells lining the bile ducts
What is hepatitis and what are the causes?
Hepatitis: hepatocyte inflammation and break down
Viral eg Hep A B C
Drugs eg paracetamol, alcohol
What is fatty liver and what are the causes?
Steatosis is fat in the liver and steatohepatitis is the fat causing an inflammatory response. It is reversible!
The main cause is alcohol, however there are other causes of fatty liver disease eg high cholesterol, obesity
What are the most common types of malignancy in the liver?
Liver metastases is more common than primary - 50% come from colorectal cancers.
Most common primary malignancy is hepatocellular carcinoma
How does chronic liver disease lead to cirrhosis and what is the complication of this?
Chronic inflammation of the liver leads to ongoing necrosis and fibrosis. There is therefore an irreversible change to the liver structure - cirrhosis (shrunken nodular irregular liver)
The increases resistance to blood flow that leads to portal hypertension.
What is biliary colic and cholecystitis?
Impaction of gallstones in the biliary tree leading to nausea and vom, abdo pain, jaundice, fever, right upper quadrant tenderness.
Cholecystitis is when the gall bladder gets inflamed and infected.
Outline the causes, presentation and treatment of acute pancreatitis
Acute pancreatitis is damage to acinar cells which release enzymes. Most common causes are gallstones and alcohol.
Presents with severe pain, vom and hypotension.
Treatment is supportive - analgesics, IV fluids and mortality is significant (10%)