Flashcards in Hepatobiliary & Pancreas Deck (42):
Summary of Hepatobiliary & Pancreas pathology
- Jaundice, Hepatitis, Cirrhosis, IEM, HCC
- Gall stones, Cholangiocarcinoma
- A/C Pancreatitis, Pancreatic tumours
What is the most common sign of Liver D?
Causes of jaundice can be divided into 3 catagories. What are they?
Pre-hepatic (too much bilirubin, unconjugated)
Hepatic (few functioning liver cells)
Post-hepatic (obstruction, conjugated)
Which type of jaundice will present as yellow eyes + dark urine?
(Chronic Liver D, Acute Liver injury, IEM)
Which type of jaundice would present as yellow eyes + dark urine + pale stools?
(Stones, tumours, stricture)
How would pre-hepatic jaundice present?
(Haemolytic anaemias, Gilbert's)
Yellow eyes/skin only
How would you investigate jaundice?
Liver biopsy (no obstruction)
The general presentation of hepatitis is..?
Increase liver enzymes
The causes of Acute/Chronic Hepatitis & Cirrhosis are all the same but with the latter, the insult persists. What are the causes?
HEP VIRUSES A-E
Chronic: IEM, Biliary, Vascular
Chronic Hepatitis can be staged A-D. How would you determine stage & cause?
State the effects of alcohol on the liver.
Fatty changes (reverses when stop drinking)
NAFLD presents the same as...?
What are its risk factors?
Fatty Liver D
CVD risk factors
The presentation of Fatty Liver D?
Cirrhosis is the end-point of Chronic liver D and therefore has the same causes. Define Cirrhosis.
= diffuse hepatic fibrosis & conversion of normal architecture --> abnormal nodules
List specific complications of cirrhosis under the umbrellas of FIBROSIS, LIVER FAILURE, INFECTIONS, HCC.
FIBROSIS - portal HTN, Oesophageal varices
LIVER FAILURE - oedema, bruising, muscle wastng, ascites, jaundice
The 3 IEM that cause liver cirrhosis from abnormal depositions in liver (+other organs) are...?
a-1 Antitrypsin def - a-1 Antitrypsin
Haemochromatosis - Fe2+
Wilson's D - Cu2+
Splenomegaly, Oesophageal varices, Piles (peri-anal varices), Ascites are all COMPLICATIONS of what?
(Treat with shunt)
Ascites = accumalation fo fluid in the peritoneal cavity causing abdo swelling. T/F?
HCC stands for...?
70% have Cirrhotic liver
In non-cirrhotic patients = mets
Risk factors for HCC?
M > F
What blood marker is used to diagnose HCC?
What is the standard treatment for HCC?
Transplant (cirrhosis is diffuse, HCC can reoccur)
(Surgery if non-cirrhotic/small)
Gall stones types are: cholesterol, pigmented, mixed. What are the risk factors?
F > M
Complications of Gall stones?
Gall stone Ileus
Treatment for gall stones?
Cholangiocarcinoma = adenocarcinoma arising from bile ducts. What are the 2 types?
Peri-hilar (large ducts, presents early, obstructive jaundice)
The pancreas is comprised of mostly what type of tissue?
(destroyed 1st in pathology)
Acute pancreatitis = MEDICAL EMERGENCY. What are the 2 top causes?
Is this a presentation of Acute/Chronic pancreatitis? Test?
-Severe sudden abdo pain radiating to back
- Grey Turner's, Cullen's sign
Chronic Pancreatitis top 2 causes?
(HPT, Infections, Recurrent acute, obstruction)
Intermittent abdo pain, back pain & weight loss, Diarrhoea, Steatorrhoea (FAT malabsorption), Diabetes, are presentation for what?
Investigations for Chronic Pancreatitis?
Direct function tests
-Duodenal aspirates (Secretin, CCK, Lundh tests)
Do Pancreatic adenocarcinomas arise from the exocrine or endocrine component of pancreas?
M > F
Hereditary cancers ~10%
Presentation of Pancreatic Adenocarcinoma is similar to chronic pancreatitis.
Epigastric pain - radiating to back
Pancreatic neuroendocrine tumours can arise from any endocrine cell. Presentation depends on hormone produced by cell.
Typically presents in whom?
Blood markers for Hepatocellular damage?
Markers for Biliary tract damage?
PIIINP, TIMP-1, Hyaluronic acid are markers for what?
Increased ALT/AST. Normal ALP is indicative of which type of jaundice?
Normal ALT/AST. Increased ALP is indicative of which type of jaundice?
IEM causing jaundice are...?