Hepatobiliary & Pancreas Flashcards Preview

Clinical Pathology > Hepatobiliary & Pancreas > Flashcards

Flashcards in Hepatobiliary & Pancreas Deck (42):
1

Summary of Hepatobiliary & Pancreas pathology

Liver pathology
- Jaundice, Hepatitis, Cirrhosis, IEM, HCC

Biliary pathology
- Gall stones, Cholangiocarcinoma

Pancreatic pathology
- A/C Pancreatitis, Pancreatic tumours

Investigations

2

What is the most common sign of Liver D?

Jaundice

3

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)

4

Which type of jaundice will present as yellow eyes + dark urine?

Hepatic jaundice

(Chronic Liver D, Acute Liver injury, IEM)

5

Which type of jaundice would present as yellow eyes + dark urine + pale stools?

Post-hepatic jaundice


(Stones, tumours, stricture)

6

How would pre-hepatic jaundice present?

(Haemolytic anaemias, Gilbert's)

Yellow eyes/skin only

7

How would you investigate jaundice?

USS (obstructive)
Liver biopsy (no obstruction)
LFTs

8

The general presentation of hepatitis is..?

OFTEN ASYMPATOMATIC

Increase liver enzymes
+/- jaundice/malaise/coagulopathy/encephalopathy/death

9

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
ALCOHOL
DRUGS
AUTOIMMUNE
Paracetamol
Idiopathic

Chronic: IEM, Biliary, Vascular

10

Chronic Hepatitis can be staged A-D. How would you determine stage & cause?

Liver biopsy

11

State the effects of alcohol on the liver.

Fatty changes (reverses when stop drinking)
Alcohol steatohepatitis
Cirrhosis

12

NAFLD presents the same as...?

What are its risk factors?

Fatty Liver D

CVD risk factors

13

The presentation of Fatty Liver D?

Steatosis
Steatohepatitis
Cirrhosis
HCC

14

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

15

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
INECTIONS
HCC

16

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+

17

Splenomegaly, Oesophageal varices, Piles (peri-anal varices), Ascites are all COMPLICATIONS of what?

Portal HTN

(Treat with shunt)

18

Ascites = accumalation fo fluid in the peritoneal cavity causing abdo swelling. T/F?

T

19

HCC stands for...?

70% have Cirrhotic liver
In non-cirrhotic patients = mets

Hepatocellular Carcinoma

20

Risk factors for HCC?

Cirrhosis
Alcohol
M > F
Obesity
Viral Hepatitis

21

What blood marker is used to diagnose HCC?

a-feroprotein

22

What is the standard treatment for HCC?

Transplant (cirrhosis is diffuse, HCC can reoccur)

(Surgery if non-cirrhotic/small)

23

Gall stones types are: cholesterol, pigmented, mixed. What are the risk factors?

Obesity
Diabetes
F > M

24

Complications of Gall stones?

OBSTRUCTIONS
Cholecystitis/Cholangitis
Pancreaitis
Gall stone Ileus
Liver abscess
GB carcinoma

25

Treatment for gall stones?

Cholecystectomy

26

Cholangiocarcinoma = adenocarcinoma arising from bile ducts. What are the 2 types?

Intra-hepatic

Peri-hilar (large ducts, presents early, obstructive jaundice)

27

The pancreas is comprised of mostly what type of tissue?

EXOCRINE 85%

(destroyed 1st in pathology)

28

Acute pancreatitis = MEDICAL EMERGENCY. What are the 2 top causes?

Gall stones*
Alcohol

29

Is this a presentation of Acute/Chronic pancreatitis? Test?

-Severe sudden abdo pain radiating to back
-Nausea/vomitting
- Grey Turner's, Cullen's sign

Acute pancreatitis

Amylase

30

Chronic Pancreatitis top 2 causes?

Alcohol
Smoking

(HPT, Infections, Recurrent acute, obstruction)

31

Intermittent abdo pain, back pain & weight loss, Diarrhoea, Steatorrhoea (FAT malabsorption), Diabetes, are presentation for what?

Chronic Pancreatitis

32

Investigations for Chronic Pancreatitis?

Direct function tests
-Duodenal aspirates (Secretin, CCK, Lundh tests)

33

Do Pancreatic adenocarcinomas arise from the exocrine or endocrine component of pancreas?
Risk factors?

Exocrine


Smoking
Alcohol
Red meats
M > F
Hereditary cancers ~10%

34

Presentation of Pancreatic Adenocarcinoma is similar to chronic pancreatitis.

Epigastric pain - radiating to back
Weight loss
Obstructive jaundice
Diabetes
Courvoiser's sign
Trousseau's syndrome

35

Pancreatic neuroendocrine tumours can arise from any endocrine cell. Presentation depends on hormone produced by cell.
Typically presents in whom?

20-60yrs
MEN1
Von-Hippel Lindau

36

Blood markers for Hepatocellular damage?

ALT*
AST
a-feroprotein

37

Markers for Biliary tract damage?

Conjugated bilirubin
ALP
y-GT

38

PIIINP, TIMP-1, Hyaluronic acid are markers for what?

Liver Fibrosis

39

Increased ALT/AST. Normal ALP is indicative of which type of jaundice?

Hepatic jaundice

40

Normal ALT/AST. Increased ALP is indicative of which type of jaundice?

Obstructive jaundice

41

IEM causing jaundice are...?

Gilberts, Crigler-Najjar

Dubin-Johnson, Rotor

42

Indications to do LFTs?

pain,itchy, jaundice, bruising, bruising, risk factors, existing liver D