hepatobilliary and pancreatic disease

Question 1

what is bile made from

Answer 1

bilirubin and bile salts

Question 2

what does the liver break down

Answer 2

drugs, insulin, ammonia, etc.

Question 3

what does the liver synthesise

Answer 3

albumin, clotting factors, complement, alpha 1 antitrypsin

Question 4

what do Kupffer cells do

Answer 4

phagocytose old blood cells, bacteria and foreign materials

Question 5

what concentration of bilirubin must be present for jaundice to occur

Answer 5

more than 40 micromoles per liter

may cause an itch

Question 6

what is unconjugated jaundice

Answer 6

water insoluble

Question 7

what is conjugated jaundice

Answer 7

water soluble so can be excreted in the urine. made in the liver and then joins the bile

Question 8

what is the cause of prehapatic jaundice

Answer 8

haemolysis leading to increase release of bilirubin

Question 9

what is intrahepatic jaundice

Answer 9

liver disease leading to excess bilirubin in the blood

Question 10

what is post hepatic jaundice

Answer 10

obstruction of bile outflow

Question 11

what are the causes of acute liver injury

Answer 11

viral infections
alcohol
drug reactions
gallstones leading to billiary obstruction

Question 12

what are the signs of acute liver injury

Answer 12

jaundice, malaise
raised serum bilirubin and transaminase
decreased albumin, ascites, bruising, encephalopathy

Question 13

what pattern of hepatocyte injury would you see with toxic or haemodynamic liver injury

Answer 13

zonal

Question 14

what is steatosis

Answer 14

infiltration of liver cells with fat associated with metabolic disturbance

Question 15

what are Mallory hyalines

Answer 15

an inclusion found in the cytoplasm of liver cells usually due to alchoholic liver disease

Question 16

how does alcoholic liver disease occur

Answer 16

acetaldehyde binds to hepatocytes causing damage and inflammations
the inflammation leads to fibrosis

Question 17

what are the two components of cirrhosis

Answer 17

fibrosis and regeneration

Question 18

what are the causes of cirrhosis

Answer 18

alcohol
hepatitis b and c 
iron overload
gallstones
autoimmune

Question 19

what is the morphological classification of cirrhosis

Answer 19

micronodular- less than 3 mm
macronodular
or mixed

Question 20

what is hepatic encephalopathy

Answer 20

toxins are not removed from the blood which damage the brain
e.g. ammonia

Question 21

what are some of the complications of cirrhosis

Answer 21

hepatic encephalopathy
build up of steroid hormones esp. hyperoestrogenism
bleeding (clotting factors)
portal hypertension 
AV shunting

oesophageal varices, caput medusae, haemorrhoids

carcinoma

Question 22

what can methyl testosterone do

Answer 22

injure bile production (cholestasis)

Question 23

what is cholangitis

Answer 23

infection of the gallbladder due to obstruction

Question 24

what is chronic hepatitis

Answer 24

liver inflammation lasting more than 6 months

sustained elevation of transaminases

Question 25

describe the classification of chronic hepatitis

Answer 25

* Type – aetiology * Grade – degree of inflammation * Stage – degree of fibrosis

Question 26

what are the features of autoimmune chronic active hepatisis

Answer 26

usually in mid to late teens plasma cells and swollen hepatocytes fibrosis raised transaminase

Question 27

what is biliary cirrhosis

Answer 27

``` autoimmune destruction of bile duct epithelium proliferation of small bile ducts architectural disturbance fibrosis and cirrhosis lymphocyte infiltration ```

Question 28

what is pruritus

Answer 28

severe itching of the skin

Question 29

what are the symptoms of primary biliary cirrhosis

Answer 29

Jaundice, pruritis, xanthelasmata

Question 30

what is haemochromatosis

Answer 30

iron deposition in the liver causing alteration of architecture and cirrhosis autosomal recessive

Question 31

what is venesection

Answer 31

blood letting to reduce iron or RBCs

Question 32

what is alpha 1 antitrypsin deficiency

Answer 32

autosomal recessive disorder proteins build up in hepatocytes can lead to cirrhosis

Question 33

what is non alcoholic steatohepatitis (fatty liver disease)

Answer 33

associated with metabolic syndrome | fat deposition in hepatocytes can lead to cirrhosis

Question 34

what is Wilson's disease

Answer 34

autosomal recessive disorder failure of the liver to excrete copper in bile leading to cirrhosis plus neuro dysfunction

Question 35

what is Ceruloplasmin

Answer 35

a ferroxidase enzyme that carries copper in the blood

Question 36

what are Kayser-Fleischer rings

Answer 36

copper deposition around the eye

Question 37

what type of developmental liver tumours are there

Answer 37

* Cysts | * Hamartomas

Question 38

what types of benign liver tumours are there

Answer 38

* Adenoma, haemangioma | * Liver cysts

Question 39

what type of malignant liver tumours are there

Answer 39

* Metastases – common * Primary – * Hepatocellular carcinoma * Cholangiocarcinoma

Question 40

what are common causes for hepatocellular carcinoma

Answer 40

hepatitis B + C cirrhosis aflatoxins

Question 41

what are common congenital malformations of the billary system

Answer 41

* Atresia | * Choledocal cysts

Question 42

what are common diseases of the gallbladder

Answer 42

* Gallstones (cholelithiasis) * Cholecystitis * Cholangiocarcinoma * Obstruction

Question 43

what is cholangiocarcinoma

Answer 43

Arises from bile duct epithelium anywhere in the biliary system (intra- and extra-hepatic) • Associated with ulcerative colitis • Causes obstructive jaundice, itch, weight loss and lethargy • Can lead to rupture of common bile duct or gallbladder – prognosis poor

Question 44

what are the risk factors for gallstones

Answer 44

* Female, fair, fat, forty, fertile | * Diabetes mellitus

Question 45

what are the symptoms of cholecystitis

Answer 45

– RUQ pain (biliary colic), fever, nausea/vomiting wall thickening

Question 46

what is an annular pancreas

Answer 46

obstruction around the 2nd part of the duodenum leading to polyhydramnios, low birth weight, poor feeding

Question 47

what are the features of pancreatitis

Answer 47

``` • Causes catastrophic metabolic consequences – ↓ calcium, ↓ albumin, ↑ glucose • High serum amylase – diagnostic • Massive fluid losses → SHOCK • High mortality rates ```

Question 48

what causes chronic pancreatitis

Answer 48

• Multiple episodes of acute • Causes fibrosis of pancreas – may lead to diabetes mellitus • Reduced production of enzymes – require supplements (creon)

Question 49

what are the features of pancreatic andenocarcinoma

Answer 49

• Associated with smoking and diabetes mellitus • Presents with painless, progressive jaundice • Weight loss • Poor prognosis • May be operable if small and close to ampulla

Question 50

what disease is cholangeocarcinoma associated with

Answer 50

UC

Question 51

what are sustained elevation of transaminases associated with

Answer 51

chronich hepatitis

Question 52

what are the most common causes of pancreatitis

Answer 52

alcohol and gallstones | also tobacco, trauma, medications, poisons

Question 53

what test is diagnostic for acute pancreatitis

Answer 53

raised serum amylase

Question 54

what type of cancer is pancreatic cancer

Answer 54

adenocarcinoma

Question 55

what increases the risk of pancreatic adenocarcinoma

Answer 55

smoking | DM

Question 56

what does raised transaminases indicate

Answer 56

chronic hepatitis

Question 57

what types of hepatitis can lead to hepatocellular carcinoma

Answer 57

B and C