Liver, Biliary Tract and Pancreas Flashcards by Stephanie Bareford

What are the only two unsaturated fatty acids?

Linoleic acid

Linolenic acid

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How much does the pancreas secrete daily?

1.5L fluid

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What are the four lipolytic enzymes?

Lipase
Colipase
Phospholipase A2
Cholesterol esterase

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What stimulates secretion of secretin?

Luminal acid

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What does secretin stimulate release of?

Bicarbonate

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What stimulates secretion of cholecystokinin (CCK)?

Proteins and fats

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What does release of CCK do?

Gallbladder contraction

Stimulates pancreatic enzyme secretion

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What does bicarbonate released from the pancreas do?

Neutralises gastric acid - intraluminal pH increases from 2 to 6/7

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What stops the release of secretin?

Neutralisation of acid by bicarbonate

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What are the three major types of cells in the pancreas?

Duct cells
Acinar cells
Islet cells

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What are the most prevalent type of cells in the pancreas?

Acinar cells

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What do duct cells secrete?

Bicarbonate

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What do acinar cells secrete?

Pancreatic enzymes

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What are some causes of acute pancreatitis?

Obstructive
Drug/toxin/metabolic
Infectious
Vascular
Trauma
Idiopathic

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Worldwide, what is the leading cause of acute pancreatitis?

Gallstones

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What is the leading cause of acute pancreatitis in UK?

Alcohol

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What is the best imaging technique for diagnosing gallstone pancreatitis?

Ultrasonography

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What blood tests would you do for acute pancreatitis?

Serum lipase (more sensitive than amylase)
CRP
FBC, U&E, LFTs, glucose

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When would a CT be used in pancreatitis?

To determine pancreatic necrosis

Look for tumours, as an unusual cause of pancreatitis

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What are the causes of chronic pancreatitis?

Hereditary
Tropical
Autoimmune
Cystic fibrosis

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What diagnostic marker is used for pancreatic cancer?

CA19-9

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What type of cancer are most pancreatic cancers?

Adenocarcinoma

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Where do most pancreatic cancers originate?

Main pancreatic duct

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What is a definite risk factor for pancreatic cancer?

Smoking

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What are the effects of pancreatic insufficiency?

Malabsorption - leading to diarrhoea and steatorrhoea Weight loss Deficiency of fat-soluble vitamins (A, D, E, K) Diabetes

What are causes of pancreatic insufficiency?

Chronic pancreatitis - normally alcohol Cystic fibrosis - children Duct obstruction - normally cancer Pancreatic atrophy - elderly

What test would measure pancreatic exocrine function in faeces?

Faecal elastase

When would pancreatic biopsy and cytology be done?

For diagnosis of cancer | Autoimmune pancreatitis

What is the presentation of acute pancreatitis?

Severe upper abdo pain Vomiting Prostration

What is the presentation of pancreatic cancer?

``` Severe upper abdo pain Weight loss Diarrhoea Jaundice (if CBD obstructed) Recent onset diabetes ```

What are the most common bile acids?

Cholic acid | Chenodeoxycholic acid

What are bile acids conjugated with in the liver?

Taurine or glycine

Where and by how are bile salts absorbed in the GIT?

Terminal ileum by active transport

What degrades red blood cells?

Reticuloendothelial system - spleen and liver

What is the first step of the degradation of haem catalysed by?

Haem oxygenase

What catalyses reduction of biliverdin to bilirubin?

Biliverdin reductase

How is bilirubin transported to the liver?

Non-covalently bound to albumin

What catalyses formation of bilirubin diglucuronide?

Bilirubin glucuronyltransferase

What happens to bilirubin diglucuronide in the intestine?

Hydrolysed and reduced by bacteria in gut to urobilinogen

What is the most common type of gallstone?

Cholesterol

What would raised inflammatory markers (ESR & CRP) in the presence of RUQ pain, guarding/tenderness and fever be indicative of?

Acute cholecystitis or empyema of gallbladder

What is biliary colic?

Gallstone lodged in cystic duct/common bile duct

How would you treat biliary colic?

Conservative - let stones pass | Cholecystectomy

What are the functions of bile acids?

Excretion route for cholesterol Emulsify lipids Form mixed micelles

How long must you have hepatitis for it to be considered chronic?

6 months or longer

Which is the most common viral hepatitis occurring worldwide?

Hepatitis A

How is hepatitis A spread?

Faeco-oral route

Who does hepatitis A commonly affect?

Children and young adults

What is the incubation period of hepatitis A?

Up to 2 weeks

When is hepatitis A maximally infectious?

Just before jaundice appears

What does anicteric mean?

Absence of jaundice

What are the mild symptoms of hepatitis A infection?

Nausea Anorexia Distaste for cigarettes

What symptoms of hepatitis A infection warrant an assessment in hospital?

Persistence of nausea or vomiting | Any mental confusion

What is the treatment for hepatitis A?

Reassurance

Will hepatitis A infection progress to chronic liver disease?

What cells does hepatitis B virus infect?

Hepatocytes

What causes liver damage in hepatitis B infection?

Cytotoxic T cells recognising viral antigen on hepatocytes and killing them

What is the difference between a Th1 and a Th2 response in hepatitis B infection?

Th1 - associated with clearance of the virus | Th2 - linked with development of chronic infection and severe disease

When can hepatitis B infection progress to hepatocellular carcinoma?

In late stages of integrated disease - where HBV DNA has become integrated with that of host

What is the incubation period of acute HBV infection?

1-2 months

What is a rise in hepatitis B antigens linked with?

A rise in ALT | Onset of symptoms

What are the symptoms of hepatitis B infection?

``` Nausea Vomiting Anorexia Fever Jaundice Rash Polyarthritis ```

What is the treatment for acute hepatitis B infection?

Symptomatic treatment

What infection can occur as a co-infection of HBV?

Hepatitis D infection

What percentage of acute infection of hepatitis C are asymptomatic?

90%

After how long can HCV RNA be detected?

1-8 weeks after infection

What can be used to treat acute cases and chronic disease of hepatitis C?

Interferon

What will the majority of asymptomatic hepatitic C infected patients go on to develop?

Chronic liver disease

What can chronic liver disease as a result of hepatitis C infection go on to develop?

Cirrhosis within 10-30 years and some of these will develop into hepatocellular carcinoma

What are the risk factors for development of fibrosis in hepatitis C infection?

Male High alcohol intake Fatty liver Diabetes

Chronic hepatitis C is usually asymptomatic. So how is it discovered?

Accidentally following routine bloods. Elevation in aminotransferases, usually ALT.

What are common symptoms of chronic hepatitis C infection?

Fatigue Nausea Anorexia Weight loss

How is hepatitis E transmitted?

Enterally, usually contaminated water

Liver, Biliary Tract and Pancreas Flashcards

(73 cards)