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Gastrointestinal > Liver Function + Pathology + Biliary Tree Damage > Flashcards

Liver Function + Pathology + Biliary Tree Damage Flashcards

1
Q

Functions of the liver

A
  • Storage: e.g. glycogen, vitamins, iron, copper
  • Synthesis: e.g. glucose, lipids,, cholesterol, bile, clotting factors, albumin
  • Metabolic: e.g. bilirubin, ammonia, drugs, alcohol, carbs, lipids
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2
Q

Symptoms of liver pathology

A

Jaundice
Oedema/ascites
Bleeding
Confusion

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3
Q

What can cause acute liver failure?

A

Excessive alcohol
Paracetamol overdose
Virus
Medications e.g. aspirin

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4
Q

What is acute liver failure?

A

Sudden onset of liver pathology symptoms with no previous background of liver disease

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5
Q

Why do we avoid giving children aspirin?

A

Can cause acute liver failure

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6
Q

What is cirrhosis

A

Permanent damage to the liver which results to impaired function + distortion of liver architecture in response to chronic inflammation of the liver

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7
Q

Key feature of liver cirrhosis

A

Nodules
Due to bands of fibrosis

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8
Q

What happens to the liver in alcoholic liver disease over weeks?

A
  • Fatty changes due to fatty deposits > Hepatomegaly
  • Normally reversible
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9
Q

What happens to the liver in alcoholic liver disease over years?

A
  • alcoholic hepatitis
  • inflammatory cells + fatty change
  • jaundice
  • right upper quadrant pain
  • Hepatomegaly
  • leads to cirrhosis
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10
Q

What infections can cause chronic liver damage?

A
  • Hepatitis B: vaccine but no cure | symptomatic
  • Hepatitis C: cure but no vaccine | asymptomatic
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11
Q

Outline non-alcoholic fatty liver disease

A
  • associated with insulin resistance
  • accumulation of triglycerides
  • inflammation over time > NASH non alcoholic steatophepatitis
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12
Q

Outline hereditary haemochromatosis

A
  • increased absorption of iron from small intestines
  • leads to excessive deposition within liver
  • autosomal recessive
  • associated with high levels of ferritin
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13
Q

Treatment of hereditary haemochromatosis

A

Venesection
Reduces iron in circulation

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14
Q

Outline Wilson’s disease

A
  • decreased copper secretion from liver to be removed
  • leads to increased deposition in liver
  • low levels of caeruloplasmin
  • can effect CNS (seizures, memory loss)
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15
Q

What autoimmune conditions can damage the liver?

A

Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis

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16
Q

Why can liver disease can jaundice?

A

Build up of bilirubin as liver cannot metabolise it effectively

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17
Q

Why can liver disease cause oedema or ascites?

A
  • decreased synthetic function
  • decrease albumin production
  • decreases osmotic pressure
  • fluid moves out more easily
    .
  • fibrosis > compression of liver sinusoids
  • exerts back pressure on portal vein
  • portal hypertension
  • fluid moves out into abdominal cavity
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18
Q

Why can liver disease cause bleeding issues?

A

Decreased synthesis of clotting factors
e.g easy bruising, nosebleeds, long bleeding time

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19
Q

What is portal hypertension?

A

When there is increased hydrostatic pressure within the portal venous system due to fibrotic changes in the liver

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20
Q

Complications of portal hypertension

A

Ascites
Splenomegaly
Varices

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21
Q

What are varices?

A

Dilated veins

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22
Q

What is heptaorenal syndrome?

A

Presence of acute or rapidly deteriorating kidney function due to underlying liver cirrhosis + portal hypertension

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23
Q

What are the three location for varices in portal hypertension?

A

Oesophagus
Umbilical
Anorectal

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24
Q

How does portal hypertension cause oesophageal varices?

A
  • left gastric vein normally drains the lower part of the oesophagus
  • in portal hypertension, varices divert blood to the azygous vein which drains into the SVC
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25
Q

Symptoms of anorectal varices

A

Rectal bleeding > anaemia
Pain
Discomfort

26
Q

What are umbilical varices also called?

A

Caput medusae

27
Q

Venous drainage of the oesophagus

A

Upper 2/3: oesophageal veins > azygous vein > SVC
Lower 1/3: left gastric vein > portal vein

28
Q

What two structure form the common bile duct?

A

Common hepatic duct
Cystic duct

29
Q

Complications of gallstones

A

Biliary colic
Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis

30
Q

How does hepatorenal syndrome occur?

A
  • presence of cirrhosis + portal hypertension increases NO in gut vasculature
  • results in splanchnic vasodilation
  • body perceives as a drop in circulating volume
  • RAAS activated > systemic vasoconstriction
  • decreased perfusion to kidney > acute kidney injury
31
Q

What is biliary colic?

A
  • sudden constant onset right upper quadrant pain (radiates to back)
  • caused by temporary obstruction of cystic duct by gallstones at neck of gallbladder
32
Q

Treatment of biliary colic

A

Pain relief
Cholecystectomy (gallbladder removal)

33
Q

What is acute cholecystitis?

A
  • inflammation of gallbladder
  • due to impaction of gallstones in cystic duct
  • right upper quadrant pain + fever
  • Murphy’s sign
34
Q

Treatment of acute cholecystitis

A

Analgesia
Antibiotics
Cholecystectomy

35
Q

Risk factors for gallstones

A

5 Fs
- fat
- female
- forty
- fertile (pregnancy)
- family history

36
Q

What is Murphys sign?

A
  • place hand on patients right side of abdomen
  • ask to take a deep breath in
  • gall bladder hits hand > patient sudden breath in and pain
  • no pain on left side
37
Q

What is acute ascending cholangitis?

A
  • infection of the biliary tree caused by gallstone blocking the common bile duct
  • Charcot’s triad presentation: RUQ pain, fever/inflammation + jaundice
38
Q

What is acute pancreatitis?

A
  • gallstone obstructs distal common bile duct where the pancreatic duct joins
  • this causes premature activation of pancreas enzymes
  • protease enzymes auto digest the pancreas
  • epigastric pain (can radiate to back)
39
Q

Presentation of acute pancreatitis

A

Epigastric pain > radiates to back
Vomiting
Cullen’s sign
Grey Turner’s sign

40
Q

Management of acute pancreatitis

A
  • Rule out other causes of Epigastric pain
  • supportive care
  • identify elevated enzymes in blood test (lipases, amylase)
41
Q

What is Cullen’s sign?

A

Superficial oedema + bruising in subcutaneous fatty tissue around umbilicus

Cullen - Central

42
Q

What is Grey Turner’s sign?

A

Bruising of the flanks

43
Q

Differentiate between the presentations of biliary colic, acute cholecystitis + acute ascending choangitis

A
  • BC: RUQ pain
  • AC: RUQ + fever/inflammation (+ Murphys sign)
  • AAC: RUQ + fever/inflammation + jaundice
44
Q

Why might someone with liver disease become confused?

A

Unconjugated bilirubin can pass the blood brain barrier

45
Q

What is the pain associated with gallstone called?

A

Biliary colic

46
Q

Why does biliary colic come on about an hour after food?

A

CCK is released during digestion

47
Q

Potential complications of stone lodging in proximal common bile duct

A

Cholangitis > post hepatic jaundice

48
Q

Potential complications of a stone lodging in the distal common bile duct

A

Acute pancreatitis

49
Q

Name the underlying change that causes liver enlargement following chronic alcohol intake

A

Steatosis (fatty liver)

50
Q

Describe the two mechanisms that lead to fatty deposition on liver

A
  • excessive intake of dietary fats: increased triglyceride accumulation in liver
  • regarding insulin resistance: impairs ability of liver to respond to insulin > increased breakdown of fats in adipose > accumulation in liver
51
Q

Causes of acute pancreatitis

A

I GET SMASHED

  • Idiopathic
  • Gall stones
  • Ethanol
  • Trauma
  • Scorpion stings
  • Mumps
  • Autoimmune
  • Steroids
  • Hypercalcaemia
  • ERCP
  • Drugs
52
Q

What can gallstones form from?

A

Cholesterol
Bile pigment
Both

53
Q

A gallstone stuck in the neck of gall bladder causes what?

A

Biliary colic

54
Q

A gallstone stuck in cystic duct causes what?

A

Cholecystitis

55
Q

A gallstone stuck in common bile duct causes what?

A

Ascending cholangitis

56
Q

What is Charot’s triad?

A

Fever
Jaundice
RUQ pain

57
Q

What is ERCP?

A

Endoscopic retrograde cholangiopancreatogrphy

58
Q

What causes biliary colic?

A
  • CCK release by small intestine during digestion
  • causes contraction of gallbladder > bile release
  • gallstones irritate entrance to galbadder
  • intermittent pain associated with eating
59
Q

What causes cholecystitis?

A
  • gallstone stuck in cystic duct
  • fluid statins inside gallbladder > inflammation + infection
  • causes RUQ pain + fever
60
Q

What causes Budd Chiari syndrome?

A

Hepatic vein becomes blocked or narrowed

61
Q

What is the triad of Budd-chiari?

A

Abdominal pain
Ascites
Hepatomegaly

Gastrointestinal (27 decks)

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