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Liver & The Biliary System Flashcards

(41 cards)

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1
Q

What are the 3 main broad functions of the liver?

A
  1. Storage - Glycogen, Vitamins, Iron, Copper
  2. Synthesis - Glucose, Protein, Lipids, Cholesterol, Bile
  3. Metabolism / Detoxification - Bilirubin, Ammonia, Drugs, Alcohol, Carbs, Lipids
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2
Q

What are the general symptoms of liver disease?

A
  • Nausea
  • Vomiting
  • Fatigue
  • Anorexia
  • Abdominal Pain
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3
Q

What can a defect in bilirubin metabolism lead to?

A

Jaundice

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4
Q

What can a defect in Ammonia metabolism lead to?

A

Confusion

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5
Q

What can a defect in albumin synthesis lead to?

A

Odema / Ascites

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6
Q

What can a defect in synthesis of clotting factors lead to?

A

Bleeding / Easy Bruising

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7
Q

What kind of things can cause acute liver failure?

A
  • Paracetamol overdose
  • Other medications e.g. tetracycline, aspirin in children
  • Acute Viral Infection e.g. EBV, CMV, Hep A/B
  • Acute excessive alcohol intake
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8
Q

What do all chronic liver diseases end with?

A

Cirrhosis

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9
Q

How does cirrhosis arise?

A
  • Ongoing inflammation causes fibrosis
  • Associated hepatocyte necrosis
  • Causes architectural changes nodules
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10
Q

What are the 3 main mechanisms by which alcohol can affect the liver?

A
  1. Fatty Change (weeks)- as more TAG made and deposited in the liver, initially reversible
  2. Alcoholic Hepatitis (years)- initially reversible
  3. Cirrhosis (years) - end stage, irriversible damage
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11
Q

How does alcoholic hepatitis present?

A
  • Rapid onset Jaundice
  • Tender Hepatomegaly (RUQ pain)
  • Nausea
  • Oedema
  • Ascites
  • Splenomegaly
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12
Q

What are the 2 main viruses that cause Viral Hepatitis?

A

Hep B - Double stranded DNA virus

Hep C - Single stranded RNA virus

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13
Q

What is non-alcoholic fatty liver disease (NAFLD)?

A

An accumulation of triglycerides and other lipids in hepatocytes

Similar pathogenesis to Alcoholic Liver Disease without the alcohol

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14
Q

What kind of things increase risk of non-alcoholic fatty liver disease?

A
  • Obesity
  • Diabetes
  • Metabolic Syndrome (dyslipidaemia)
  • Familial Hyperlipidaemia

Due to link with insulin resistance

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15
Q

What is Hereditary Haemochromatosis? How does it occur?

A

An abnormality of iron metabolism

  • Increased absorption of iron from the small intestine causing excess depostion
  • Autosomal recessive disorder
  • Increased ferratin
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16
Q

How do you treat Hereditary Haemochromatosis?

A

Venesection treatment to remove iron load from the blood

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17
Q

What is Wilson’s Disease? How does it occur?

Study These Flashcards
A

An abormality in Copper Metabolism

  • Autosomal recessive disorder
  • Reduced Copper secretion from the biliary system causes an accumulation in tissues
  • Low Caeruloplasmin
18
Q

What are some auto-immune causes of liver cirrhosis?

Study These Flashcards
A
  1. Autoimmune Hepatitis
  2. Primary Biliary Cirrhosis
  3. Primary Sclerosing Colangitis
19
Q

What veins form the portal vein?

20
Q

What is portal hypertension?

Study These Flashcards
A

A build up of blood in the portal venous sytem

21
Q

What is the effect of a fibrotic liver on the portal venous system?

Study These Flashcards
A
  • Fibrotic liver not very expansive
  • Compresses veins entering liver from portal venous system
  • Increased hydrostatic pressure causes fluid to be forced out of veins → ascites
  • Increased build up of pressure in splenic circulation → splenomegaly
22
Q

What are the 3 most important sites of varices in portal hypertension?

Study These Flashcards
A
  1. Oesophageal
  2. Anorectal
  3. Umbilical
23
Q

Where are oesophageal varcies located and what can happen to them?

Study These Flashcards
A
  • Locted in the upper 2/3 of the oesophagus
  • Can lead to mucosal varcies
  • If rupured can cause significan haematemesis
24
Q

Where are anorectal varices usually located?

Study These Flashcards
A

Between the superior rectal and middle/ inferior rectal veins and the anus

25
Why are anorectal varices usually painless?
As they are **above** the dendate line and have visceral pain which is poorly localised
26
What is caput medusa?
When blood flows through the **ligamentum teres** (usually has no blood flow) during portal hypertension, causing superficial veins of the abdominal wall to distend
27
What is Hepatorenal Syndrome?
The development of Acute Kidney Injury in the presence of cirrhosis
28
Describe the pathophysiology of Hepatorenal syndrome
1. Portal Hypertension 2. Splanchnic artery vasodilation 3. RAAS activated 4. Renal artery vasconstriction reduces blood flow to the kidney
29
Label the Biliary Tree
30
What are gallstones formed from?
Either: * Cholesterol * Bile Pigments * Or a mix of both
31
Which diagnostic imaging procedure would you use to identify gallstones and why?
Ulstrasound Gallstones are radiolucent so will **not show on XRay**
32
What are some risk factors for developing gallstones?
* Diet and lifestyle rich in fat and cholesterole * Age \>40 years * Gender: **Female** \> Male * Pregnancy due to stasis * Pre-existing liver disease
33
What is the name given to temporary obstruction of the **cystic** duct that causes RUQ pain a few hours after eating a fatty meal?
**Biliary Colic**
34
Why does the pain in biliary colic arise a few hours after eating a fatty meal?
Fatty food entering the duodenum triggers the release of **CCK** which causes the **gallbladder to move** which causes the pain as contents cannot escape
35
How do you manage Biliary Colic?
* Analgesia * Elective cholecystectomy
36
What is **acute cholecystitis?**
An **impacted stone** in the **cystic duct** * initially similar presentation to biliary colic * **Inflmmatory features** seen on ultrasound → thickened gallbladder * Murphy's Sign Positive
37
What is Murphy's Sign?
* The liver, gallbladder and diaphragm are connected * On inspiration the diaphragm **flattens, lowering the liver and gallbladder** * In Murphy's sign the Dr places their hand on the RHS of the abdomen, on **inspiration** it will cause pain
38
What is acute ascending cholangitis?
An infection of biliary tree typically due to an **impacted stone** in the **common bile duct** Presents with **Charcot's Triad:** RUQ pain, fever, jaundice
39
How do you manage acute ascending cholangitis?
* IV antibiotics * Fluids * Relieve obstruction
40
How can gallstones lead to **acute pancreatitis?**
Blockage of the **pancreatic duct** evokes an **inflammatory** response as contents cannot leave. Pancreatic enzymes start to **autodigest** the pancreas causing acinar cell injury and necrosis
41
How does acute pancreatitis present?
* Epigastric pain that **radiates** to the back * Often have vomiting * Cullen's Sign (bruising down the tummy) * Grey Turner's Sign (brusing down the flanks)

GI System (15 decks)

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