S7) Liver and Pancreatic Pathology Flashcards Preview

Y2 SEM 3: Gastro-intestinal System > S7) Liver and Pancreatic Pathology > Flashcards

Flashcards in S7) Liver and Pancreatic Pathology Deck (50)
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Describe the anatomical relationship of the liver with the gallbladder and duodenum


Outline the transport and metabolism of bilirubin


Identify 3 ways in which we can measure liver dysfunction

- Failure of anabolism

- Failure of catabolism and excretion

- Markers of hepatocyte damage/dysfunction 


Identify 4 things produced by the liver (anabolism)

- Albumin

- Glycogen

- Coagulation factors

- Haematopoiesis (in foetus / adult with bone marrow failure) 


In terms of anabolism, identify 2 indicators of poor liver function

Hypoalbuminaemia due to failure to produce albumin

- Prolonged prothrombin time (PT/INR) due to failure to produce coagulation factors


Identify 5 things broken down by the liver (catabolism)

- Drugs

- Hormones

- Haemoglobin

- Poisons

- Aged RBCs (after splenectomy)


Identify and describe 3 abnormalities of bilirubin production/excretion 

- Pre-hepatic jaundice: too much bilirubin e.g. haemolytic anemia

- Intra-hepatic jaundice: failure of hepatocytes to conjugate and/or secrete bilirubin e.g hepatitis, cirrhosis 

- Post-hepatic jaundice: failure of the biliary tree to convey conjugated bilirubin to duodenum e.g. biliary tree obstruction


How can excess bilirubin be measured?

Conjugated bilirubin is water soluble so when elevated, serum levels can be measured with a dipstick (dark yellow)


Identify 3 signs of pre-hepatic jaundice

- Raised serum bilirubin

- Increased urinary urobilinogen

- No conjugated bilirubin present in urine 


Identify 4 symptoms of pre-hepatic jaundice

- Mild jaundice (lemon tinge)

- Stools may be very dark

- Normal urine colour 

- No pruritis 


Identify 3 signs of intra-hepatic jaundice

- Raised serum bilirubin

- Normal urinary urobiliogen

- Conjugated bilirubin present in urine 


Identify 4 symptoms of intra-hepatic jaundice

- Moderate jaundice

- Stools normal

- Urine dark

- No pruritis usually 


Identify 3 signs of post-hepatic jaundice

- Raised serum bilirubin

- Decreased urinary urobilinogen

- Conjugated bilirubin present in urine 


Identify 4 symptoms of post-hepatic jaundice

- Severe jaundice (green tinge!)

- Stools pale

- Urine dark

- Pruritis 


Identify 3 enzyme markers of hepatocyte damage/dysfunction

- Alanine aminotransferase (ALT) is released by inflamed/damaged hepatocytes

- Alkaline phosphatase (Alk Phos) is present in the liver canaliculi, bile ducts and bone 

Gamma-glutamyl transferase (Gamma GT) is present in bile duct cells 


A raised ALT is due to hepatitis.

Identify 4 causes of hepatitis

- Viral (A, B, C etc.)

- Acute alcohol intake

- Fatty liver disease

- Drugs/toxins 


Identify 2 main causes of a raised Alk Phos

- Bile duct/liver disease with cholestasis

- Bone disease


Identify 4 conditions which lead to bile duct/liver disease presenting with a raised Alk Phos

- Biliary obstruction

- Cirrhosis

- Liver metastases

- Drugs 


Identify 4 conditions which lead to bone disease presenting with a raised Alk Phos

- Bone metastases/fracture

- Osteomalacia

- Hyperparathyroidism

- Paget’s disease of bone 


Identify 5 causes of a raised Gamma GT

- Biliary duct obstruction/cholestasis

- Cirrhosis

- Liver metastases

- Drugs

- Alcoholism 


Identify 4 common liver and bile duct diseases

- Hepatitis

- Cirrhosis

- Gallstones and biliary tract obstruction

- Liver metastases 


How does liver failure present?

- Increased susceptibility to infections 

- Increased susceptibility to toxins and drugs

- Increased blood ammonia (failure to clear ammonia via urea cycle) 


Identify 6 symptoms of hepatitis

- Malaise

- Anorexia

- Fever

- Right upper quadrant pain

- Dark urine

- Jaundice 


What are the typical blood test findings in acute hepatitis?

- Normal albumin and INR

- High serum bilirubin

- Very high serum ALT

- Normal/slightly raised Alk Phos

- Normal/slightly raised Gamma GT 


What is cirrhosis?

Cirrhosis is a condition caused by liver fibrosis, producing a shrunken hard nodular liver 


Identify 3 consequences of liver fibrosis

Portal hypertension due to pressure and occlusion of the hepatic sinusoids

- Reduced excretion due to pressure on the bile canaliculi

- Reduced albumin and clotting factor production due to replacement of hepatocytes by fibrous tissue


Identify 4 main causes of liver cirrhosis

- Alcohol

- Consequence of viral hepatitis (B,C)

- Fatty liver disease

- Idiopathic 


Identify 3 sites of portosystemic anastomoses

- Anorectal junction

- Ligamentum teres of falciform ligament

- Oesophagogastric junction 


In two steps, explain how oesophageal varices results from liver cirrhosis

- Pressure and occlusion of the hepatic sinusoids leads to portal hypertension

- Portal hypertension leads to portosystemic shunting, including oesophageal varices


Identify 5 symptoms of cirrhosis

- Fatigue/weakness

- Ascites

- Swollen legs (hypoproteinaemia)

- Weight loss

- Jaundice