S7) Liver and Pancreatic Pathology Flashcards Preview

[AMS] Gastro-intestinal System > S7) Liver and Pancreatic Pathology > Flashcards

Flashcards in S7) Liver and Pancreatic Pathology Deck (50)
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1

Describe the anatomical relationship of the liver with the gallbladder and duodenum

2

Outline the transport and metabolism of bilirubin

3

Identify 3 ways in which we can measure liver dysfunction

- Failure of anabolism

- Failure of catabolism and excretion

- Markers of hepatocyte damage/dysfunction 

4

Identify 4 things produced by the liver (anabolism)

- Albumin

- Glycogen

- Coagulation factors

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

5

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

6

Identify 5 things broken down by the liver (catabolism)

- Drugs

- Hormones

- Haemoglobin

- Poisons

- Aged RBCs (after splenectomy)

7

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

8

How can excess bilirubin be measured?

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

9

Identify 3 signs of pre-hepatic jaundice

- Raised serum bilirubin

- Increased urinary urobilinogen

- No conjugated bilirubin present in urine 

10

Identify 4 symptoms of pre-hepatic jaundice

- Mild jaundice (lemon tinge)

- Stools may be very dark

- Normal urine colour 

- No pruritis 

11

Identify 3 signs of intra-hepatic jaundice

- Raised serum bilirubin

- Normal urinary urobiliogen

- Conjugated bilirubin present in urine 

12

Identify 4 symptoms of intra-hepatic jaundice

- Moderate jaundice

- Stools normal

- Urine dark

- No pruritis usually 

13

Identify 3 signs of post-hepatic jaundice

- Raised serum bilirubin

- Decreased urinary urobilinogen

- Conjugated bilirubin present in urine 

14

Identify 4 symptoms of post-hepatic jaundice

- Severe jaundice (green tinge!)

- Stools pale

- Urine dark

- Pruritis 

15

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 

16

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 

17

Identify 2 main causes of a raised Alk Phos

- Bile duct/liver disease with cholestasis

- Bone disease

18

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

- Biliary obstruction

- Cirrhosis

- Liver metastases

- Drugs 

19

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

- Bone metastases/fracture

- Osteomalacia

- Hyperparathyroidism

- Paget’s disease of bone 

20

Identify 5 causes of a raised Gamma GT

- Biliary duct obstruction/cholestasis

- Cirrhosis

- Liver metastases

- Drugs

- Alcoholism 

21

Identify 4 common liver and bile duct diseases

- Hepatitis

- Cirrhosis

- Gallstones and biliary tract obstruction

- Liver metastases 

22

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) 

23

Identify 6 symptoms of hepatitis

- Malaise

- Anorexia

- Fever

- Right upper quadrant pain

- Dark urine

- Jaundice 

24

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 

25

What is cirrhosis?

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

26

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

27

Identify 4 main causes of liver cirrhosis

- Alcohol

- Consequence of viral hepatitis (B,C)

- Fatty liver disease

- Idiopathic 

28

Identify 3 sites of portosystemic anastomoses

- Anorectal junction

- Ligamentum teres of falciform ligament

- Oesophagogastric junction 

29

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

30

Identify 5 symptoms of cirrhosis

- Fatigue/weakness

- Ascites

- Swollen legs (hypoproteinaemia)

- Weight loss

- Jaundice