Week 7 - Liver and pancreatic disease Flashcards Preview

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Flashcards in Week 7 - Liver and pancreatic disease Deck (71):
1

What LFT do you measure to look for cholestasis?

-Bilirubin
-Alkaline phosphatase

2

What LFT do you measure for synthetic function?

-Albumin
-Prothrombin time

3

What is jaundice?

-Yellow pigmentation of the skin and eyes

4

Explain pre-hepatic jaundice

-Jaundice from haemolytic causes eg excessive haemolysis
-> Liver is unable to cope with excessive bilirubin and you get unconjugated hyperbilirubinaemia and reticulocytosis

5

Give some causes of pre-hepatic jaundice

-Inherited -> red cell membrane defects
-Congenital -> Gilbert's syndrome
-Aquired -> Infection

6

Explain hepatic jaundice

-Deranged hepatocellular function whereby hepatocytes cannot extrete bilirubin
-Conjugated and unconjugated hyperbilirubinaemia

7

Explain LFTs in hepatic jaundice

-Both AST and ALT raised to reflect liver damage
-Abnormal prothrombin time

8

Give some causes of hepatic jaundice

-Hepatitis (Any eg alcoholic, viral, autoimune)
-Drugs (paracetamol)
-Cirrhosis
-Hepatic tumours

9

Explain post-hepatic jaundice

-Caused by obstruction of the billiary tree preventing conjugated hyperbilirubinaemia as passageway blocked

10

Explain the LFTs found in post-hepatic jaundice

-Normal or slightly high AST/ALT due to mild liver damage from pressure
-High ALP

11

Give some causes of post-hepatic jaundice

-Hepatitis, primary biliary cirrhosis, gallstones, stricture, pancreatic tumour

12

What is a cholangiocarcinoma?

-Carcinoma of the bile duct

13

What is hepatitis?

-Inflammation of the liver in which you get acute hepatocyte breakdown with synthetic failure

14

List some causes of hepatitis

-Viral (A,B,C,d)
-Autoimmune
-Drugs
-Hereditary

15

What LFT do you measure for hepatocellular damage?

-ALT/AST
-g-glutamyl transpeptidse (g-GT)

16

Describe the progression of alcoholic liver disease

-Fatty liver
-Alcoholic hepatitis
-Cirrhosis

17

Describe some complications which ca arise from alcoholic liver disease

-Hepatocellular carcinoma
-Liver failure
-Wenicke-Korsakoff syndrome
-Encephalopathy
-Dementia
-Epilepsy

18

Name 2 conditions which can cause confusion and CNS disturbances as a result of alcohol abuse

-Wernicke-Korsakoff syndrome
-Hepatic encephalopathy

19

What causes wernicke-korsakoff?

-Thiamine deficiency

20

What is liver cirrhosis?

-Liver cell necrosis followed by nodular regeneration and fibrosis resulting in increased resistance to blood flow and deranged liver function

21

Name some causes of liver cirrhosis

-Hepatitis B and C
-Alcohol
-Billiary cirrhosis
-Autoimmune hepatitis
-Haemochromocytosis
-Wilsons disease

22

What are the clinical features of cirrhosis?

-Jaundice
-Anaemia
-Bruising
-Palmar erythema
-Dupuytrens contracture
-Portal hypertension

23

What is palmar erythema?

-reddening of palms over thenar and hypothenar eminences

24

What is Dupuytren's contracture?

-Fixed forward curvature of one or more fingers

25

What do LFTs show in cirrhosis?

-Elevated AST/ALT
-Elevated ALP
-Elevated Bilirubin
-Low Albumin
-Deranged clottinf

26

How is liver cirrhosis managed?

-Stop alcohol intake
-Treat complications
-Transplant

27

What is primary biliary cirrhosis?

-Chronic destruction of bile ducts leading to jaundice, pruritis and xanthalasma

28

What is hereditary haemochromotosis?

-An autosomal recessive condition in which abnormal iron transport results in ion deposition in various organs including heart, pancreas, liver and skin

29

What is wilson's disease?

-Autosomal recessive condition resulting in disordered copper transport leading to deposition in liver (cirrhosis), basal ganglia (tremor) and kidney(tubular degeneration)

30

What is portal hypertension?

-Increase in portal venous pressure by >20mmHg

31

Name some intrahepatic causes of portal hypertension

-Cirrhosis
-Hepatoportal sclerosis
-Sarcoidosis
-Schostosomaisis

32

Describe the porto-systemic anastomoses

-Oesophageal vein and azygous system
-Superior rectal vein and inferior rectal veins
-Portal veins and veins of ant. abdominal wall

33

What are the clinical manifestations of portal hypertension?

-Ascites
-Splenomegaly
-Spider naevi
-Caput medusae
-Osophageal/rectal varices

34

What are spider naevi?

-Swollen blood vessels underneath the skin in the distribution of SVC

35

What is fulminant hepatic failure?

-Increased metabolic demand which causes acute and/or sever decompensation of hepatic function causing hepatic encephalopathy within 2 months of diagnosis

36

Give some causes of fulminant hepatic failure

-Hepatitis A, D and E
-Drugs (paracetamol/ecstasy)
-Wilson's disease
-Alcohol
-Pregnancy

37

Gove some features of fulminant hepatic failure

-Jaundice
-Encephalopathy
-Hypoglycaemia

38

What is hepatic encephalopathy?

-Reversible neuropsychiatric deficit which results from a decreased ability to remove ammonia from the blood

39

What can precipitate hepatic encephalopathy?

-Sepsis/infection
-Diuretics
-Alcohol withdrawal
-GI bleed

40

What are the clinical features of hepatic encephalopathy?

-Flapping tremor
-Personality change
-Intellectual deterioration

41

What is cholelithiasis?

-Gallstones

42

State some risk factors of gallstones

-Female
-Increasing age
-Obesity
-Diet
-Drugs

43

Describe the stones which can occur in gallstones

-Cholesterol stones
-Pigment stones
-Mixed

44

What is biliary colic?

-Intermittent pain caused by contraction of the gall bladder in attempt to move the stone

45

What is cholecystitis? How does it present?

-Inflammation of the gallbladder caused by gallstones leading to oedema and mucosal ulceration
-Often presents with pain and SIRS/sepsis

46

What is mucocoele?

-Mucus secretion causing painful distension of the gall bladder

47

Name 3 complications of gallstones

-Ascending cholangitis
-Obstructuve jaundice
-Acute pancreatitis

48

What is gallstone ileus?

-Gallstone erodes through mucosa of gallbladder and through into duodenum -> can move and obstruct ileus

49

What is charcot's triad and what does it represent?

-RUQ pain, jaundice and fever
-Ascending cholangitis

50

What is pancreatitis?

-Inflammation of the pancreas caused by effects of enzymes released from pancreatic acini

51

What are the causes of acute pancreatitis?

-Gallstones
-Ethanol
-Trauma

-Scorpion bite
-Mumps
-Autoimmune
-Steroids
-Hyperlipidaemia
-ERCP
-Drugs

52

What damage do protease, lipase and elastase cause in pancreatitis?

-Protease destroys tissue
-Lipase causes fat necrosis
-Elastase causes blood vessel destruction

53

What are the clinical manifestations of pancreatitis?

-Severe pain
-Vomiting
-Dehydration
-SIRS

54

What is chronic pancreatitis?

-Parenchymal destruction, fibrosis, loss of acini and duct stenosis

55

What are the clinical features of chronic pancreatitis?

-Pain
-Malabsorption (steatorrhoea, wt loss)
-DM
-Jaundice

56

What are most pancreatic carcinomas?

-Ductal adenocarcinoma

57

What is the prognosis like for pancreatic carcinomas?

-Very poor (account for 5% of all ca deaths)

58

What are the risk factors for pancreatic carcinomas?

-Smoking
-Beta napthylamine
-Familial

59

What are the clinical features of pancreatic carcinoma?

-Initially asymptomatic
-Pain, vomiting, malabsorption, diabetes

60

What is shifting dullness indicative of?

-Ascites

61

Why does ascites form in cirrhosis?

-Portal hypertension causes a rise in systemic venous pressure
-Liver damage causes a reduced synthetic function and thus reduced albumin production
-Together low oncotic pressure and high hydrostatic pressure cause fluid to move out of the peritoneal capillaries into the peritoneal space

62

How can oesophageal varices present?

-Haematemesis

63

Where does oesophageal venous system meet the systemic circulation?

-Oesophageal branch of left gastric vein and azygous system

64

Name 3 disease processes which would increase the breakdown of RBCs

-Haemolytic anaemia
-Malaria
-Sickle cell anaemia

65

What is the function of UDP-glucuronyl transferase?

-Conjugate bilirubin with glucaronic acid

66

Why do people present with pale stools and dark urine in jaundice?

-Pale stools because no bilirubin is reaching the GI tract -> normally bilirubin converted to stercobilin which gives faeces their colour
-Dark urine as bilirubin is in the urine

67

What would be present in a blood test if pancreatitis was present?

-Amylase

68

Why is ALT more specific than AST?

-ALT is located only in hepatocytes
-AST is also present in myocardium

69

Which LFT is specific of alcoholic liver disease?

-g-GT

70

What does an ALT:AST ratio less than 1 indicate?

-Viral hepatitis

71

What does an AST:ALT>2 indicate?

-Alcoholic disease