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