Flashcards in Week 7 - Liver and pancreatic disease Deck (71):
What LFT do you measure to look for cholestasis?
What LFT do you measure for synthetic function?
What is jaundice?
-Yellow pigmentation of the skin and eyes
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
Give some causes of pre-hepatic jaundice
-Inherited -> red cell membrane defects
-Congenital -> Gilbert's syndrome
-Aquired -> Infection
Explain hepatic jaundice
-Deranged hepatocellular function whereby hepatocytes cannot extrete bilirubin
-Conjugated and unconjugated hyperbilirubinaemia
Explain LFTs in hepatic jaundice
-Both AST and ALT raised to reflect liver damage
-Abnormal prothrombin time
Give some causes of hepatic jaundice
-Hepatitis (Any eg alcoholic, viral, autoimune)
Explain post-hepatic jaundice
-Caused by obstruction of the billiary tree preventing conjugated hyperbilirubinaemia as passageway blocked
Explain the LFTs found in post-hepatic jaundice
-Normal or slightly high AST/ALT due to mild liver damage from pressure
Give some causes of post-hepatic jaundice
-Hepatitis, primary biliary cirrhosis, gallstones, stricture, pancreatic tumour
What is a cholangiocarcinoma?
-Carcinoma of the bile duct
What is hepatitis?
-Inflammation of the liver in which you get acute hepatocyte breakdown with synthetic failure
List some causes of hepatitis
What LFT do you measure for hepatocellular damage?
-g-glutamyl transpeptidse (g-GT)
Describe the progression of alcoholic liver disease
Describe some complications which ca arise from alcoholic liver disease
Name 2 conditions which can cause confusion and CNS disturbances as a result of alcohol abuse
What causes wernicke-korsakoff?
What is liver cirrhosis?
-Liver cell necrosis followed by nodular regeneration and fibrosis resulting in increased resistance to blood flow and deranged liver function
Name some causes of liver cirrhosis
-Hepatitis B and C
What are the clinical features of cirrhosis?
What is palmar erythema?
-reddening of palms over thenar and hypothenar eminences
What is Dupuytren's contracture?
-Fixed forward curvature of one or more fingers
What do LFTs show in cirrhosis?
How is liver cirrhosis managed?
-Stop alcohol intake
What is primary biliary cirrhosis?
-Chronic destruction of bile ducts leading to jaundice, pruritis and xanthalasma
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
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)
What is portal hypertension?
-Increase in portal venous pressure by >20mmHg
Name some intrahepatic causes of portal hypertension
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
What are the clinical manifestations of portal hypertension?
What are spider naevi?
-Swollen blood vessels underneath the skin in the distribution of SVC
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
Give some causes of fulminant hepatic failure
-Hepatitis A, D and E
Gove some features of fulminant hepatic failure
What is hepatic encephalopathy?
-Reversible neuropsychiatric deficit which results from a decreased ability to remove ammonia from the blood
What can precipitate hepatic encephalopathy?
What are the clinical features of hepatic encephalopathy?
What is cholelithiasis?
State some risk factors of gallstones
Describe the stones which can occur in gallstones
What is biliary colic?
-Intermittent pain caused by contraction of the gall bladder in attempt to move the stone
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
What is mucocoele?
-Mucus secretion causing painful distension of the gall bladder
Name 3 complications of gallstones
What is gallstone ileus?
-Gallstone erodes through mucosa of gallbladder and through into duodenum -> can move and obstruct ileus
What is charcot's triad and what does it represent?
-RUQ pain, jaundice and fever
What is pancreatitis?
-Inflammation of the pancreas caused by effects of enzymes released from pancreatic acini
What are the causes of acute pancreatitis?
What damage do protease, lipase and elastase cause in pancreatitis?
-Protease destroys tissue
-Lipase causes fat necrosis
-Elastase causes blood vessel destruction
What are the clinical manifestations of pancreatitis?
What is chronic pancreatitis?
-Parenchymal destruction, fibrosis, loss of acini and duct stenosis
What are the clinical features of chronic pancreatitis?
-Malabsorption (steatorrhoea, wt loss)
What are most pancreatic carcinomas?
What is the prognosis like for pancreatic carcinomas?
-Very poor (account for 5% of all ca deaths)
What are the risk factors for pancreatic carcinomas?
What are the clinical features of pancreatic carcinoma?
-Pain, vomiting, malabsorption, diabetes
What is shifting dullness indicative of?
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
How can oesophageal varices present?
Where does oesophageal venous system meet the systemic circulation?
-Oesophageal branch of left gastric vein and azygous system
Name 3 disease processes which would increase the breakdown of RBCs
-Sickle cell anaemia
What is the function of UDP-glucuronyl transferase?
-Conjugate bilirubin with glucaronic acid
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
What would be present in a blood test if pancreatitis was present?
Why is ALT more specific than AST?
-ALT is located only in hepatocytes
-AST is also present in myocardium
Which LFT is specific of alcoholic liver disease?
What does an ALT:AST ratio less than 1 indicate?