302 Introduction to hepatology, liver function tests, and jaundice Flashcards
What is the sphincter of Oddi?
Where the duct from the pancreas, liver, and gall bladder enters the duodenum
hat gives faeces its colour?
Stercobilin
What enzyme conjugates bilirubin
UDP-Glucaronyl transferase
What are some diseases that interfere with conjugation of bilirubin?
Gilbert’s
Crigler Najjar syndrome
Dubin Johnson syndrome
What gives you information about liver function?
Albumin
Bilirubin
INR
What do liver enzymes tell you?
The extent and patterns of liver damage
What are hepatitic causes of liver damage?
Viral hepatitis (A,B,C,E); drug induced liver injury (DILI); autoimmune hepatitis; Wilson’s disease
Has raised ALT
What are some cholestatic causes of liver damage?
Intrahepatic: viral Hepatitis; DILI; autoimmune hepatitis, primary biliary cholangitis; Wilson’s disease, genetic cholestatic syndromes; sepsis
Extrahepatic: stones; benign/malignant stricture, primary sclerosing cholangitis
Shows raised Bilirubin and ALP
What are some mixed (cholestatic hepatitis causes of liver damage?
Viral hepatitis, autoimmune hepatitis; DILI
Shows high bilirubin and ALT
What is the difference between cirrhosis and fibrosis of the liver?
Fibrosis can be reversed
What are some examples of non-invasive Assessment of Hepatic Fibrosis?
AST/ALT ratio
FIB-4 Test
Liver stiffness measurement (fibroscan)
ELF test
Liver biopsy remains gold standard
How does hepatic encephalopathy occur?
Because the liver is no longer filtering the toxins out of the blood so it affects the brain
What is acute liver failure?
You get jaundiced and then develop encephalopathy within 4 weeks with no pre existing liver disease
What are some causes of hyperacute liver injury?
Paracetamol overdose
Hep A and E
What is acute on chronic liver failure (ACLF)?
Organ failure in the presence of liver disease
Eg. kidneys, coagulation, circulation, or respiratory failure
What is included in a hepatitis serology?
hepatitis A IgM, hepatitis B surface antigen, hepatitis C antibody, hepatitis E IgM
IgG will be present if people have had it in the past. Not indicative of current disease status
What is haemochromatosis?
When iron-binding protein accumulates in various tissues, typically leading to liver damage, diabetes mellitus, and bronze discoloration of the skin
What is Autoimmune Hepatitis?
Immune mediated chronic liver disease of unknown cause – almost all are women
Excellent response to immunosuppression
What is Autoimmune Biliary Disease: Primary Biliary Cholangitis?
90% are women aged 40-50
Asymptomatic/itching, cholestatic liver panel
Small interlobular bile ducts: biopsy shows granulomatous hepatitis
Ursodeoxycholic acid effective, second line treatment is obetacholic acid
What is Autoimmune Biliary Disease: Primary Sclerosing Cholangitis?
75% are men and 75% have IBD
PSC triggered by bacteria that enter portal circulation through inflamed intestine
Involve intra or extra hepatic bile ducts
Biopsy shows concentric fibrosis around bile ducts
No effective medical treatment
Increased risk of cholangicarcinoma
What are Congenital Cholestatic Syndromes (PFIC/BRIC)?
They’re genetic disorders that present in childhood
They affect bile and bile acid formation and secretion
What is cholangitis?
Presentations: Jaundice, rigors and RUQ pain (i.e. painful jaundice)
Liver USG shows dilated CBD
-Commonest cause is gallstones
Treated with antibiotics and ERCP with sphincterotomy and stone removal
