69. jaundice

Question 1

liver/jaundice history taking

Answer 1

GI system history
Difficulty swallowing
Indigestion/heartburn
Vomiting - colour, amount consistency, any blood
Stool: frequency, consistency, colour, blood
Abdominal pain: location, character etc SOCRATES
Abdominal distension
Liver: Itching, yellowing of skin,
Renal:
Urine regularly, how many in past 12 hours?, colour of urine? Blood, frothy
Systemic:
Weight loss, fever, arthralgia, myalgia

MHx: diabetes (NAFLD)
DHx:
Exposure to drugs and chemicals - OTC, prescribed, recreational,
Transfusion
Alcohol, smoking
SHx:
Travel
Contaminated food
alcohol
Sexual activity
Tattoo

Question 2

examination liver/jaundice

Answer 2

General:
Nutritional status and wasting (long standing eg CLD or pancreatic cancer)
Stigmata of CLD? Eg spider naevi, gynecomastia, palmar erythema, dupuytren’s contracture
Enlarged Lymph nodes? Virchow’s node (suggest intra-abdominal malignancy)
Increased JVP (sign of right heart failure → hepatic
Asterixis!!

Abdominal:
Enlarged liver: (cirrhosis -enlarged LL) (grossly enlarged and tender → malignancy)
Splenomegaly (CLD w portal HTN)
Ascites (liver cirrhosis and GI malignancy)
Pain and tenderness (hepatitis and cholecystitis

Question 3

what is the most sensitive and specific lab finding for a diagnosis of liver cirrhosis in those with chronic liver disease

Answer 3

Thrombocytopenia (platelet count <150,000 mm^3) is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

Question 4

what is hepatitis

Answer 4

acute inflammation

Question 5

what is fibrosis

Answer 5

this is where the functional liver cells are replaced with scar tissue. Chronically this leads to cirrhosis. Fibrosis affects the structure and blood flow through the liver, increasing the resistance in the vessels leading into the liver. This increased resistance and pressure in the portal system is called portal hypertension

Question 6

what is cirrhosis

Answer 6

the result of chronic inflammation and damage to liver cells

Question 7

what is decompensated cirrhosis

Answer 7

acute deterioration in someone with cirrhosis. Characterised by ascites, hepatic encephalopathy, coagulopathy, jaundice, hepatorenal syndrome, variceal haemorrhage

Question 8

what is acute liver failure

Answer 8

rapid deterioration/death of liver cells w/o previous cirrhosis

Question 9

what is portal hypertension

Answer 9

this occurs once cirrhosis is established. Portal HTN is increased blood pressure in the hepatic portal system. This can cause ascites, varices, splenomegaly, hepatorenal syndrome

Question 10

what is ascites

Answer 10

Increased pressure in the portal blood vessels may cause protein-containing (ascitic) fluid to leak from the surface of the liver and intestine and to accumulate within the abdomen. This condition is called ascites.

Question 11

what is hepatorenal syndrome

Answer 11

as a result of portal HTN, there is widespread splanchnic vasodilation → reduce blood flow to kidneys → can cause life-threatening AKI

Question 12

features of heaptic encephalopathy

Answer 12

Confusion
Drowsiness
Hyperventilation
Asterixis
Fetor hepaticus

Question 13

management encephalopathy

Answer 13

supportive care plus lactulose until laxative effect is achieved