ALD

Question 1

What is jaundice?

Answer 1

Yellowing of the skin and sclera due to high bilirubin levels being deposited in these places

Question 2

What 3 main areas of pathology can cause jaundice?

Answer 2

1) pre-hepatic
2) hepatic
3) post-hepatic (blockage)

Question 3

Name a pre-hepatic cause of jaundice?

Answer 3

Haemolytic anaemia

Question 4

What is the main age group at risk of ALD?

Answer 4

45-64

Males > females

Question 5

What is normal bilirubin?

Answer 5

30-35micromol/L

Question 6

What is normal alkaline phosphatase?

Answer 6

100-150 U/L

Question 7

What is normal ALT?

Answer 7

40-45 U/L

Question 8

What is normal albumin?

Answer 8

35-55 g/L

Question 9

What are the main causes of post-hepatic jaundice?

Answer 9

Blockage issues = malignancy or bending tumour

Question 10

Can alcohol cause post-hepatic jaundice?

Answer 10

No, alcohol Hx does not always mean it is the cause

Question 11

What is the most common type of pancreatic cancer?

Answer 11

Pancreatic adenocarcinoma

Question 12

What is the treatment for post-hepatic blockage causing jaundice?

Answer 12

ERCP

Stenting of ducts

Treatment of underlying blockage cause (tumour/mass)

Question 13

What signs may you see on a patient with chronic alcoholic liver disease?

Answer 13

• Spider naevi/angioma = Liver can not metabolise oestrogen, which is the cause of this due to its effect of dilating the sphincters of cutaneous arterioles
• Dupuytren’s contracture
• Ascites
• Caput Medusa
• Pruritic scratch marks (bilirubin from jaundice causes pruritis)

Question 14

Ascites can be transudates or exudates.

Explain the difference and how each occurs in Ascites.

Answer 14

Transudates = low protein content = caused by increased hepatic portal vein pressure = cirrhosis causes

Exudates = active secretion due to inflammation = protein content high (>30g/L) = malignancy causes

Question 15

What is pabrinex?

What does it treat?

Answer 15

Injection

Contains Vits B and C (thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid)

Treats poor diet (alcoholics, psychiatric, post-surgery)

Question 16

What is the treatment for alcoholic hepatitis?

Answer 16

Steroid (prednisolone)

Question 17

What type of bleed is melena associated with?

Answer 17

Upper GI (e.g. oesophageal varices)

Question 18

What is the treatment for bleeding oesophageal varices?

Answer 18

Oesophageal banding

Question 19

What is the name of the scoring system used to stage CLD/cirrhosis?

Answer 19

Child-Pugh score

Question 20

Why do CLD patients get oedema in their lower extremities?

Answer 20

Less albumin produced by cirrhosed liver = serum albumin low = water loss from vasculature into tissues

Question 21

What type of anaemia is seen in CLD?

Answer 21

Macrocytic