Biliary and liver disease Flashcards
How does conjugated bilirubin appear as in urine?
- Urobilinogen.
What are the key features of the following Viral Hepatitises.
- A
- B
- C
- D
- E
A: oro-anal sex, fleco-oral, acute, asymptomatic (usually)
B: Serology, most adults are able to clear, never have acute hepatitis. Children stay as carriers.
C: Blood spread (IVDU), chronic infection, patients unaware of infection -> fibrosis, cirrhosis, carcinoma.
D: Superinfection of B
E: Expectant mothers beware, particular morbidity in pregnant women. Faeco-oral, self limiting,
What investigation differentiates HBV from other viral causes.
What do the following Hep B serology markers mean?
- HbsAg
- HbeAg
- Anti-Hbs
- Anti-Hbc
- All other viral hepatitides can cause acute hepatitis with transaminitis. Most adults clear Hep B and become chronic carriers of Hep C.
- s: Current infection (acute or chronic)
- e: Infective
- Anti-s: Immune
- Anti-c: caught in past, natural immunity.
What are 3 causes of transaminitis in the 1000s?
What does raised GGT and ALP indicate?
What does low albumin show?
What does 2:1 ratio of AST:ALT indicate?
Give 3 causes of low urea.
Give 2 causes of raised urea.
- Paracetamol, Ischaemic hit, viral.
- Cholestasis/ obstruction, biliary damage. GGT related to alcohol.
- Low albumin: poor synthetic liver function
- AST double ALT means alcoholic hepatitis.
- Low urea: severe liver damage, malnutrition, pregnancy.
1. Upper GI bleed/ large protein meal
2. Dehydration/ AKI- urea excreted renally.
What two conditions come under Non-Alcohol steatohepatitis?
What is the aetiology of NASH.
- Steatosis and steatohepatitis.
Initial fatty liver due to alcohol abuse. If fat persists (in absence of alcohol), causes inflammation and fibrosis aka steatohepatitis.
NASH is usually found as incidental finding. Give 4 occasional symptoms.
- RUQ pain
- Fatigue
- Unexplained weight loss
- Weakness.
20% of people with NASH will develop cirrhosis.
Give 2 serum LFTs for alcoholic hepatitis.
Chronic liver disease may be expected, what size liver would be found.
- AST:ALT > 2:1
- Raised GGT.
- Small liver in chronic liver disease.
What is inheritance of Wilson’s disease?
Where do copper transporters remain intact?
Give 3 locations of copper deposits
- Autosomal recessive, mutation in ATP7B gene.
- Intact transporters in CNS
Copper deposition - Liver: chronic liver disease
- Basal ganglia: neuropsychiatric and parkinsonism Sx.
- Cornea: Keyser Fleischer rings.
Give 3 investigation findings for Wilson’s disease.
- Low serum caereuloplasmin- serum copper carrying protein
- High urinary copper
- Low serum Cu- paradoxical (not reliable)
What causes raised iron in haemochromatosis?
- What is the inheritance pattern?
- Give 3 locations of iron deposition.
- Give 4 presenting features of haemochromatosis
- Increased dietary absorption and increased release from macrophages.
- Autosomal recessive
- Liver, pancreas, pituitary gland
- Bronzed skin
- MCP arthritis
- Diabetes
- hepatomegaly
What will the following haematinic levels be in haemochromatosis?
- Ferritin
- Transferin
- TIBC
What protein is mutated in 90% of cases?
- Ferritin high- lots of storage
- Transferrin low
- TIBC low
- Hepcidin: deficiency means hepcidin cannot inhibit ferroportin. Increased intestinal absorption of Fe means high serum iron.
Which antibody is present in autoimmune hepatitis?
What type of patient is suspect?
- Anti-smooth muscle antibodies.
- Young female, overweight, autoimmune conditions.
Differentiate biliary colic, acute cholecystitis and cholangitis by Charcot’s triad.
What are 5 Fs of gallbladder disease?
What is order of investigations for gallbladder disease?
Biliary colic: RUQ pain
Acute cholecystitis: RUQ pain + Fever. Murphy’s sign +ve
Cholangitis: RUQ + Fever + jaundice
Fat, Female, 40, Fertile, FHx
- LFTs
- Abdo USS- gold standard Dx
- Then consider MRCP
What is management of cholelithiasis?
What is management of choledocholithiasis?
Cholelithiasis: Cholecystectomy
Choledocholithiasis: ERCP.
What are the 2 investigations for pancreatic cancer.
What type are most pancreatic cancers?
How may it also present?
What is Courvoisier law?
- LFTs, Protocol CT scan
- 90% are adenocarcinoma
- May present as sudden onset diabetes mellitus.
- Courvoisier law: palpable gall bladder in presence of painless jaundice is unlikely to be due to stones.
i. e. palpable GB + Jaundice = head of pancreas/ CBD cancer.
