Chem Path: Liver diseases CPC Flashcards
What are the causes of high bilirubin
Pre hepatic - Haemolysis - You will have unconjungated bilirubin
hepatic
Post hepatic - Obstruction
What is Van den Bergh reaction?
Test for unconjugated vs conjugated bilirubin
Direct - Conjugated
Indirect - Unconjugated
What is Gilberts
Benign raised bilirubin due to UDP glucoronyl transferase activity downregulation
How is Gilbert inherited
Autosomal recessive
What makes Gilbert’s worse and how is Gilberts treated
Worse on fasting and treated by phenobarbital
What does it mean if there is no urobilinogen in urine?
Bilirubin is broken down by gut bacteria into sterco and uro bilinogen. Some of this is reabsorbed and peed out. If it is not present in urine, that means the biliary tree is blocked
When would ALT leak out?
Liver damage
How would the LFTs be in paracetamol overdose
Very high ALT and AST
What is the antidote for paracetamol overdose
N acetyl cysteine
How is Prothrombin time a good indicator of how serious paracetamol overdose is
If PT > no of hours since overdose, liver transplant is needed
Which LFT rises a lot in obstruction
ALP
How do you contract Hep A?
Contaminated water and faecal matter
What is the serology of Hep A like?
Jaundice
Rise in IgM, which will eventually taper off
Later rise in IgG which will stay forever
What is the serology of Hep B like for someone who has been infected?
HbS and HbE antigens will present first. When they fall there will be a rise in Antobodies against HbS and HbE and HbC
What will the serology of a Hep B vaccinated person look iike?
Only antibody against HbS will be there
What would you see in fatty changes in liver
Swollen/Ballooing cell - Mallory-Hyaline
What would you see in histology of alcoholic hepatitis
Neutrophil polymorphs and megamitochondria
What does it mean if you see blue staining on liver histology?
Collagen - End stage liver disease
What does thiamine/B1 deficiency cause?
Beri beri
What does vit C deficiency cause
Scurvy
What does B12 deficiency cause
Pernicious anaemia
What does b3 deficiency cuase
Pellagra - caused by mothers who do not take folic acid
How does stable chronic liver disease present
Spider naevi
Duputryens contracture
Gynacomastia
Palmar erythema
What would you see in portal hypertension
Caput Medusa and splenomegaly and ascites (You will NOT have hepatomegaly)
What is the portal vein made up of
Splenic vein and superior mesenteric vein
What does shifting dullness indicate?
Ascites
What kind of nodules will you have in alcoholic cirrhosis
Micronodular
What happens in porto systemic anastomoses
If portal pressure increases, it can lead to varices and blood can back down the azygos vein. It it bursts, you can die
List some sites where varices can form
Oesophageal
Rectal
Spleno-rectal
Umblicial vein recanalising
What happens in liver failure
Decrease in clotting factors
Reduced clearance of bilirubin
Reduced clearance of ammonia leading to hepatic encephalopathy
What do scratch marks in the background of jaundice mean?
Obstructive jaundice is the only reason you will have scratch marks due to bile salts
What is courvasiers law
A palpable gall bladder with jaundice mostly mean its pancreatic cancer
What type of cancer is pancreatic tumour
Adenocarcinoma
How does pancreatic cancer spread
Lymph
How does pancreatic cancer spread to the liver
Via the portal vein that goes back to the liver
