DPD: Liver disease Flashcards
What is the prehepatic aetiology of jaundice? What can cause this? What investigation would be useful if suspected?
Excessive production of BR:
Haemolysis (intravascular + extravascular)
Gilbert’s syndrome
FBC + blood film
What is the hepatic aetiology of jaundice? What investigation would be useful if suspected?
Liver pathology Viral hepatitis Alcoholic hepatitis Cirrhosis LFT's
What is the posthepatic aetiology of jaundice? What can cause this? What investigation would be useful if suspected?
Obstruction Gallstones Pancreatic cancer ALP + GGT Amylase + lipase
Why differentiate between conjugated and unconjugated BR in children?
Jaundice can be normal
BR should be unconjugated as the cause is liver immaturity + fall in Hb early in life
What is Gilberts syndrome? How does it cause jaundice?
Reduced UGT-1 activity (enzyme that conjugates BR)
Results in unconjugated hyperbilirubinaemia
Unconjugated BR tightly albumin bound thus does not enter urine
What can be considered the most representative marker/ result of liver function?
PT: rapidly changes in dysfunction
Rise correlates with deterioration of patient unlike ALT + AST which rise disproportionately
List 3 good measures of liver function
Albumin
Clotting factors (PT, PTTK)
Bilirubin
How do you differentiate between the 2 main causes of post hepatic jaundice?
Gallstones = Painful
Pancreatic cancer = Painless
What is suggested by an AST > ALT?
Excessive alcohol intake
What is suggested by an ALT > AST?
Viral hepatitis
What are the 2 outcomes of hepatitis A infection?
Death
Immunity
What is indicated by the presence of the anti-HBe antibody?
Exposure to live Hepatitis B virus
Which antigen is used to vaccinate people against hepatitis B?
Surface antigen (HBs)
List 3 defining histological features of alcoholic hepatitis. What are 2 other associated histological features?
Liver cell damage Inflammation Fibrosis Fatty change Megamitochondria
What is the treatment approach and 3 interventions recommended for alcoholic hepatitis?
Supportive
Stop alcohol
Nutrition
IV Thiamine + vitamin B1
What is caused by Vitamin B1 deficiency?
Beri-Beri disease
What 4 signs may be present in chronic stable liver disease?
Multiple spider navei
Dupuytrens contracture
Palmar erythema
Gynaecomastia
What signs may be seen in a patient with portal hypertension?
Visible veins on abdominal wall
Splenomegaly
Ascites (shifting dullness)
What causes portal hypertension?
Cirrhosis
What are the physiological outcomes of liver failure?
Failed synthesis of clotting factors: bruise + bleed
Failed synthesis of albumin: retain Na+ as kidneys detect fall in BP
Failed clearance of BR: jaundice
Failed clearance of ammonia: irritates brain causes Encephalopathy
List 4 features of cirrhosis
Whole liver involvement
Nodules of regenerating hepatocytes
Fibrosis
Shunting of blood
List 6 causes of cirrhosis
Fatty liver disease (alcoholic + non alcoholic) Viral hepatitis (B, C + D) Haemochromatosis Wilsons disease PBC PSC
How could you differentiate between fatty liver disease and viral hepatitis?
FLD: Micronodular
VH: Macronodular
List 4 sites of porto-systemic anastomoses
Oesophageal varices
Rectal varices
Umbilical vein recanalising
Spleno-renal shunt
What do scratch marks suggest?
Obstruction of bile ducts as bile salts build up in skin + are not excreted
What is the cause if the gall bladder is palpable in a jaundiced patient?
Pancreatic cancer
Describe courvoisiers law
Gall bladder with stones is usually small + fibrotic + incapable of being large + palpable, If gallbladder is palpable must be due to stretching + filling with fluid due to pancreatic cancer obstructing the bile duct
