exam and investigations

Question 1

Jaundice Inspection (11)?

Answer 1

Icteric, Jaundiced, cachectic (malignancy), scratch marks (pruritis), needle track marks, spider nevi, palmar erythema clubbing bruising or gynaecomastia (chronic liver disease), bronzed tan (haemochromatosis) Kayser-Fleischer rings (Wilsons).

Question 2

Jaundice Palpation findings and causes (5)?

Answer 2

Hepatomegaly (malignancy or acute hepatitis),

splenomegaly (extravascular haemolysis),

RUQ tenderness (acute hepatitis or gallbladder disease),

ascites (chronic liver disease),

palpable lymphadenopathy (malignancy).

Question 3

Jaundice Bloods flow chart

Answer 3

Question 4

Jaundice investigations FBC and reticulocytes?

Answer 4

low RBC count with a high reticulocyte count suggests increased RBC turnover consistent with haemolysis or recent bleed.

Low RBC volume (microcytosis) would be consistent with thalassaemia.

Question 5

Jaundice investigations seum bilirubin levels?

Answer 5

if conjugated is >20% of bilirubin, suggests the problem is obstruction to bile flow.

Question 6

Jaundice investigations liver enzymes?

Answer 6

if AST and ALT are raised, theres damage to hepatocytes. AST>ALT suggests excessive alcohol intake, ALT>AST suggests viral hepatitis.

Question 7

Jaundice investigations ALP and GGT?

Answer 7

ALP is released from damaged biliary epithelial cells. GGT is expressed from biliary epithelial cells. So these raised means bile duct pathology.

Question 8

Jaundice investigations serum amylase or lipase?

Answer 8

pancreatic pathology (pancreatitis).

Question 9

Jaundice investigations urinalysis?

Answer 9

bilirubin in urine is posthepatic obstruction.

Question 10

Jaundice investigations haemolysis screen?

Answer 10

checks haptoglobins, lactate dehydrogenase, a direct antiglobin test, a blood film.

Question 11

Jaundice investigations viral screen?

Answer 11

Hep A B C, EBV, CMV and HIV.

Question 12

Jaundice investigations congenital screen?

Answer 12

haemochromatosis and wilsons disease.

Question 13

Jaundice investigations abdominal USS?

Answer 13

will show liver cirrhosis or liver carcinoma, shows dilation of CBD or mechanical obstruction.

Question 14

Gilberts syndrome?

Answer 14

normally a diagnosis of exclusion. Affests 3-8% of Caucasian people that results in the liver not being able to conjugate bilirubin at an adequate rate in times of physiological stress.

Question 15

Management of PBC

Answer 15

immunosuppression, bile salt replacement, fat-soluble vitamin replacement, pruritus management.

Question 16

Patients with UC

Answer 16

increased risk of PSC. Management for PSC is the same as for PBC.