Gastroenterology - Liver Disease and Jaundice

Question 1

72 Year Old Man - 1 month of Jaundice - what else do you want to know?

Answer 1

Other symptoms
Medications - current, any allergies
PMH - Crohn’s disease linked to liver disease?
Social Hx - Job, alcohol intake
Family Hx - all q’s
Red flag q’s

Question 2

72 Year Old Man - 1 month of Jaundice - Upon examination looks well but jaundiced - no stigmata of CLD, CVS + RS unremarkable - What next?

Answer 2

Special investigations -LFTs
ALT, ALP, Bilirubin, Albumin, INR, gamma-glutamyl transferase (GGT)

Question 3

72 Year Old Man - 1 month of Jaundice - Upon examination looks well but jaundiced - no stigmata of CLD, CVS + RS unremarkable - High bilirubin, ALT, ALP and INR - What next after special investigations?

Answer 3

Imaging - U/S

• Dilated common bile duct and intrahepatic ducts
• Gall bladder - no stones seen
• Pancreas obscured

Question 4

72 Year Old Man - 1 month of Jaundice - Upon examination looks well but jaundiced - no stigmata of CLD, CVS + RS unremarkable - LFTs done, U/S done -

• Dilated common bile duct and intrahepatic ducts
• Gall bladder - no stones seen
• Pancreas obscured

What is the diagnosis?

Answer 4

Obstructive Jaundice

No liver disease - INR raised due to

Question 5

Why may INR be raised? (Without liver disease?) (2 reasons)

Answer 5

• Taking anticoagulants
• Vitamin K needed for some clotting proteins - fat soluble vitamin - to absorb fat you need bile, no bile = no vitamin K absorption - INR goes up

Question 6

Jaundice - Causes

Answer 6

• Pre-hepatic
• Hepatic
• Post-hepatic

Question 7

The … bilirubin is soluble in water, insoluble in fat and alcohol. The …. bilirubin is insoluble in water, soluble in fat and alcohol.

Answer 7

The conjugated bilirubin is soluble in water, insoluble in fat and alcohol. The unconjugated bilirubin is insoluble in water, soluble in fat and alcohol.

Question 8

… is a tetrapyrrolic bile pigment and is one end-product of heme catabolism. It is the chemical responsible for the brown color of human feces and was originally isolated from feces in 1932.

Answer 8

Stercobilin is a tetrapyrrolic bile pigment and is one end-product of heme catabolism. It is the chemical responsible for the brown color of human feces and was originally isolated from feces in 1932.

Question 9

33 Year Old Women - Jaundice for 2 weeks - What do you want to know?

Answer 9

PMH - ?

TH - thiamine, b vitamins, fluoxetine and diazepam PRN

FH - none

SH - 14 units of alcohol a day

Question 10

33 Year Old Women - Jaundice for 2 weeks - Examination:

• Unwell - deeply jaundice, sarcopaenia, spider naevi, distended abdomen with shifting dullness - What is this indicating?

Answer 10

Long standing liver disease

Question 11

33 Year Old Women - Jaundice for 2 weeks - Examination:

Unwell - deeply jaundice, sarcopaenia, spider naevi, distended abdomen with shifting dullness - What investigations?

Answer 11

Question 12

33 Year Old Women - Jaundice for 2 weeks - Examination:

Unwell - deeply jaundice, sarcopaenia, spider naevi, distended abdomen with shifting dullness - What imaging after LFTs?