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Y4 GI / Surgery > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

Put these in order for bilirubin metabolism

  • Conjugated bilirubin
  • Urobilinogen
  • Heme
  • Unconjugated bilirubin
  • Biliverdin
  • Bile
A

Heme > biliverdin > unconjugated bilirubin > conjugated bilirubin > bile > urobilinogen > faeces

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2
Q

In what organism is bilirubin conjugated in?

A

Liver

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3
Q

Jaundice is due to excess what?

A

Hyperbiliriubinaemia and deposition of bile pigments

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4
Q

Jaundice is visible when the bilirubin is above what level?

A

50

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5
Q

How is jaundice categorised?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

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6
Q

What type of jaundice is associated with bilirubin levels of 5-17, 50-350, 100-750?

A

5-17 pre-hepatic
50-350 intra-hepatic
100-750 post-hepatic

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7
Q

What is the AST, ALT and ALP in pre, intra and post hepatic jaundice?

A

Pre-hepatic: normal ALP, normal AST, normal ALT
Intra-hepatic:&raquo_space;AST,&raquo_space;ALT, ALP
Post-hepatic: >AST, >ALT,&raquo_space;ALP

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8
Q

What type of jaundice has dark urine and pale stools?

A

Post-hepatic obstructive

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9
Q

Congenital disorder causing episodic jaundice when unwell or drink carefully describes what syndrome?

A

Gilbert’s syndrome

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10
Q

Does Gilbert’s syndrome cause a rise in conjugated or unconjugated bilirubin?

A

Unconjugated

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11
Q

What colour is urine in pre-hepatic jaundice?

A

Normal

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12
Q

What type of jaundice does sickle-cell anaemia cause?

A

Pre-hepatic

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13
Q

What type of jaundice does a file duct stricture cause?

A

Obstructive post-hepatic

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14
Q

What type of jaundice does pancreatic cancer and cholangiocarcinoma cause?

A

Obstructive post-hepatic

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15
Q

What type of jaundice does alpha-1 antitrypsin deficiency cause?

A

Intra hepatic

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16
Q

What type of jaundice does Budd Chiari syndrome cause?

A

Intra-hepatic

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17
Q

What type of jaundice does viral hepatitis cause?

A

Intra-hepatic

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18
Q

What type of jaundice could a blood transfusion cause?

A

Pre-hepatic

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19
Q

What type of jaundice does primary biliary cirrhosis and primary sclerosing cholangitis cause?

A

Post-hepatic

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20
Q

Type of jaundice has haemochromatosis cause?

A

Intra-hepatic

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21
Q

What type of jaundice does haemolytic anaemia cause?

A

Pre-hepatic

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22
Q

What is Courvoisier sign?

A

In a patient with painless jaundice + enlarged gallbladder the cause is unlikely to be gallstone (presume biliary/pancreatic neoplasm causing obstruction)

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23
Q

What type of jaundice would sphincter of Oddi dysfunction cause?

A

Obstructive post-hepatic

Mx surgical / botox

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24
Q

What is the function of bile?

A

To absorb that in the gut

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25
Q

What type of jaundice could statins cause?

A

Intra-hepatic

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26
Q

What type of jaundice could paracetamol cause?

A

Intra-hepatic

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27
Q

Which liver enzyme reflects hepatocyte trauma?

A

ALT

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28
Q

What does ALT stand for?

A

Alanine aminotransferase

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29
Q

What does AST stand for?

A

Aspartate aminotransferase

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30
Q

Albumin, bilirubin and PT/INR are all tests of what?

A

Test of intrinsic synthetic liver function

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31
Q

What causes a raised GGT?

A

Liver disease, cholestatic disease, drugs, alcohol

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32
Q

What part of the hepatobiliary system does a raised ALP suggest dysfunction of?

A

The biliary tree

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33
Q

Does NAFLD cause a higher ALP or AST?

A

ALT higher than AST

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34
Q

What is the management of NAFLD?

A

Weight loss + control risk factors

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35
Q

What is the commonest viral hepatitis in the UK?

A

HCV

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36
Q

What type of viral hepatitis is chronic?

A

HCV

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37
Q

How would acute viral hepatitis present?

A

N+V, fatigue, myalgia, headache, jaundice, hepatomegaly, RUQ pain

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38
Q

What types of viral hepatitis are associated with HCC? Which is most strongly associated?

A

HBV, HCV, HBV

HCV

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39
Q

What types of viral hepatitis are associated with cirrhosis?

A

HBV, HCV, HDV

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40
Q

Which types of viral hepatitis are blood-borne and which are faecal oral spread?

A 
HAB FOS
HBV BB 
HCV BB 
HDV BB
HEV FOS

HBV also sex

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41
Q

When is the HBsAg present after infection? What does it indicate?

A

1-6 months

Prolonged past 6 months implies HBV carrier

42
Q

When is the HBeAg present after infection? What does it indicate?

A

1-3 months after acute infection

Indicates high infectivity

43
Q

When investigating HCV, if the blood tests show a hepatitic picture what test would you do next? What test would do you

A

First check HCV Ab, if thats positive check RNA PCR

44
Q

What would blood tests show to indicate active HCV infection? For past infection?

A

Active: positive HCV Ab, positive RNA PCR
Past: positive HCV Ab, negative RNA PCR

45
Q

Learn HBV serology

A

Soz g just go learn it

46
Q

What is HBV serology in someone who is vaccinated?

A

Negative core Ab
Negative surface Ag
Positive surface Ab

47
Q

What is HBV serology in someone with previous HBV infection?

A

Positive core Ab
Negative surface Ag
Positive surface Ag

48
Q

What is HBV serology in someone with chronic HBV?

A

Positive core Ab
Positive surface Ag
Negative surface Ab

49
Q

How is cirrhosis functionally classified?

A

Compensated or decompensated

50
Q

Where does varices present?

A

Oesophagus
Caput medusae
Haemorrhoids

51
Q

What effect does cirrhosis have on:

  • LFTs
  • Albumin
  • PT
  • WCC
  • PLT count
  • CRP
A
  • Raised LFTs
  • Low albumin
  • High PT
  • Low WCC
  • Low PLTs
  • CRP normal
52
Q

Why is there low platelets in cirrhosis?

A

Platelet sequestration due to hypersplenism

53
Q

What is a fibroscan?

A

US measures fibrosis of the liver

54
Q

What does a liver screen test? Unsure if you really need to know this but read it to be aware of it

A 
Ferritin
Viral hepatitis serology
Autoimmune (AHA, AMA, SMA)
AFP
Alpha 1 anti-typsin
Caeruloplasmin if <40yr
55
Q

What drug is given to manage itch in cirrhosis?

A

Colestyramine

56
Q

Accumulate of toxic substances eg ammonia nitrogenous waste normally removed by the liver that cross the BBB causes …

A

Hepatic encephalopathy

graded 1-4

57
Q

What surgical procedure is used for refractory ascites?

A

TIPSS

Procedure has a risk of hepatic encephalopathy

58
Q

Hepatocellular carcinoma is a complication of cirrhosis. How is this monitored for?

A

Every 6 months US + AFP

59
Q

What is the management of a coagulopathy due to cirrhosis?

A

Give vitamin K

If actively bleeding give FFP

60
Q

Haemochromatosis is a disorder of _____ metabolism, there is increased intestinal absorption. What is the inheritance pattern? Where is it deposited?

A

Iron
Autosomal recessive
Joints / heart / liver

61
Q

In haemochromatosis there is an increased risk of what type of cancer?

62
Q

What dermatological presentation can haemochromatosis cause?

A

Slate grey skin
Or bronzed
(Or jaundiced)

63
Q

What is the 1st + 2nd line management of haemochromatosis?

A

1st lifelong regular venesection

2nd desferrioxamine

64
Q

Alpha 1 anti-trypsin deficiency is due to a lack of protease inhibitor normally produced by the liver. What is the inheritance pattern? What 2 disease processes occur as a result?

A

AR

Emphysema + cirrhosis

65
Q

Wilson’s disease is a disorder of biliary ____ excretion. It causes _____ deposited in _____ and _____. What is the inheritance pattern?

A

Copper
Liver + basal ganglia
AR

66
Q

What effect does Wilson’s disease have on

  • Urinary copper
  • Caeruloplasmin
  • Serum copper
  • LFTs
A

High urinary copper
Low caeruloplasmin
Low serum copper
High LFTs

67
Q

What sign can be seen on examination of the face in Wilson’s disease?

A

Kayser-Fleisher rings

around iris due to copper deposition in cornea

68
Q

What is the management of Wilson’s disease?

A

Penicillamine

chelates copper

69
Q

Intralobular bile duct inflammation is caused by what disorder?

A

Primary biliary cirrhosis

70
Q

What autoantibodies are raised in PBC?

A

AMA

M2 IgM

71
Q

What is the management of PBC?

A

Ursodeoxycholic acid

72
Q

What are the 3 Ms in PBC?

A

Middle age female
IgM
anti-AMA

73
Q

Are lipids raised (eg xanthelasma) in PBC or PSC?

74
Q

What autoantibodies are raised in PSC? primary sclerosing cholangitis

A

anti-SMA

also ANA, +- ANCA

75
Q

Which causes pruritus - primary sclerosing cholangitis or primary biliary cirrhosis?

A

Both

may see excoriations due to intense itch

76
Q

What causes a raised ALP - primary sclerosing cholangitis or primary biliary cirrhosis?

77
Q

What test is done for primary sclerosing cholangitis diagnosis?

A

MRPC - see beaded strictures

78
Q

What can cause ascending cholangitis - primary sclerosing cholangitis or primary biliary cirrhosis?

79
Q

What is the management of PSC primary sclerosing cholangitis?

A

Transplant for severe end stage disease

80
Q

‘Autoantibodies direct at hepatocyte surface antigens’ is the description of what disease?

A

Autoimmune hepatitis

81
Q

What autoantibodies are associated with autoimmune hepatitis? Which LFTs are off?

A

anti-SMA smooth muscle Ab
anti-ANA
>ALT >AST

82
Q

Shifting dullness on examination is a sign of what?

83
Q

What drug is used in the management of autoimmune hepatitis?

84
Q

What colour is fluid on US?

85
Q

How does cirrhosis cause ascites?

A

Fibrosis causes backpressure portal hypertension causes vasodilation of splanchnic arteries

86
Q

In ascites where is excess fluid?

A

In peritoneal cavity

87
Q

What investigation and calculation is used to help determine the cause of ascites?

A

Ascitic tap AKA paracentesis

SAAG

88
Q

Following ascitic tap, if SAAG is low does this indicate exudate or transudate?

A

Low SAAG = exudate

High SAAG = transudate

89
Q

In ascites, does malignancy cause a high or low SAAG?

A

Low SAAG = exudate

90
Q

In ascites, does nephrotic syndrome cause a high or low SAAG?

A

Low SAAG = exudate

91
Q

In ascites, does cirrhosis cause a high or low SAAG?

A

High SAAG transudate

92
Q

In ascites, does HF cause a high or low SAAG?

A

High SAAG transudate

93
Q

What is the 1st line management of ascites?

A

Spironolactone

94
Q

What acute complication of ascites would cause sudden deterioration?

A

Spontaneous bacterial peritonitis

95
Q

How is spontaneous bacterial peritonitis diagnosed?

A

Ascitic tap AKA paracentesis

WCC >250 + 90% neutrophils

96
Q

What is the management of spontaneous bacterial peritonitis?

A

IV piperacillin or tazobactam

97
Q

What is the management of an incidental finding of bacterial peritonitis on ascitic tap?

A

IV co-trimoxazole

98
Q

Acute liver failure + encephalopathy + jaundice =

A

Fulminant hepatic failure

99
Q

Hepatic encephalopathy is a complication of decompensated cirrhosis, it usually occurs in patients with _____ liver failure.

100
Q

How does hepatic encephalopathy present?

A

Mood/behaviour change, sleep disturbance, dyspraxia
Next confusion, drowsy, slurred speech, liver flap
Next stupor
Next coma

101
Q

What is the management of hepatic encephalopathy

A

IV lactulose, regular enemas, IV rifamixin

102
Q

What should you look out for on blood tests in methanol poisoning?

A

Hi osmolal gap

Y4 GI / Surgery (11 decks)

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