Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology & Hepatology > Interpreting LFTS & Causes Of Jaundice > Flashcards

Interpreting LFTS & Causes Of Jaundice Flashcards

1
Q

What is neutropenic sepsis?

A

Potentially life-threatening complication of neutropenia (low neutrophil count)
Complication of anti cancer or immunosuppressive drug treatment
Temp of greater than 38 and any symptoms/signs of sepsis, in a person with a neutrophil count of 0.5 x 10^9/L or lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neutropenic sepsis is a complication of what treatments?

A

Immunosuppressive drugs and anti cancer treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define septic shock

A

Sepsis with hypotension not responsive to 20ml/kg or requiring vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define sepsis

A

Life-threatening organ dysfunction (medical emergency) caused by a dysregulated host response to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Severe sepsis - define

A

Sepsis with Organ dysfunction or high lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sepsis 6

A

Take - blood cultures, lactate and Hb, urine output

Give - oxygen, antibiotics, fluid challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Types of shock:

A

Cardio genie, hypovolaemic, obstructive, distributive (septic, anaphylactic, neurogenic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 types of distributive shock

A

Septic, anaphylactic, neurogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neutropenic sepsis - what bacteria is it? And how do we treat?

A

Gram + or negative bacteria
Broad spectrum antibiotics
Anti-fungals +/-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Primary sclerosing cholangitis is associated with …

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

‘Beads on a string’ appearance is seen in a cholangiogram in what condition?

A

Primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a cholangiogram?

A

X-ray of bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Abnormal LFTS - Hepatitic vs cholestatic

A 
Hepatitic = very high ALT/AST, slightly high ASP/bilirubin/GGT
Cholestatic = very high ALP/bilirubin/GGT, slightly high ALT/AST
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
… = very high ALT/AST, slightly high ASP/bilirubin/GGT
… = very high ALP/bilirubin/GGT, slightly high ALT/AST
A 
Hepatitic = very high ALT/AST, slightly high ASP/bilirubin/GGT
Cholestatic = very high ALP/bilirubin/GGT, slightly high ALT/AST
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ALT>AST is associated with what?

A

Chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AST>ALT is associated with … and …

A

Cirrhosis and acute alcoholic hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common causes of acute hepatocellular injury (3)

A

Poisoning i.e. paracetamol overdose
Infection (Hep A/B)
Liver Ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common causes of chronic hepatocellular injury (3)

A

Alcoholic fatty liver disease
Non-alcoholic fatty liver disease
Chronic infection (Hep B/C)
Primary biliary cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is prothrombin time? (PT)

A

Prothrombin time is a measure of the blood’s coagulation tendency, specifically assessing the extrinsic pathway.
In the absence of other secondary causes such as anticoagulant drug use and vitamin K deficiency, an increased PT can indicate liver disease and dysfunction.
The liver is responsible for the synthesis of clotting factors, therefore hepatic pathology can impair this process resulting in increased prothrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Albumin levels can fall due to:

A

Liver disease resulting in a decreased production of albumin (e.g. cirrhosis)
Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin
Excessive lots of albumin due to protein-losing enteropathies or nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bilirubin is a breakdown product of what?

A

Haemoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Jaundice usually occurs when bilirubin levels are …

A

> 60umol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Darker urine indicates the patient has … hyperbilirubinaemia

A

Conjugated - as this can pass into the urine as urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The stool colour can help to differentiate the causes of jaundice - if bile and pancreatic lipases are not able to reach the bowel due to blockage, fat is not absorbed, meaning the stool is …

A

Pale, bulky and more difficult to flush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Normal stools + normal urine = … hepatic cause of jaundice

A

Pre hepatic cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Normal stools + dark urine = … hepatic cause of jaundice

A

Hepatic cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pale stools + dark urine = … hepatic cause of jaundice

A

Post-hepatic cause (obstructive)

28
Q

Causes of unconjugated hyperbilirubinaemia include:

A

Haemolytic (e.g. haemolytic anaemia)
Impaired hepatic uptake (E.g. drugs, congestive cardiac failure)
Impaired conjugation (e.g. Gilbert’s syndrome)

29
Q

Causes of conjugated hyperbilirubinaemia include:

A

Hepatocellular injury

Cholestasis

30
Q

The liver’s main functions are … (4)

A

Conjugation and elimination of bilirubin
Synthesis of albumin
Synthesis of clotting factors
Gluconeogenesis

31
Q

If the patient is jaundiced but ALT and ALP levels are normal - it is suggestive of a … cause of jaundice

A

Pre-hepatic

32
Q

Causes of an isolated rise in bilirubin include:

A

Gilbert’s syndrome: the most common cause

Haemolysis - check a blood film, full blood count, reticulocyte count, haptoglobin and LDH levels to confirm

33
Q

A greater than 10-fold increase in ALT and a less than 3-fold increase in ALP suggests a predominantly … injury

A

Hepatocellular injury

34
Q

A less than 10-fold increase in ALT and a more than 3-fold increase in ALP suggests …

A

Cholestasis

35
Q

Is it possible to have a mixed picture of hepatocellular injury and Cholestasis?

A

Yes

36
Q

If there is a rise in ALP, it is important to review the level of GGT also - why?

A

A raised GGT can be suggestive of biliary epithelial damage and bile flow obstruction. It can also be raised in response to alcohol and drugs such as phenytoin. A markedly raised ALP with a raised GGT is highly suggestive of Cholestasis.

37
Q

A markedly raised ALP with a raised GGT is highly suggestive of …

A

Cholestasis

38
Q

Causes of an isolated rise in ALP include:

A

Bony metastases or primary bone tumours
Vitamin D deficiency
Recent bone fractures
Renal osteodystrophy

39
Q

… is found in high concentrations within hepatocytes and enters the blood following hepatocellular injury.

A

ALT

40
Q

… is particularly concentrated in the liver, bile duct and bone tissues. It is often raised in liver pathology due to increased synthesis in response to Cholestasis.

A

ALP - so it is a useful indirect marker of Cholestasis

41
Q

If the ALT is raised decide if this is a more than a … fold rise of less than a … fold rise

A

10 fold (more or less)

42
Q

If the ALP is raised decide if this is a more than a … fold rise of less than a … fold rise

A

3 fold rise (more or less)

43
Q

ALT, AST, ALP and GGT are used to distinguish between … damage and ….

A

hepatocellular damage and Cholestasis

44
Q

Bilirubin, albumin and PT are used to assess what?

A

Livers synthetic function

45
Q

What blood tests are used to assess liver function?

A 
ALT
AST
ALP
GGT
Bilirubin
Albumin
Prothrombin time (PT)
46
Q

In pre-hepatic jaundice, there is excessive red blood cell breakdown which leads to what?

A

Overwhelms the livers ability to conjugate bilirubin - causing an unconjugated hyperbilirubinaemia

47
Q

Hepatocellular jaundice - dysfunction of hepatic cells - bilirubin is …

A

Mixed - both conjugated and unconjugated

48
Q

Post-hepatic jaundice refers to obstruction of biliary drainage - so the result is ..

A

Conjugated hyperbilirubinaemia

49
Q

Differential diagnosis of abnormal LFTS (hepatitic)

A

Alcoholic fatty liver disease
Non alcoholic fatty liver disease
Viral hepatitis
Paracetamol overdose

50
Q

Differential diagnosis of abnormal LFTS (cholestatic)

A 
Gallstones
Drugs
Primary sclerosing cholangitis
Primary biliary cirrhosis
Cancer
51
Q

What is primary biliary cirrhosis (cholangitis)?

A

A chronic disease of the small intrahepatic bile ducts that is characterised by progressive bile duct damage (and eventual loss) occurring in the context of chronic portal tract inflammation. Fibrosis develops as a consequence of the original insult and the secondary effects of toxic bile acids retained in the liver, resulting ultimately in cirrhosis. The almost universal presence of autoantibodies in PBC patients (classically anti-mitochondrial antibodies) has led to the widely held view that the disease has an autoimmune component to its aetiology.

52
Q

Key diagnostic factors in primary biliary cirrhosis (cholangitis) - age and sex

A

Typically female sex, age 45-60years

53
Q

Which condition is largely associated with IBD?

- Primary sclerosing cholangitis? Or Primary biliary cirrhosis?

A

Primary sclerosing cholangitis - usually have a history of IBD, male sex more common, age in 40s/50s

54
Q

Primary biliary cholangitis vs primary sclerosing cholangitis - key diagnostic factors

A

Primary biliary cholangitis predominantly affects middle-aged women and is not associated with IBD, whereas primary sclerosing cholangitis typically in men and with people with a history of IBD

55
Q

Will people with primary biliary cholangitis have a normal cholangiogram?

A

Usually it is normal but hard to distinguish from intrahepatic PSC

56
Q

What autoantibody is present in 95% of those with primary biliary cholangitis?

A

Antimitochondrial autoantibody is present in 95% of cases

57
Q

The classic histopathological finding of … is presence of periductal concentric “onion skin” fibrosis

A

Primary sclerosing cholangitis

58
Q

Someone that is thin, but not cachectic is less likely to have what?

A

Crohn’s with ileitis and malabsorption

59
Q

Neutrophil count of 0.1 is suggestive of …

A

Agranulocytosis- can be due to side effects of immunosuppressive drugs or anti cancer therapy

60
Q

‘Onion skin’ fibrosis =

A

Cirrhosis due to PSC

61
Q

Tender brushes on skin - usually shins indicates …

A

Erythema nodosum

62
Q

‘Skip lesions’ on colonoscopy and transmural inflammation with granulomas =

A

Crohn’s disease

63
Q

Positive antimitochondrial antibody =

A

Primary biliary cirrhosis

64
Q

‘Beads on a string’ appearance on ERCP =

A

Primary sclerosing cholangitis

65
Q

Abdominal distension in acute colitis - important to do an abdominal X-ray to look for what?

A

Toxic mega colon - dilated transverse colon - it is life-threatening

66
Q

Ursodeoxycholic acid is used to help … drainage in patients with PSC and PBS

A

Bile drainage

Gastroenterology & Hepatology (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions