investigation of jaundice

Question 1

definition of acute liver failure

Answer 1

• reversible

- onset of hepatic encephalopathy occurs within 8 weeks of the first onset of illness

Question 2

definition of chronic liver disease

Answer 2

-usually the result of cirrhosis

Question 3

what is seen in the histology of the liver with liver disease

Answer 3

• activated stellate cells
• deposition of a scar matrix
• loss of fenestrae
• loss of hepatocyte microvilli
• Kupffer cell activation

Question 4

adverse prognostic criteria in ALF caused by paracetamol

Answer 4

pH <7.3
HE grade III or IV
Cr>300
PT>100 seconds 
or 2 of 3 above with deterioration or lactate>3.5

Question 5

adverse prognostic criteria in ALF caused by non paracetamol

Answer 5

Pt>100 seconds or
3 of the following
-PT>50
-age <10 or >40
-jaundice to enceph >7 days 
-bilirubin>300
aetiology not HAV or HBV

Question 6

ethanol detoxification pathway

Answer 6

ethanol->acetaldehyde- ADH
acetaldehyde-> acetic acid
acetic acid-> co2+h20

Question 7

methanol detoxification pathway

Answer 7

methanol->formaldehyde ADH

formaldehyde-> formic acid

Question 8

what do formaldehyde and formic acid cause

Answer 8

blindness
cerebral oedema
metabolic acidosis

Question 9

ethylene glycol pathyway and what effects on the body does it have

Answer 9

->glycoaldehyde (ADH)-CNS
Glycolic acid-metabolic acid
glyoxylate-lactic acidosis
oxalate- brain and renal damage

Question 10

treatment for methanol or ethylene glycol poisoning

Answer 10

to give fomepizole competitive inhibitor of ADH

Question 11

paracetamol pathway in over dose

Answer 11

Bad one
CYP450 forms Nacetylbenzoquinoneimine binds to cells causes hepatotoxicity and nephrotoxicity
-as glutathione is saturated or depleted in chronic alcoholism

Question 12

what do you give for paracetamol overdose

Answer 12

n-acetylcysteine which is basically glutathione breaks it down into nice products

Question 13

production of bilirubin pathway

Answer 13

spleen=haemoglobin-> haem-> bilirubin
blood=unconjugated albumin bound bilirubin
liver=conjugated bilirubin

Biliary excretion
Bile-> intestines and faecal excretion (makes it brown)

Question 14

what conjugates bilirubin

Answer 14

UDP glucuronyl transferase

Question 15

what changes urobilinogen to sterobilins

Answer 15

bacterial

Question 16

what is the rate limiting step in bilirubin metabolism

Answer 16

biliary excretion as requires ATP

Question 17

plasma, urine and faecal findings of bilirubin in health

Answer 17

plasma=unconjugated small amounts
urine=none
faeces=excreted amount

Question 18

3 types of jaundice

Answer 18

pre-hepatic
hepatic
post-hepatic

Question 19

lab results for pre-hepatic jaundice

Answer 19

unconjugated hyperbilirubinaemia
no bilirubin in urine
<60 bilirubin
normal LFTs

Question 20

lab results for hepatic jaundice

Answer 20

mixed hyperbilirbinaemia
bilirubin in urine
<200
increased LFTs- ast and alt

Question 21

lab results for post-hepatic jaundice

Answer 21

conjugated hyperbilirubinaemia
bilirubin in urine
pale stools 
<400
increase LFT: cholestatic

Question 22

what is kernicterus and treatment

Answer 22

-premature babies may not be able to conjugate bilirubin until UDP glucuronyl transferase produce
-unconjugated
-toxic to brain=kernicterus
treat with phototherapy

Question 23

gilbert’s syndrome which gene

Answer 23

-syndrome where liver doesn’t break down bilirubin
-mutation in UGTA1 gene
-autosomal dominant
-unconjugated
-don’t need treatment unless severe
more common in males

Question 24

what is red lysis

Answer 24

over production haemolysis so get unconjugated hyperbilirubinemia

Question 25

causes of post hepatic jaundice

Answer 25

• gallstones chol
• psc or pbc
• alcohol
• drugs
• tumour

Question 26

symptoms of cholestatic jaundice

Answer 26

pruritus
pale stools
dark urine

Question 27

Courvoisier’s law

Answer 27

if the gallbladder is palpable the jaundice is unlikely to be caused by biliary obstruction

Question 28

which lft might be normal in hepatitis

Answer 28

albumin