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Year 2- GIT > Jaundice > Flashcards

Jaundice Flashcards

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1
Q

List some of the things produced by the liver.

A

Clotting factors
Bile acids

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2
Q

Which processes relating to carbohydrates does the liver help with carrying out?

A

Gluconeogenesis
Glycolysis
Glycogenesis

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3
Q

What role does the liver have to do with proteins?

A

Synthesis of albumin

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4
Q

What role does the liver has to do with lipids?

A

Cholesterol synthesis
Production of Lipoprotein
Triglyceride synthesis

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5
Q

Which organ is the main detoxifier?

A

Liver

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6
Q

How does the liver have a role in detoxification?

A

Detoxifies drugs
Bilirubin metabolism
Breakdown of insulin and hormones
Produces urea from ammonia

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7
Q

How does the liver have an immune function?

A

Combats infections, clears blood particles of infection and bacteria

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8
Q

The liver has a large storage function.
List the things stored in the liver.

A

Glycogen
Vitamins B12, A, D, K
Copper
Iron

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9
Q

How is bilirubin produced?

A

It’s a breakdown product from haeme in RBC’s

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10
Q

What is bilirubin initially bound to?

A

Albumin

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11
Q

What is bilirubin known as when it is bound to albumin?

A

Unconjugated bilirubin

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12
Q

How does unconjugated bilirubin become conjugated bilirubin?

A

Liver helps to solubilise it, conjugating the bilirubin to become water soluble

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13
Q

Name three types of bilirubin elevation.

A

Pre-hepatic
Hepatic
Post-hepatic

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14
Q

How can pre-hepatic elevation of bilirubin occur?

A

Increased haemolysis of RBC’s

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15
Q

How can hepatic bilirubin elevation occur?

A

Liver damage

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16
Q

How can post-hepatic bilirubin be eleavted?

A

Bilirubin does not reach intestines

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17
Q

What is carried out if there is an elevation in bilirubin?

A

Test for aminotransferases

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18
Q

What are aminotransferases?

A

Enzymes present in hepatocytes

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19
Q

What is more specific- ALT or AST?

A

ALT

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20
Q

Which condition can the ALT:AST ratio help to diagnose?

A

Alcoholic liver disease

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21
Q

Where is alkaline phosphatase predominantly produced?

A

Bile ducts

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22
Q

When may alkaline phosphatase be elevated?

A

Bile duct obstruction or liver infiltration

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23
Q

When is Gamma GT, a non-specific liver enzyme, elevated?

A

Elevated with alcohol use

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24
Q

What does it mean if Gamme GT and alkaline phosphatase are both elevated?

A

It is a biliary disease

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25
Q

Give an example of a type of drug which can increase levels of Gamma GT.

A

NSAIDs

26
Q

What is tested to check the synthetic function of the liver?

A

Albumin

27
Q

What does low albumin suggest?

A

Chronic liver disease

28
Q

When may albumin levels also be low?

A

Kidney disorders and malnutrition

29
Q

What would testing the prothrombin time of the liver tell us?

A

Degree of liver dysfunction.

30
Q

What would you need to test to determine survival from liver disease and also for critical assessment of liver transplant?

A

Creatinine

READ NOT CREATINE

31
Q

Which blood test would need to be carried out when testing for liver disease?

A

Platelet count

32
Q

The liver produces thrombopoietin. What is it?

A

Hormone which regulates production of platelets.

33
Q

What would low platelet levels suggest?

A

Cirrhosis

34
Q

What can low platelet counts be an indirect indicator of?

A

Portal hypertension

35
Q

What does jaundice cause to happen physically?

A

Yellowing to eyes and skin

36
Q

Why does jaundice cause yellow eyes and skin?

A

Excess circulating bilirubin

37
Q

Bilirubin levels are only detectable when?

A

When total plasma bilirubin > 34umol/L

38
Q

What is the differential diagnosis for jaundice?

A

Carotenemia

39
Q

Where do RBC’s die?

A

Spleen

40
Q

In prehepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

A

Unconjugated

41
Q

In hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

A

Conjugated

42
Q

In post hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

A

Conjugated

43
Q

Upon taking a history, what are some things that are suggestive of pre-hepatic jaundice?

A

History of anaemia
Acholuric jaundice

44
Q

Upon taking a history, what are some things that are suggestive of hepatic jaundice?

A

Risk factors for liver disease e.g. IVDU, drug intake
Decompensation history (ascites, variceal bleed and encephalopathy)

45
Q

Upon taking a history, what are some things that are suggestive of post-hepatic jaundice?

A

Abdominal pain
Cholestasis

46
Q

Ascites?

A

Collection of fluid in abdomen

47
Q

Variceal bleed?

A

Bleeding of varices found throughout the gastrointestinal tract, such as in the oesophagus, stomach, and rectum

48
Q

Encephalopathy?

A

Damage or disease that affects the brain

49
Q

Upon examination, what may indicate pre-hepatic jaundice?

A

Pallor
Large splenomegaly* (note this can happen w hepatic and post-hepatic too)

*Enlargement of spleen

50
Q

Upon examination, what may indicate hepatic jaundice?

A

Ascites
Asterixis
Stigmata of Chronic Liver disease e.g. spider naevi, gynaecomastia

51
Q

Upon examination, what may indicate post-hepatic jaundice?

A

Palpable gall bladder

52
Q

List some of the investigations used for patients w suspected jaundice.

A

-Chronic liver screening via Hepatitis A & C Serology and autoimmune profiling.
-Check copper and iron levels
-Alpha 1 antitrypsin deficiency
-Fasting glucose and lipid profile for diabetes

53
Q

What is the most important test to distinguish where the jaundice is coming from?

A

Abdomen Ultrasound

54
Q

Which test is better to identify gallstones- ERCP or MRCP?

A

ERCP

55
Q

Which test involves radiation- ERCP or MRCP?

A

ERCP

MRCP= MRI

56
Q

What can therapeutic ERCP be useful for?

A

-Dilated biliary tree
-Acute gallstone pancreatitis
-Stenting of biliary tract obstruction
–Post-operative biliary complications

57
Q

What are some of the complications for ERCP?

A

Pancreatitis
Cholangitis
Sedation related cardio and resp problems
Risk of bleeding and perforation

58
Q

What can endoscopic ultrasounds help with?

A

-Characterising pancreatic masses
-Staging of tumours
-Fine needle aspirate of cysts and tumours

59
Q

What is required to confirm diagnosis of liver conditions?

A

Liver biopsy

60
Q
A

Year 2- GIT (37 decks)

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