Jaundice Flashcards
List some of the things produced by the liver.
Clotting factors
Bile acids
Which processes relating to carbohydrates does the liver help with carrying out?
Gluconeogenesis
Glycolysis
Glycogenesis
What role does the liver have to do with proteins?
Synthesis of albumin
What role does the liver has to do with lipids?
Cholesterol synthesis
Production of Lipoprotein
Triglyceride synthesis
Which organ is the main detoxifier?
Liver
How does the liver have a role in detoxification?
Detoxifies drugs
Bilirubin metabolism
Breakdown of insulin and hormones
Produces urea from ammonia
How does the liver have an immune function?
Combats infections, clears blood particles of infection and bacteria
The liver has a large storage function.
List the things stored in the liver.
Glycogen
Vitamins B12, A, D, K
Copper
Iron
How is bilirubin produced?
It’s a breakdown product from haeme in RBC’s
What is bilirubin initially bound to?
Albumin
What is bilirubin known as when it is bound to albumin?
Unconjugated bilirubin
How does unconjugated bilirubin become conjugated bilirubin?
Liver helps to solubilise it, conjugating the bilirubin to become water soluble
Name three types of bilirubin elevation.
Pre-hepatic
Hepatic
Post-hepatic
How can pre-hepatic elevation of bilirubin occur?
Increased haemolysis of RBC’s
How can hepatic bilirubin elevation occur?
Liver damage
How can post-hepatic bilirubin be eleavted?
Bilirubin does not reach intestines
What is carried out if there is an elevation in bilirubin?
Test for aminotransferases
What are aminotransferases?
Enzymes present in hepatocytes
What is more specific- ALT or AST?
ALT
Which condition can the ALT:AST ratio help to diagnose?
Alcoholic liver disease
Where is alkaline phosphatase predominantly produced?
Bile ducts
When may alkaline phosphatase be elevated?
Bile duct obstruction or liver infiltration
When is Gamma GT, a non-specific liver enzyme, elevated?
Elevated with alcohol use
What does it mean if Gamme GT and alkaline phosphatase are both elevated?
It is a biliary disease
Give an example of a type of drug which can increase levels of Gamma GT.
NSAIDs
What is tested to check the synthetic function of the liver?
Albumin
What does low albumin suggest?
Chronic liver disease
When may albumin levels also be low?
Kidney disorders and malnutrition
What would testing the prothrombin time of the liver tell us?
Degree of liver dysfunction.
What would you need to test to determine survival from liver disease and also for critical assessment of liver transplant?
Creatinine
READ NOT CREATINE
Which blood test would need to be carried out when testing for liver disease?
Platelet count
The liver produces thrombopoietin. What is it?
Hormone which regulates production of platelets.
What would low platelet levels suggest?
Cirrhosis
What can low platelet counts be an indirect indicator of?
Portal hypertension
What does jaundice cause to happen physically?
Yellowing to eyes and skin
Why does jaundice cause yellow eyes and skin?
Excess circulating bilirubin
Bilirubin levels are only detectable when?
When total plasma bilirubin > 34umol/L
What is the differential diagnosis for jaundice?
Carotenemia
Where do RBC’s die?
Spleen
In prehepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?
Unconjugated
In hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?
Conjugated
In post hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?
Conjugated
Upon taking a history, what are some things that are suggestive of pre-hepatic jaundice?
History of anaemia
Acholuric jaundice
Upon taking a history, what are some things that are suggestive of hepatic jaundice?
Risk factors for liver disease e.g. IVDU, drug intake
Decompensation history (ascites, variceal bleed and encephalopathy)
Upon taking a history, what are some things that are suggestive of post-hepatic jaundice?
Abdominal pain
Cholestasis
Ascites?
Collection of fluid in abdomen
Variceal bleed?
Bleeding of varices found throughout the gastrointestinal tract, such as in the oesophagus, stomach, and rectum
Encephalopathy?
Damage or disease that affects the brain
Upon examination, what may indicate pre-hepatic jaundice?
Pallor
Large splenomegaly* (note this can happen w hepatic and post-hepatic too)
*Enlargement of spleen
Upon examination, what may indicate hepatic jaundice?
Ascites
Asterixis
Stigmata of Chronic Liver disease e.g. spider naevi, gynaecomastia
Upon examination, what may indicate post-hepatic jaundice?
Palpable gall bladder
List some of the investigations used for patients w suspected jaundice.
-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
What is the most important test to distinguish where the jaundice is coming from?
Abdomen Ultrasound
Which test is better to identify gallstones- ERCP or MRCP?
ERCP
Which test involves radiation- ERCP or MRCP?
ERCP
MRCP= MRI
What can therapeutic ERCP be useful for?
-Dilated biliary tree
-Acute gallstone pancreatitis
-Stenting of biliary tract obstruction
–Post-operative biliary complications
What are some of the complications for ERCP?
Pancreatitis
Cholangitis
Sedation related cardio and resp problems
Risk of bleeding and perforation
What can endoscopic ultrasounds help with?
-Characterising pancreatic masses
-Staging of tumours
-Fine needle aspirate of cysts and tumours
What is required to confirm diagnosis of liver conditions?
Liver biopsy
