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Jaundice Flashcards

1
Q

synthetic functions of the liver

A

Clotting factors

Bile acids

Carbohydrates
Gluconeogenesis, Glycogenolysis, Glycogenesis

Proteins
Albumin synthesis,

Lipids
Cholesterol synthesis, Lipoprotein and TG synthesis

Hormones
Angiotensinogen, insulin like growth factor

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2
Q

what roles does the liver play in detoxification

A

Urea production from ammonia

Detoxification of drugs

Bilirubin metabolism

Breakdown of insulin and hormones

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3
Q

what role does the liver play in immune function

A

Combating infections

Clearing the blood of particles and infections, including bacteria

Neutralizing and destroying all drugs and toxins

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4
Q

what storage functions does the liver play

A

Stores glycogen
Stores Vitamin A, D, B12 and K
Stores copper and iron

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5
Q

what is bilirubin

A

By product of haeme metabolism

Generated by senescent RBC’s in spleen

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6
Q

in what state is bilirubin originally found

A

Initially bound to albumin (unconjugated)
Liver helps to solubilise it (conjugated)

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7
Q

when is bilirubin elevated
pre-hepatic

A

Haemolysis

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8
Q

when is bilirubin elevated
hepatic

A

Parenchymal damage

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9
Q

when is bilirubin elevated
post hepatic

A

Obstructive

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10
Q

Aminotransferases

A

Enzymes present in hepatocytes

ALT more specific than AST

AST/ALT ratio can point towards ALD

Suggests parenchymal involvement

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11
Q

what is the difference between ALT and AST

A

Serum aspartate transaminase (AST) is mainly found in the liver, cardiac muscle, and other tissues while serum alanine transaminase (ALT) is predominantly found in the liver.

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12
Q

Alkaline phosphatase

A

Enzyme present in bile ducts
Elevated with obstruction or liver infiltration
Also present in bone, placenta and intestines

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13
Q

Gamma GT

A

Non specific liver enzyme
Elevated with alcohol use
Useful to confirm liver source of ALP
Drugs like NSAID’s can raise levels

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14
Q

Albumin

A

important test for synthetic function of liver
Low levels suggest chronic liver disease
Can be low in kidney disorders and malnutrition

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15
Q

Prothrombin time

A

Extremely important test for liver function

Tells degree of liver dysfunction
Used to calculate scores to decide stage of liver disease, who needs a liver transplant and who gets a liver transplant

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16
Q

Creatinine

A

Essentially kidney function
Determines survival from liver disease
Critical assessment for need for transplant

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17
Q

Platelet count

A

Liver is an important source of thrombopoietin
Cirrhosis results in splenomegaly
Platelets low in cirrhotic subjects as a result of hypersplenism
Indirect marker of portal hypertension

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18
Q

what are important markers for liver and kidney damage

A

bilirubin, aminotranderase, alkaline phosphatase, gamma gt, albumin,prothrombin time, creatinine, platelet count

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19
Q

symptoms of liver malfunction

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

20
Q

definition of jaundice

A

Yellowing of the skin, sclerae, and other tissues caused by excess circulating bilirubin.

21
Q

when is jaundice detectable

A

when total plasma bilirubin levels exceed 34 µmol/L

22
Q

what is the differential diagnosis for jaundice

A

carotenemia

23
Q

pre-hepatic jaundice

A

Increased quantity of bilirubin (Haemolysis)

Impaired transport

24
Q

hepatic jaundice

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

25
post-hepatic jaundice
Defective transport of bilirubin by the biliary ducts
26
identifying features during history taking for pre hepatic jaundice
History of anaemia (fatigue, dyspnoea, chest pain) Acholuric jaundice
27
identifying features during history taking for hepatic jaundice
Risk factors for liver disease (IVDU, drug intake) Decompensation (ascites, variceal bleed,encephalopathy)
28
identifying features during history taking for post-hepatic jaundice
Abdominal pain Cholestasis (Pruritus, pale stools, high coloured urine)
29
clinical examination clues for pre-hepatic jaundice
Pallor Splenomegaly
30
clinical examination clues for hepatic jaundice
Stigmata of CLD (spider naevi, gynaecomastia) Ascites Asterixis
31
clinical examination clues for post-hepatic jaundice
Palpable gall bladder (Courvoisier's sign)
32
investigations for liver failure
Liver screen Hepatitis B & C serology Autoantibody profile, serum immunoglobulins Caeruloplasmin and copper Ferritin and transferrin saturation Alpha 1 anti trypsin Fasting glucose and lipid profile
33
what is the most important investigative test
Ultrasound of the abdomen
34
why is an abdominal ultrasound important
Differentiates extrahepatic and intrahepatic obstruction Delineates site of obstruction Delineates cause of obstruction Documents evidence of portal hypertension Preliminary staging of extent of disease e.g. cancer spread
35
ultrasound benefits
Cheap No radiation Portable, widely available Good for gallstones High specificity Lower sensitivity Examines organs as well as biliary system
36
ct scan / MRI benefits
Better for pancreas High specificity High sensitivity Examines organs (and biliary system)
37
ct scan / MRI negatives
Expensive Radiation (only for CT scan) Requires CT / MRI scanner
38
ERCP
endoscopic test which we do by putting a specialised side viewing endoscope, then using the X-ray machine to find out what's happening in the bile duct by injecting dye within the bile duct - helping to take out stones and place stents that can take care of jaundice
39
ERCP features
Radiation Sedation Complications (5%) Failure rate (10%) Only images ducts Therapeutic option
40
MRCP features
No radiation No complications 5% claustrophobia Can image out with the ducts
41
when is therapeutic ERCP used
Acute gallstone pancreatitis Stenting of biliary tract obstruction Post-operative biliary complications
42
Complications of ERCP
Sedation related - respiratory - cardiovascular Procedure related Pancreatitis Cholangitis Sphincterotomy Bleeding Perforation
43
when is Percutaneous Transhepatic Cholangiogram (PTC) used
ERCP not possible due to duodenal obstruction or previous surgery Hilar stenting
44
disadvatage of Percutaneous Transhepatic Cholangiogram (PTC)
More invasive than ERCP
45
when is Endoscopic Ultrasound (EUS) used
Characterising pancreatic masses Staging of tumours Fine needle aspirate (FNA) of tumours and cysts Excluding biliary microcalculi
46
why are liver biopsies important
Important for definitive diagnosis of certain conditions e.g. autoimmune hepatitis Important to confirm diagnosis e.g. PBC, DILI Important for staging of severity e.g. Alcoholic hepatitis, NAFLD

Alimentary System (44 decks)

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