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Alimentary System > Jaundice > Flashcards

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
Q

post-hepatic jaundice

A

Defective transport of bilirubin by the biliary ducts

26
Q

identifying features during history taking for pre hepatic jaundice

A

History of anaemia (fatigue, dyspnoea, chest pain)

Acholuric jaundice

27
Q

identifying features during history taking for hepatic jaundice

A

Risk factors for liver disease (IVDU, drug intake)

Decompensation (ascites, variceal bleed,encephalopathy)

28
Q

identifying features during history taking for post-hepatic jaundice

A

Abdominal pain

Cholestasis (Pruritus, pale stools, high coloured urine)

29
Q

clinical examination clues for pre-hepatic jaundice

A

Pallor
Splenomegaly

30
Q

clinical examination clues for hepatic jaundice

A

Stigmata of CLD (spider naevi, gynaecomastia)

Ascites

Asterixis

31
Q

clinical examination clues for post-hepatic jaundice

A

Palpable gall bladder (Courvoisier’s sign)

32
Q

investigations for liver failure

A

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
Q

what is the most important investigative test

A

Ultrasound of the abdomen

34
Q

why is an abdominal ultrasound important

A

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
Q

ultrasound benefits

A

Cheap
No radiation
Portable, widely available
Good for gallstones
High specificity
Lower sensitivity
Examines organs as well as biliary system

36
Q

ct scan / MRI benefits

A

Better for pancreas
High specificity
High sensitivity
Examines organs
(and biliary system)

37
Q

ct scan / MRI negatives

A

Expensive
Radiation (only for CT scan)
Requires CT / MRI scanner

38
Q

ERCP

A

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
Q

ERCP features

A

Radiation
Sedation
Complications (5%)
Failure rate (10%)
Only images ducts
Therapeutic option

40
Q

MRCP features

A

No radiation
No complications
5% claustrophobia
Can image out with the ducts

41
Q

when is therapeutic ERCP used

A

Acute gallstone pancreatitis

Stenting of biliary tract obstruction

Post-operative biliary complications

42
Q

Complications of ERCP

A

Sedation related - respiratory
- cardiovascular
Procedure related
Pancreatitis
Cholangitis
Sphincterotomy
Bleeding
Perforation

43
Q

when is Percutaneous Transhepatic Cholangiogram (PTC) used

A

ERCP not possible due to
duodenal obstruction
or previous surgery

Hilar stenting

44
Q

disadvatage of Percutaneous Transhepatic Cholangiogram (PTC)

A

More invasive than ERCP

45
Q

when is Endoscopic Ultrasound (EUS) used

A

Characterising pancreatic masses

Staging of tumours

Fine needle aspirate (FNA) of tumours and cysts

Excluding biliary microcalculi

46
Q

why are liver biopsies important

A

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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