Jaundice Flashcards
Which structure divides the liver into right and left lobes?
The falciform ligament
Blood supply and drainage of the liver?
Supply- the hepatic artery and portal vein
Drainage- right, middle and left hepatic veins, draining into inferior vena cava
What is the functional unit of the liver?
The hepatic acinus
Describe the structure of the acinus with respect to blood flow from the portal system?
Sheets of hepatocytes, separated by interlacing venous sinusoids draining to a branch of the hepatic vein in the centre
Functions of the liver?
Storage of glucose as glycogen Lipid metabolism Metabolism of drugs Storage of vitamins and minerals Synthesis of coagulation factors Synthesis of albumin Removal of damaged blood cells/viruses/toxins/bacteria from circulation
Jaundice is caused by…?
Increase in circulating bilirubin
Classification of jaundice?
Haemolytic
Hepatocellular (unconjugated)
Cholestatic (conjugated)
Why does cholestatic jaundice cause pale stools and dark urine?
Blocked biliary tree means bile cannot pass into digestive system; the bilirubin is conjugated meaning it is water soluble, and stains the urine dark
High levels of unconjugated bilirubin in the serum, but no bilirubin in the urine suggests what type of jaundice?
Haemolytic
Obstruction causes what pattern of LFT derangement?
Elevated alkaline phosphatase and bilirubin with moderately increased ALT/AST
Why does biliary obstruction cause pruritus?
Inability to secrete bile salts into the obstructed biliary system
Stigmata of chronic liver disease? (6)
Spider naevi Gynaecomastia Testicular atrophy Palmar erythema Ascites Caput medusae
What are caput medusae?
Large collateral veins in the peri-umbilical region
Radiological techniques to investigate obstructive symptoms/LFTs?
Ultrasound
MRCP
ERCP
CT
Drawback and advantage of ERCP?
Drawback- can cause cholangitis, pancreatitis
Advantage- can be used to endoscopically treat stones, tumours, insert stents
Symptoms of pyogenic liver abscess?
Pyrexia, rigors, jaundice, tender liver
Management of pyogenic abscess?
Percutaneous drainage of accessible abscesses, leaving a drainage tube in place
Antibiotic therapy based on C+S
What is the commonest aetiological factor in portal hypertension in a) developed countries b) North Africa, China, MIddle east?
a) alcohol/cirrhosis
b) schistosomiasis
At what three sites does portosystemic shunting occur in portal hypertension? (3)
Oesophageal/gastric fundus venous plexus
Veins of anterior abdominal wall
Rectal plexus
Haematological consequences of portal hypertension?
Enlargement of the spleen, causing anaemia thrombocytopenia and leucopenia
Aetiology of ascites?
Increased lymph formation; hypoalbuminaemia; salt and water retention
Symptoms of cirrhosis?
Anorexia, malaise, weight loss
Stigmata of chronic liver disease
What do slurring of speech, flapping tremor and dysarthria indicate in the cirrhotic patient?
Hepatic encephalopathy
What is the main differential diagnosis which should be considered in a patient presenting with presumed variceal bleeding?
Bleeding from peptic ulcer
