Jaundice

Question 1

LFTs in acute hepatitis

Answer 1

AST very high
ALT very high
ALP normal
Bilirubin High

Question 2

LFTs in chronic hepatitis

Answer 2

AST and ALT - slightly high
ALP - normal
BR - normal

Question 3

Biliary disease

Answer 3

AST and ALT - normal/slight elevation
ALP - high
BR - high

Question 4

Jaundice red flags

Answer 4

Painless 
Palpable mass 
WL 
Encephalopathy 
Sepsis

Question 5

Signs of CLD

Answer 5

Asterixis 
Spider naevi 
Clubbing
Splenomegaly 
Ascites
Palmar erythema 
Gynaecomastia

Question 6

Hepato-renal syndrome pathophysiology

Answer 6

Portal hypertension - VD in splanchnic circulation - kidneys think dropped BP so vasoconstrict

Question 7

What signs/sx do you see in HRS?

Answer 7

See a reduction in: MAP, GFR, Na excretion

• Increased Cr
• Normal urine sediment
• No/minimal proteinuria
• Low Na excretion
• Nonoliguria or oliguria

Question 8

Types of HRS

Answer 8

Type 1 = more serious. At least 2 X increase in serum Cr

Type 2 = less feature - ascites resistant to diuretics

Question 9

Treatment for HRS

Answer 9

• Terlipressin 1mg IV QDS with 20% HAS continually infused at 25mls/hr for 2/52
• Portasystemic shunting TIPS)
• Liver transplant

Question 10

Signs of liver failure

Answer 10

Hypotension 
Encephalopathy 
Hypoglycaemia 
Bleeding 
Renal dysfunction

Question 11

How to treat encephalopathy

Answer 11

Lactulose 20-30ml QDS aiming and adjusted for 2 soft stools a day

Question 12

Hyper acute liver failure definition

Answer 12

Encephalopathy <7d within onset of jaundice

Question 13

Acute liver failure definition

Answer 13

Encephalopathy 8-28d from onset of jaundice

Question 14

Sub-acute liver failure definition

Answer 14

Encephalopathy 4-12w from onset of jaundice

Question 15

Treatment for fulminant liver failure

Answer 15

NAC
IV PPI
NG/oral fluconazole 100mg
Tazocin 4.5g TDS
Tx low Mg or Ph 

• Lactulose for encephalopathy
• Terlipressin/albumin for HRS
• Glucose for hypo

Can give vit K 1-2 doses of 10mg IV but unlikely to significantly effect the INR

Question 16

Is hypo or hyper phosphataemia in liver failure a good sign?

Answer 16

Hypo = good prognostic sign that there is liver cell regeneration

Hyper = bad - indicates severe liver cell necrosis

Question 17

Kings criteria for liver transplant for fulminant liver disease (paracetamol)

Answer 17

pH <7.3 after fluid resus
OR all of the following
- PT > 100s (INR >6.5)
- Cr >300
- Grade 3/4 encephalopathy

Question 18

Kings criteria for liver transplant for fulminant liver disease (non-paracetamol)

Answer 18

PT >100s (INR >6.5) irrespective of encephalopathy stage or any 3 of the following:

• Age <11 or >40
• Aetiology of non-A/non-B hepatitis, halothane hepatitis or idiosyncratic drug reactions
• Duration of jaundice >7d before onset of encephalopathy
• PT >50s (INR>3.5)
• BR >17

Question 19

Other poor prognosis without a liver transplant

Answer 19

lactate >3.5 at 4hrs after fluid resus or >3h after 12h OR phosphate >3.75 at 48-96h