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GI System > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

What is jaundice?

A

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

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2
Q

When can jaundice be detected?

A

When the total plasma bilirubin levels exceed 34μmol/L

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3
Q

What is the lifespan of a RBC?

A

120 days

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4
Q

What happens when a RBC starts to breakdown?

A

Haem part is converted to biliverdin (Unconjugated - Insoluble form) and is then converted to bilirubin (Conjugated - Soluble form) in the liver

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5
Q

What type of bilirubin is found pre-hepatic?

A

Unconjugated

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6
Q

What type of bilirubin is found hepatic and post-hepatic?

A

Conjugated

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7
Q

What is most likely to have happened for post-hepatic jaundice to occur?

A

An obstruction condition

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8
Q

After conjugation where does most of the bilirubin go?

A

Most to the stool

A little to the kidneys

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9
Q

What are the features of pre-hepatic jaundice?

A 
Increased quantity of bilirubin 
Impaired transport - No urine change
History of anaemia e.g. Fatigue, Dyspnoea & Chest pain
Acholuric jaundice
Pallor & Splenomegaly
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10
Q

What are the features of hepatic jaundice?

A

Defective uptake of bilirubin
Defective conjugation and excretion
Risk factors liver disease and decompensation e.g. Ascites
Stigmata of CLD, Ascites & Asteris (Flapping tremor)

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11
Q

What are the features of post-hepatic jaundice?

A

Defective transport of bilirubin by the biliary ducts
Abdominal pain
Cholestasis - Bile cannot flow from the liver to the duodenum; may cause pruritus pales stools & high coloured urine

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12
Q

What can cause an enlarged gallbladder?

A

Obstruction in the bile duct past the cystic causing a build up of bile in the gallbladder

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13
Q

What part of LFTs is raised in hepatic jaundice?

A

AST & ALT

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14
Q

What part of LFTs is raised in post-hepatic jaundice?

A

Alk phos and GGT

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15
Q

What is the best course of management for obstructive jaundice?

A

Obstruction relief, Complication prevention & Prevent recurrence

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16
Q

What is the best course of management for ascending cholangitis?

A

Prompt drainage & Control infection

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17
Q

What is cholangitis?

A

Infection of the biliary tract

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18
Q

After what period of time is liver disease classed as chronic?

A

6 months

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19
Q

What kinds of CLD are there?

A 
Chronic hepatitis
Chronic cholestasis
Fibrosis
Cirrhosis
Tumours
20
Q

List 10 possible reasons for CLD?

A 
Alcohol
Autoimmune - PBC/PSC
Haemochromatosis
Chronic Viral Hepatitis - B & C
NAFLD
Drugs - Amiodarone
CF
Vascular problems - Portal hypertension
Cryptogenic
Others - Sarcoidosis, Amyloid & Schistosomiasis
21
Q

How does CLD present?

A

Compensated CLD - Abnormality of LFTs
Decompensated CLD - Ascites, Variceal bleeding & Hepatic encephalopathy
Hepatocellular carcinoma

22
Q

What volume of fluid is required for ascites to be detected?

A

1500ml

23
Q

What evidence corroborates with ascites?

A 
Spider naevi
Palmar erythema
Abdominal veins
Fetor hepaticus
Umbilical nodule
JVP elevation
Flank haematoma
24
Q

Investigation needed on first ascites evaluation?

A

Protein & Albumin concentration
Cell count and differential
SAAG - Serum-ascites albumin gradient

25
Q

What would indicate that the ascites is likely not liver disease?

A

Exudative process with high protein and inflammation present

26
Q

What would neutrophils in the ascites indicate?

A

Peritonitis

27
Q

What type of ascites indicates liver disease?

A

Transudative

28
Q

What causes variceal haemorrhages?

A

Portal hypertension

29
Q

Where are variceal haemorrhages seen?

A

Porto-systemic anastamoses - Skin, Rectal & Oesophageal/Gastric

30
Q

What types of varices are not as serious?

A

Posterior abdominal wall veins

Rectal varices

31
Q

What must the body do with blood if the liver is having problems?

A

Choose an alternate for the blood to flow

32
Q

What should be done to manage variceal haemorrhage?

A

Resuscitate patient
Find good IV access
Blood transfusion as required
Emergency endoscopy - Don’t want to rush this

33
Q

What percentage of people die with acute GI bleeding?

A

20%

34
Q

What can stop the bleeding in the stomach but what is the condition with this treatment?

A

SB tube - So a balloon inflates the fundus part of the stomach to stop the bleeding however, it can’t be done for longer than 24 hours

35
Q

What treats portal hypertension and can be a cure to varicies?

A

TIPPS

36
Q

What is hepatic encephalopathy?

A

Confusion due to liver disease

37
Q

What are precipitants of hepatic encephalopathy?

A 
GI Bleed
Infection
Constipation
Dehydration
Medication - Especially sedation
38
Q

What do you treat for hepatic encephalopathy?

A

The underlying cause

39
Q

What do colonic bacteria produce?

A

Ammonia

40
Q

How does hepatocellular carcinoma present?

A

Decompensation of liver disease
Abdominal mass/pain
Weight loss
Bleeding from tumour

41
Q

What hepatocellular carcinoma occur in the background of?

A

Cirrhosis

42
Q

What investigations should be done to diagnose hepatocellular carcinoma?

A

Tumour markers - AFP
Ultrasounds, CT & MRI
Biopsy - Done rarely

43
Q

What is treatment for hepatocellular carcinoma?

A 
Hepatic resection
Liver transplantation
Chemotherapy
Locally ablative treatments
Sorafenib
Hormonal therapy e,g, Tamoxifen
*Transplant if both lobes are affected*
44
Q

What does SAAG stand for?

A

Serum-ascites albumin gradient

45
Q

What does a SAAG with >1.1g/dl indicate?

A 
Portal hypertension & Cirrhosis
CHF
Constrivtive ericarditis
Budd chiarri
Myxdema
Massive liver metastases
46
Q

What does a SAAG with

A 
Malignancy
TB
Chylous ascites
Pancreatic
Biliary ascites
Nephrotic syndrome
Serositis
47
Q

How is SAAG treated?

A 
Diuretics
Paracentesis if there is a large volume
TIPS - A shunt
Aquaretics
Liver transplant

GI System (38 decks)

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