Jaundice and Chronic Liver Disease Flashcards
What does the liver store?
Glycogen
Vitamin A, D, B12, K
Copper and Iron
What is jaundice?
Yellowing of skin, sclera and other tissues
What is the cause of jaundice?
Excess circulating bilirubin
At what level does bilirubin become detectable?
Exceeds 34 micro mol/L
What are the 3 classifications of jaundice?
Pre hepatic
Hepatic
Post hepatic
What is pre hepatic jaundice?
Increased quantity of bilirubin
Impaired transport
What is hepatic jaundice?
Defective uptake of bilirubin
Defective conjugation
Defective excretion
What is post hepatic jaundice?
Defective transport of bilirubin by the biliary ducts
What are the clinical signs of pre hepatic jaundice?
Pallor
Splenomegaly
History of anaemia
Acholuric jaundice
What are the clinical signs of hepatic jaundice?
Ascites Asterixis Stigmata of CLD (spider nave, gynaecomastia) Risk factors of liver disease Decompensation Highly coloured urine
What are the clinical signs of post hepatic jaundice?
Palpable gall bladder Abdominal pain Cholestasis Highly coloured urine Pale stools
What are the investigations used to diagnose jaundice?
Liver screen
Abdominal ultrasound
CT
MRI
What does ERCP stand for?
Endoscopic retrograde cholangio pancreatography
What does MRCP stand for?
Magnetic retrograde cholangio pancreatography
What are the differences between ERCP and MRCP?
MRCP uses no radiation
MRCP has no complications
MRCP has no sedation
What are the uses of ERCP?
Stenting of biliary tract obstruction
Acute gallstone pancreatitis
Dilated biliary tree (stone/tumour removal)
What are the complications of ERCP?
Sedation related (resp/cardio) Bleeding Perforation Pancreatitis Cholangitis
What does PTC stand for?
Percutaneous transhepatic cholangiogram §
What are the uses of EUS?
Characterising pancreatic masses
Tumour staging
Fine needle aspiration of tumours and cysts
What is the definition of chronic liver disease?
Liver disease that persists beyond 6 months
What are the symptoms of hepatocellular carcinoma?
Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour
What are the investigations for hepatocellular carcinoma?
Ultrasound
CT
MRI
Tumour markers (alpha feto protein)
What is the treatment for hepatocellular carcinoma?
Hepatic resection
Liver transplantation
Chemotherapy
Hormonal therapy
What are the symptoms of hepatic encephalopathy?
GI bleed Infection Constipation Dehydration Foetor hepaticus
What is the treatment for hepatic encephalopathy?
Laxatives
Neomycin
Rifaximin broad spectrum non absorbed antibiotic
What causes variceal haemorrhage?
Portal hypertension
Where are the areas associated with variceal haemorrhages?
Skin -caput medusa Oesophageal and gastric Rectal Posterior abdominal wall Stomal
How do you manage variceal haemorrhage?
Resuscitate patient
Good IV access
Blood transfusion
Emergency endoscopy (band ligation)
What is an ascite?
Abdominal distension due to fluid?
What are the clinical features of an ascite>
Dullness in flanks Shifting dullness Flank haematoma JVP elevation Umbilical nodule Palmar erythema Foetor hepaticus Spider naevi
How are ascites diagnosed?
Diagnostic paracentesis
Protein and albumin concentrations
Cell count and differential
SAAG (serum ascites alumni gradient)
How are ascites treated?
Diuretics Large volume paracentesis TIPS Aquaretics Liver transplantation
What are the causes of cirrhosis?
Alcohol Hepatits B and C Non alcoholic fatty liver disease Drugs Cystic fibrosis Autoimmune
What are the pathological changes in a cirrhotic liver?
Sinusoids will convert to abnormal cell, starts laying down collagen, chokes off sinusoid, increases pressure
What is the presentation of cirrhosis?
Abnormal liver function tests Ascites Variceal bleeding Hepatic encephalopathy Hepatocellular carcinoma
What is bilirubin?
Byproduct of haeme metabolism
Initially bound to albumin (unconjugated)
Liver will solubilise it (conjugated)
What are the aminotransferase?
Enzymes present in hepatocytes
What is alkaline phosphatase?
Enzyme present in bile ducts
When is alkaline phosphatase elevated?
Obstruction orr liver infiltration
What is gamma GT?
Non specific liver enzyme
Confrims liver source of ALP
When is gamma GT elevated?
Alcohol use
Drugs like NSAID’s
What do low levels of albumin suggests?
Chronic liver disease
Kidney disorders
Malnutrition
What is prothrombin time?
Tells the degree of liver dysfunction and to stage liver disease
How is creatine used?
Determines survival from liver disease
When is platelet count low in liver disease?
Cirrhosis patients (as a result of hyperslenism)
