Jaundice and Chronic Liver Disease

Question 1

What does the liver store?

Answer 1

Glycogen
Vitamin A, D, B12, K
Copper and Iron

Question 2

What is jaundice?

Answer 2

Yellowing of skin, sclera and other tissues

Question 3

What is the cause of jaundice?

Answer 3

Excess circulating bilirubin

Question 4

At what level does bilirubin become detectable?

Answer 4

Exceeds 34 micro mol/L

Question 5

What are the 3 classifications of jaundice?

Answer 5

Pre hepatic
Hepatic
Post hepatic

Question 6

What is pre hepatic jaundice?

Answer 6

Increased quantity of bilirubin

Impaired transport

Question 7

What is hepatic jaundice?

Answer 7

Defective uptake of bilirubin
Defective conjugation
Defective excretion

Question 8

What is post hepatic jaundice?

Answer 8

Defective transport of bilirubin by the biliary ducts

Question 9

What are the clinical signs of pre hepatic jaundice?

Answer 9

Pallor
Splenomegaly
History of anaemia
Acholuric jaundice

Question 10

What are the clinical signs of hepatic jaundice?

Answer 10

Ascites 
Asterixis 
Stigmata of CLD (spider nave, gynaecomastia)
Risk factors of liver disease 
Decompensation 
Highly coloured urine

Question 11

What are the clinical signs of post hepatic jaundice?

Answer 11

Palpable gall bladder 
Abdominal pain 
Cholestasis 
Highly coloured urine 
Pale stools

Question 12

What are the investigations used to diagnose jaundice?

Answer 12

Liver screen
Abdominal ultrasound
CT
MRI

Question 13

What does ERCP stand for?

Answer 13

Endoscopic retrograde cholangio pancreatography

Question 14

What does MRCP stand for?

Answer 14

Magnetic retrograde cholangio pancreatography

Question 15

What are the differences between ERCP and MRCP?

Answer 15

MRCP uses no radiation
MRCP has no complications
MRCP has no sedation

Question 16

What are the uses of ERCP?

Answer 16

Stenting of biliary tract obstruction
Acute gallstone pancreatitis
Dilated biliary tree (stone/tumour removal)

Question 17

What are the complications of ERCP?

Answer 17

Sedation related (resp/cardio) 
Bleeding 
Perforation 
Pancreatitis 
Cholangitis

Question 18

What does PTC stand for?

Answer 18

Percutaneous transhepatic cholangiogram §

Question 19

What are the uses of EUS?

Answer 19

Characterising pancreatic masses
Tumour staging
Fine needle aspiration of tumours and cysts

Question 20

What is the definition of chronic liver disease?

Answer 20

Liver disease that persists beyond 6 months

Question 21

What are the symptoms of hepatocellular carcinoma?

Answer 21

Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour

Question 22

What are the investigations for hepatocellular carcinoma?

Answer 22

Ultrasound
CT
MRI
Tumour markers (alpha feto protein)

Question 23

What is the treatment for hepatocellular carcinoma?

Answer 23

Hepatic resection
Liver transplantation
Chemotherapy
Hormonal therapy

Question 24

What are the symptoms of hepatic encephalopathy?

Answer 24

GI bleed 
Infection 
Constipation 
Dehydration 
Foetor hepaticus

Question 25

What is the treatment for hepatic encephalopathy?

Answer 25

Laxatives Neomycin Rifaximin broad spectrum non absorbed antibiotic

Question 26

What causes variceal haemorrhage?

Answer 26

Portal hypertension

Question 27

Where are the areas associated with variceal haemorrhages?

Answer 27

``` Skin -caput medusa Oesophageal and gastric Rectal Posterior abdominal wall Stomal ```

Question 28

How do you manage variceal haemorrhage?

Answer 28

Resuscitate patient Good IV access Blood transfusion Emergency endoscopy (band ligation)

Question 29

What is an ascite?

Answer 29

Abdominal distension due to fluid?

Question 30

What are the clinical features of an ascite>

Answer 30

``` Dullness in flanks Shifting dullness Flank haematoma JVP elevation Umbilical nodule Palmar erythema Foetor hepaticus Spider naevi ```

Question 31

How are ascites diagnosed?

Answer 31

Diagnostic paracentesis Protein and albumin concentrations Cell count and differential SAAG (serum ascites alumni gradient)

Question 32

How are ascites treated?

Answer 32

``` Diuretics Large volume paracentesis TIPS Aquaretics Liver transplantation ```

Question 33

What are the causes of cirrhosis?

Answer 33

``` Alcohol Hepatits B and C Non alcoholic fatty liver disease Drugs Cystic fibrosis Autoimmune ```

Question 34

What are the pathological changes in a cirrhotic liver?

Answer 34

Sinusoids will convert to abnormal cell, starts laying down collagen, chokes off sinusoid, increases pressure

Question 35

What is the presentation of cirrhosis?

Answer 35

``` Abnormal liver function tests Ascites Variceal bleeding Hepatic encephalopathy Hepatocellular carcinoma ```

Question 36

What is bilirubin?

Answer 36

Byproduct of haeme metabolism Initially bound to albumin (unconjugated) Liver will solubilise it (conjugated)

Question 37

What are the aminotransferase?

Answer 37

Enzymes present in hepatocytes

Question 38

What is alkaline phosphatase?

Answer 38

Enzyme present in bile ducts

Question 39

When is alkaline phosphatase elevated?

Answer 39

Obstruction orr liver infiltration

Question 40

What is gamma GT?

Answer 40

Non specific liver enzyme | Confrims liver source of ALP

Question 41

When is gamma GT elevated?

Answer 41

Alcohol use | Drugs like NSAID's

Question 42

What do low levels of albumin suggests?

Answer 42

Chronic liver disease Kidney disorders Malnutrition

Question 43

What is prothrombin time?

Answer 43

Tells the degree of liver dysfunction and to stage liver disease

Question 44

How is creatine used?

Answer 44

Determines survival from liver disease

Question 45

When is platelet count low in liver disease?

Answer 45

Cirrhosis patients (as a result of hyperslenism)