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GI > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

What does the liver store?

A

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

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2
Q

What is jaundice?

A

Yellowing of skin, sclera and other tissues

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3
Q

What is the cause of jaundice?

A

Excess circulating bilirubin

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4
Q

At what level does bilirubin become detectable?

A

Exceeds 34 micro mol/L

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5
Q

What are the 3 classifications of jaundice?

A

Pre hepatic
Hepatic
Post hepatic

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6
Q

What is pre hepatic jaundice?

A

Increased quantity of bilirubin

Impaired transport

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7
Q

What is hepatic jaundice?

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

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8
Q

What is post hepatic jaundice?

A

Defective transport of bilirubin by the biliary ducts

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9
Q

What are the clinical signs of pre hepatic jaundice?

A

Pallor
Splenomegaly
History of anaemia
Acholuric jaundice

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10
Q

What are the clinical signs of hepatic jaundice?

A 
Ascites 
Asterixis 
Stigmata of CLD (spider nave, gynaecomastia)
Risk factors of liver disease 
Decompensation 
Highly coloured urine
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11
Q

What are the clinical signs of post hepatic jaundice?

A 
Palpable gall bladder 
Abdominal pain 
Cholestasis 
Highly coloured urine 
Pale stools
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12
Q

What are the investigations used to diagnose jaundice?

A

Liver screen
Abdominal ultrasound
CT
MRI

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13
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangio pancreatography

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14
Q

What does MRCP stand for?

A

Magnetic retrograde cholangio pancreatography

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15
Q

What are the differences between ERCP and MRCP?

A

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

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16
Q

What are the uses of ERCP?

A

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

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17
Q

What are the complications of ERCP?

A 
Sedation related (resp/cardio) 
Bleeding 
Perforation 
Pancreatitis 
Cholangitis
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18
Q

What does PTC stand for?

A

Percutaneous transhepatic cholangiogram §

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19
Q

What are the uses of EUS?

A

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

20
Q

What is the definition of chronic liver disease?

A

Liver disease that persists beyond 6 months

21
Q

What are the symptoms of hepatocellular carcinoma?

A

Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour

22
Q

What are the investigations for hepatocellular carcinoma?

A

Ultrasound
CT
MRI
Tumour markers (alpha feto protein)

23
Q

What is the treatment for hepatocellular carcinoma?

A

Hepatic resection
Liver transplantation
Chemotherapy
Hormonal therapy

24
Q

What are the symptoms of hepatic encephalopathy?

A 
GI bleed 
Infection 
Constipation 
Dehydration 
Foetor hepaticus
25
Q

What is the treatment for hepatic encephalopathy?

A

Laxatives
Neomycin
Rifaximin broad spectrum non absorbed antibiotic

26
Q

What causes variceal haemorrhage?

A

Portal hypertension

27
Q

Where are the areas associated with variceal haemorrhages?

A 
Skin -caput medusa 
Oesophageal and gastric 
Rectal 
Posterior abdominal wall 
Stomal
28
Q

How do you manage variceal haemorrhage?

A

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

29
Q

What is an ascite?

A

Abdominal distension due to fluid?

30
Q

What are the clinical features of an ascite>

A 
Dullness in flanks 
Shifting dullness 
Flank haematoma 
JVP elevation 
Umbilical nodule 
Palmar erythema 
Foetor hepaticus 
Spider naevi
31
Q

How are ascites diagnosed?

A

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

32
Q

How are ascites treated?

A 
Diuretics 
Large volume paracentesis 
TIPS 
Aquaretics 
Liver transplantation
33
Q

What are the causes of cirrhosis?

A 
Alcohol 
Hepatits B and C 
Non alcoholic fatty liver disease 
Drugs 
Cystic fibrosis 
Autoimmune
34
Q

What are the pathological changes in a cirrhotic liver?

A

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

35
Q

What is the presentation of cirrhosis?

A 
Abnormal liver function tests 
Ascites 
Variceal bleeding 
Hepatic encephalopathy 
Hepatocellular carcinoma
36
Q

What is bilirubin?

A

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

37
Q

What are the aminotransferase?

A

Enzymes present in hepatocytes

38
Q

What is alkaline phosphatase?

A

Enzyme present in bile ducts

39
Q

When is alkaline phosphatase elevated?

A

Obstruction orr liver infiltration

40
Q

What is gamma GT?

A

Non specific liver enzyme

Confrims liver source of ALP

41
Q

When is gamma GT elevated?

A

Alcohol use

Drugs like NSAID’s

42
Q

What do low levels of albumin suggests?

A

Chronic liver disease
Kidney disorders
Malnutrition

43
Q

What is prothrombin time?

A

Tells the degree of liver dysfunction and to stage liver disease

44
Q

How is creatine used?

A

Determines survival from liver disease

45
Q

When is platelet count low in liver disease?

A

Cirrhosis patients (as a result of hyperslenism)

GI (27 decks)

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