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Jaundice and chronic liver disease Flashcards

1
Q

What are the roles of the liver?

A

Synthesis
Detoxification
Immune function
Storage funtion

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2
Q

What does the liver synthesise?

A 
Clotting factors
Bile acids
Carbohydrates
Proteins
Lipids
Hormones
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3
Q

How is the liver involved in detoxification?

A

Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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4
Q

What is the immune role of the liver?

A

Combating infections
Clearing blood pf particles and infections
Neutralising and destroying all drugs and toxicities

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5
Q

What does the liver store?

A

Glycogen
Vit A, D, B12, K
Copper and iron

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6
Q

What is bilirubin?

A

Byproduct of ham metabolism generated by old/dying RBCs in the spleen

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7
Q

What is the cycle of bilirubin?

A

Initially bound to albumin- unconjugated form

Liver then solubilises it to its conjugated form

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8
Q

What can cause elevated bilirubin?

A

Prehepatic- haemolytic
Hepatic- parenchymal damage
Post hepatic- obstruction

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9
Q

What are aminotransferases?

A

Enzymes in hepatocytes

Present in parenchyma

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10
Q

What does elevated aminotransferase indicate?

A

Parenchymal damage

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11
Q

What does a high AST/ALT ratio indicate?

A

Alcoholic liver disease

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12
Q

What is alkaline phosphatase?

A

Enzyme of the bile ducts

Not specific to liver

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13
Q

When is alkaline phosphatase raised?

A

Obstruction of liver infiltration

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14
Q

Where is alkaline phosphatase present?

A

Liver
Bone
Intestines
Placenta

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15
Q

What is gamma GT?

A

Non specific liver enzyme

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16
Q

What is gamma GT used for?

A

To confirm high alkaline ohoshatase levels are due to liver pathology

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17
Q

What is albumin?

A

Protein produced by liver

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18
Q

What does low albumin indicate?

A

Chronic liver disease

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19
Q

What does prothrombin time indicate?

A

Degree of liver damage

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20
Q

What is prothrombin time used to calculate?

A

Stage of liver disease and priority of transplant patients

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21
Q

What is creatinine used to determine?

A

Kidney function and survival odds from liver disease

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22
Q

When is the platelet count low?

A

In cirrhotic patients as a result of hypersplenism

Indirect marker of portal hypertension

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23
Q

What is jaundice?

A

Yellowing of skin, sclerae and other tissues due to excess circulating bilirubin

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24
Q

What are the 3 forms of jaundice?

A

Pre hepatic
Hepatic
Post hepatic

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25
What are the causes of pre hepatic jaundice?
Increased bilirubin from haemolytic | Impaired transport to liver
26
Want are the hepatic causes of jaundice?
Defective uptake of bilirubin- defective conjugation or secretion
27
What is the post hepatic cause of jaundice?
Defective transport by biliary system
28
What is the presentation of pre hepatic jaundice?
History of anaemia Pallor Splenomegaly Acholuric jaundice
29
What is choleric jaundice?
Jaundice caused by excess circulating unconjugated bilirubin
30
What is the presentation of hepatic jaundice?
``` Risk factors for liver disease Decompensation Ascites Asterixis Spider navel Gynacomastia ```
31
What is the presentation of post hepatic jaundice?
``` Abdo pain Pruritus Pale stools High coloured urine Palpable gallbladder ```
32
What investigations are done for jaundice?
Liver screen Ultrasound MRCP
33
What tests are done in a liver screen for jaundice?
``` Hep B and C serology Autoantibody profile, serum Its Caeruloplasmin and copper Ferritin and transferrin Alpha1 antitrypsin Fasting glucose and liver profile ```
34
What is the purpose of doing an ultrasound for jaundice?
Can see site and cause of obstruction | Cheap, safe and noninvasive
35
How is jaundice treated?
Via ECRP
36
What can ECRP treat?
Dilated biliary tree Acute gallstone pancreatitis Post op biliary complications Biliary tract obstruction
37
How is acute gallstone pancreatitis treated?
Removal via sphincetrectomy or breakdown of stones via ECRP
38
How is biliary tract obstruction treated?
Stenting
39
What is chronic liver disease?
Liver disease persisting for over 6 months
40
What are some examples of chronic liver disease?
``` Chronic hepatitis Chronic cholestasis Fibrosis and cirrhosis Liver tumours Others... ```
41
What is cirrhosis?
Advanced fibrosis replaces functional parenchyma and prevents movement of blood into and out of the liver
42
What is the presentation of compensated chronic liver disease?
Abnormality of LFTs
43
What is the presentation of decompensated chronic liver disease?
Ascites Variceal bleeding Hepatic encephalopathy
44
What is hepatic encephalopathy?
Confusion brought on by liver disease
45
What causes hepatic encephalopathy?
``` GI bleeds Infecton Constipation Dehydration Medication ```
46
What is the presentation of hepatic encephalopathy?
Confusion Flapping tremor Foetor hepaticas (bad breath)
47
What is the treatment of hepatic encephalopathy?
Treat underlying cause | Repeat admissions- indication for liver transplant
48
What is hepatocellular carcinoma associated with?
Chronic Hep B and C | cirrhosis
49
How is hepatocellular carcinoma diagnosed?
``` Tumour marker tests in those with cirrhosis Ultrasound CT MRI Liver biopsy in rare cases ```
50
What is the curative treatment for hepatocellilar carcinoma?
Hepatic resection | Transplant
51
What are the palliative treatments for hepatocellualr carcinoma?
Chemo Local ablative treatments- alcohol injection, radio frequency ablation Sorafenib Hormonal therapy
52
What is ascites?
Accumulation of fluid in peritoneal cavity
53
What is found on a physical exam with ascites?
Dullness in flanks and shifting dullness
54
What is the presentation of ascites?
Spider navel, palmar erythema, abdomen veins, fetter hepaticas Umbilical nodule JVP elevation Flank haematoma
55
What investigations are carried out for ascites?
Protein and albumin concentration of fluid Cell count of fluid Serum ascites albumin gradient
56
How is ascites treated?
Diuretic Large volume paracentesis Liver transplant in serious cases
57
What are varices?
Abnormally dilated vessel with tortuous course
58
What is the cause of varices?
Portal hypertension
59
How are varices treated?
Resusitation- possible blood transfusions Endoscopic ban ligation Control bleeding
60
Where do you get varices?
Oesophagus Stomach Rectum Umbilicus

GI AM (34 decks)

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