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Year 2 GI (JK) > Jaundice and chronic liver disease > Flashcards

Jaundice and chronic liver disease Flashcards

1
Q

What are the synthetic functions of the liver? Try and give some examples

A 
clotting factors
carbohydrates 
bile acids
proteins - albumin 
lipids - cholesterol
hormones - angiotensin, thrombopoetin
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2
Q

What are the detoxification functions of the liver?

A

drugs, urea from ammonium, insulin and hormone breakdown and bilirubin metabolism

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3
Q

What are the immune functions of the liver?

A

combat infection, neutralise and destroy toxins and clear the blood of bacteria

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4
Q

What substances does the liver store?

A

clotting factors, glycogen, iron and copper, vitamins eg B12, K, A, D

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5
Q

What is bilirubin initially bound to?

A

albumin

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6
Q

What 3 ways can bilirubin be elevated?

A

pre-hepatic - haemolysis
hepatic - parenchymal damage
post hepatic - obstructive eg bile ducts, duodeunum

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7
Q

Where are aminotransferase enzymes present?

A

in hepatocytes

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8
Q

Is ALT or AST ore specific?

A

ALT

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9
Q

What can a AST/ALT ratio give an indication of?

A

alcoholic liver disease

parenchymal involvement and damage

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10
Q

Where is alkaline phosphatase found?

A

bile ducts

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11
Q

What is alkaline phosphatase raised with?

A

obstruction or liver infiltration

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12
Q

Where is alkaline phosphatase also present and give an example of when it may be raised without bile duct involvement

A

placenta, bone marrow and intestines

pregnancy

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13
Q

What is Gamma GT? What is it raised with?

A

non specific enzyme used in conjunction with alkaline phosphatase to confirm liver involvement
alcohol and drug use eg NSAIDS

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14
Q

What is albumin an important test for?

A

synthetic function as produced by the liver

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15
Q

What can low levels of albumin suggest?

A

chronic liver disease, malnutrition and kidney disorders

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16
Q

What prothrombin time measure?

A

time taken for the blood to clot - tells of liver dysfunction and clotting factors

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17
Q

What is prothrombin time used for?

A

to calculate a score to decide the stage of liver disease and transplantation lists

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18
Q

What is creatine test important for?

A

determining survival from liver disease and critical for transplantation assessment

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19
Q

Why does cirrhosis lead to splenomegaly?

A

due to portal hypertension and the spleen chewing up the platelets

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20
Q

What are the 4 main symptoms of liver dysfunction?

A

jaundice, ascites, variceal bleeding and hepatic encephalopathy

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21
Q

What is jaundice?

A

Yellowing of the skin, tissues and SCLERAE due to excess circulating bilirubin

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22
Q

What plasma level is jaundice detectable at?

A

> 34 micromol/L

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23
Q

What is the differential diagnosis for jaundice and what is the key difference between them?

A

carotenemia

no yellowing of the sclerae

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24
Q

What are pre hepatic causes of jaundice?

A

increased bilirubin and impaired transport

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25
Q

What are hepatic causes of jaundice?

A

defective bilirubin uptake, conjugation and excretion

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26
Q

What are post hepatic causes of jaundice?

A

defective bilirubin transport by biliary ducts

27
Q

What are the symptoms and signs of pre hepatic jaundice?

A

history of anaemia eg fatigue, dyspnoea, chest pain
acholuric jaundice - excessive unconjugated bilirubin

pallor, splenomegaly

28
Q

What are the symptoms and signs of hepatic jaundice?

A

risk factors of liver disease (IVDU)
decompensation - ascites, encephalopathy and variceal bleeding

CLD signs - spider naevi, gynaecomastia
ascites and asterixis

29
Q

What is asterixis?

A

flapping tremor

30
Q

What are the symptoms and signs of post hepatic jaundice?

A

abdominal pain eg gallstones
cholestasis, pale stool, pruirits, high colour urine

palpable gallbladder - malignancy

31
Q

What is a liver screen?

A

hepatitis B and C serology, serum immunoglobulins, ferritin, fasting glucose etc

32
Q

What can an ultrasound look for and confirm in a patient with jaundice?

A

extra or intra hepatic
location and cause of obstruction
portal hypertension, stage disease

33
Q

What is the differences between ERCP and MRCP?

A

ERCP can take biopsy and stent but uses sedation and radiation and dyes. only image bile ducts.
MRCP can be claustrophobic

34
Q

What are some complications of ERCP?

A

sedation related - CVS, resp

procedure related - pancreatitis, cholangitis and with sphincterotomy can lead to bleeding and perforation

35
Q

When is PTC used?

A

when ERCP not possible due to previous surgery or duodenal obstruction
hilar stenting

36
Q

What are the disadvantages of PTC?

A

Invasive and risk liver bleed due to puncturing

37
Q

What is possible to do with an EUS?

A

biopsy, aspirate, stage tumours of pancreas

38
Q

What are some chronic liver diseases?

A

chronic hepatitis, tumours, chronic cholestasis, steatosis, fibrosis and cirrhosis

39
Q

What are some causes of liver cirrhosis?

A

alcohol, autoimmune, chronic viral hepatitis, NFLD, drugs, CF, unknown and sarcoidosis

40
Q

What are the 3 autoimmune diseases which cause cirrhosis?

A

PBC, PSC and autoimmune heaptitis

41
Q

What are the pathological changes to the liver during cirrhosis?

A

injury - smaller, fibrosed and scarred

blocks nutrient entry so the pressure rises and blood has to bypass channels

42
Q

How does compensated cirrhosis present?

A

usually picked up by a screening test and abnormal LFTs

43
Q

How does decompensated cirrhosis present?

A

ascites, variceal bleeding, hepatic encephalopathy

44
Q

How else can cirrhosis present?

A

hepatocellular carcinoma

45
Q

What is the use of ultrasound with ascites?

A

detect shifting dullness and fluid

46
Q

What clinical signs are important to look for with ascites?

A

spider naevi, gynaecomastia, palmar erythema and abdominal veins

47
Q

What is fetor hepaticus?

A

characteristic breath smell, foul in portal hypertension

48
Q

What can ascites do to JVP?

A

Raise

49
Q

What test MUST be done on any patient presenting with ascites?

A

diagnostic paracentesis

50
Q

What does diagnostic paracentesis look for?

A

protein and albumin, cell count, SAAG

51
Q

What can SAAG tell us?

A

check if it is related liver (>1.1g)

52
Q

How is ascites treated?

A

diuretics, large volume aspiration and TIPs

53
Q

What are varices?

A

Due to portal hypertension at porto-systemic anastomoses - enlarged veins

54
Q

Where can varices be found?

A

skin, oesophagus, rectal, stomal and posterior abdominal wall

55
Q

What are the management options for varices?

A

resuscitate patient, blood transfusion and emergency endoscopy
band ligation by endoscope

56
Q

What is hepatic encephalopathy?

A

Confusion due to liver disease

57
Q

What is the cause of hepatic encephalopathy?

A

metabolites to the brain and cross the blood brain barrier as they are not being metabolised in the liver

58
Q

What clinical conditions are common to be found in someone with hepatic encephalopathy?

A

GI bleed, infection, dehydration

59
Q

What are the clinical signs of hepatic encephalopathy?

A

flapping tremor - foetor hepaticus

60
Q

How is hepatic encephalopathy treated?

A

broad spectrum antibiotics, fluids, laxatives, transplant

61
Q

How does someone with hepatocellular carcinoma present?

A

mass, decompensated liver disease, pain, weight loss, bleeding

62
Q

How Is hepatocellular carcinoma diagnosed? - marker and scans

A

AFP

US, CT, MRI

63
Q

List 4 ways to treat hepatocellular carcinoma

A

liver resection
chemotherapy
radiofrequency ablation
liver transplantation

Year 2 GI (JK) (39 decks)

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