Jaundice and Chronic Liver Disease

Question 1

synthetic products of the liver

Answer 1

clotting factors

bile acids

carbohydrate
proteins
lipid

hormons

Question 2

elaborate on how the liver functions to detoxify blood

Answer 2

ammonia –> urea

detoxification of drugs

bilirubin metabolism

breakdown of insulin and hormones

Question 3

elaborate on the immune functions of the liver

Answer 3

combats infections

clears the blood of particles and infections
(including bacteria)

neutralising and destroying all drugs and toxins

Question 4

what does the liver store

Answer 4

glycogen

vitamin A, D, B12 and K

copper

iron

Question 5

what is bilirubin

Answer 5

byproduct of haeme metabolism generated by dying red blood cells in the spleen

Question 6

what does the liver do to bilirubin

Answer 6

helps solubilise it

Question 7

what can cause bilirubin to be raise

Answer 7

haemolysis

parenchymal damage

obstruction post-hepatic

Question 8

what are aminotransferases and where are they located

Answer 8

enzymes

hepatocytes

Question 9

which aminotransferases are more/ less specific and why

Answer 9

ALT more specific than AST because AST can be elevated due to other conditions outwith the liver, where as ALT will only be elevated with a liver problem

Question 10

what are alkaline phosphatase and where are they present

Answer 10

enzymes

bile ducts (GI)
also present in bone, placenta and intestines

Question 11

what can cause alkaline phosphatase to be raised

Answer 11

obstruction or liver infiltration

Question 12

what is gamma GT

Answer 12

non specific liver enzyme

Question 13

what can cause raised Gamma GT

Answer 13

• alcohol use

- NSAIDs

Question 14

what do low levels of albumin suggest

Answer 14

chronic liver disease

kidney disorders

malnutrition

Question 15

what does prothrombin time indicate

Answer 15

degree of liver dysfunction

Question 16

what can prothrombin time be used to calculate

Answer 16

scores to decide stage of liver disease, who needs a liver transplant and who gets a transplant

Question 17

Indicators from creatine LFT

Answer 17

determines survival from liver disease

Question 18

why/how can platelet count be influenced by the liver

Answer 18

liver is source thrombopoietin

cirrhosis results in splenomegaly

platelets low in cirrhotic subjects mainly as a result of hypersplenism

indirect marker of portal hypertension

Question 19

symptoms of liver problems

Answer 19

jaundice

ascites

variceal bleeding

hepatic encephalopathy

Question 20

definition of jaundice

Answer 20

yellowing of the skin and other tissues caused by excess circulating bilirubin

Question 21

possible differential diagnosis’s for yellowing of the skin

Answer 21

jaundice

carotenemia

Question 22

3 classifications of jaundice

Answer 22

pre-hepatic

hepatic

post hepatic

Question 23

effect of pre-hepatic jaundice

Answer 23

• increased quantity of bilirubin

- impaired transport

Question 24

effects of hepatic jaundice

Answer 24

defective uptake of bilirubin

defective conjugation

defective excretion

Question 25

effects of post-hepatic excretion

Answer 25

defective transport of bilirubin by the biliary ducts

Question 26

asterixis

Answer 26

liver flap

Question 27

ultrasound of the abdomen - what can it show?

Answer 27

where
cause
changes
spread

Question 28

benefits of ultrasound over CT/MRI

Answer 28

cheaper
no radiation
portable
good for gallstones

Question 29

benefits of CT/MRI over ultrasound

Answer 29

high sensitivity

better for pancreas

Question 30

MRCP benefits over ERCP

Answer 30

no radiation

no complications

no sedation required

can image outwith the ducts

Question 31

ERCP > MRCP benefits

Answer 31

therapeutic options

no claustrophobia

Question 32

uses of therapeutic ERCP

Answer 32

• biopsies of tumours
• can remove stones
• stenting of biliary tract obstruction

Question 33

downsides of therapeutic ERCP

Answer 33

• acute pancreatitis
• post operative biliary complications

bleeding

perforation

cholangitis

sedation issues

Question 34

when would a percutaneous transhepatic cholangiogram be used instead of ERCP

Answer 34

duodenal obstruction or previous surgery

for hilar stenting

Question 35

functions of endoscopic ultrasound

Answer 35

• characterising pancreatic masses

staging tumours

fine needle aspiration of tumours and cysts

excluding biliary microcalculi

Question 36

chronic liver disease

Answer 36

liver disease that persists beyond 6 months