Jaundice and Chronic Liver Disease Flashcards
synthetic products of the liver
clotting factors
bile acids
carbohydrate
proteins
lipid
hormons
elaborate on how the liver functions to detoxify blood
ammonia –> urea
detoxification of drugs
bilirubin metabolism
breakdown of insulin and hormones
elaborate on the immune functions of the liver
combats infections
clears the blood of particles and infections
(including bacteria)
neutralising and destroying all drugs and toxins
what does the liver store
glycogen
vitamin A, D, B12 and K
copper
iron
what is bilirubin
byproduct of haeme metabolism generated by dying red blood cells in the spleen
what does the liver do to bilirubin
helps solubilise it
what can cause bilirubin to be raise
haemolysis
parenchymal damage
obstruction post-hepatic
what are aminotransferases and where are they located
enzymes
hepatocytes
which aminotransferases are more/ less specific and why
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
what are alkaline phosphatase and where are they present
enzymes
bile ducts (GI) also present in bone, placenta and intestines
what can cause alkaline phosphatase to be raised
obstruction or liver infiltration
what is gamma GT
non specific liver enzyme
what can cause raised Gamma GT
- alcohol use
- NSAIDs
what do low levels of albumin suggest
chronic liver disease
kidney disorders
malnutrition
what does prothrombin time indicate
degree of liver dysfunction
what can prothrombin time be used to calculate
scores to decide stage of liver disease, who needs a liver transplant and who gets a transplant
Indicators from creatine LFT
determines survival from liver disease
why/how can platelet count be influenced by the liver
liver is source thrombopoietin
cirrhosis results in splenomegaly
platelets low in cirrhotic subjects mainly as a result of hypersplenism
indirect marker of portal hypertension
symptoms of liver problems
jaundice
ascites
variceal bleeding
hepatic encephalopathy
definition of jaundice
yellowing of the skin and other tissues caused by excess circulating bilirubin
possible differential diagnosis’s for yellowing of the skin
jaundice
carotenemia
3 classifications of jaundice
pre-hepatic
hepatic
post hepatic
effect of pre-hepatic jaundice
- increased quantity of bilirubin
- impaired transport
effects of hepatic jaundice
defective uptake of bilirubin
defective conjugation
defective excretion
effects of post-hepatic excretion
defective transport of bilirubin by the biliary ducts
asterixis
liver flap
ultrasound of the abdomen - what can it show?
where
cause
changes
spread
benefits of ultrasound over CT/MRI
cheaper
no radiation
portable
good for gallstones
benefits of CT/MRI over ultrasound
high sensitivity
better for pancreas
MRCP benefits over ERCP
no radiation
no complications
no sedation required
can image outwith the ducts
ERCP > MRCP benefits
therapeutic options
no claustrophobia
uses of therapeutic ERCP
- biopsies of tumours
- can remove stones
- stenting of biliary tract obstruction
downsides of therapeutic ERCP
- acute pancreatitis
- post operative biliary complications
bleeding
perforation
cholangitis
sedation issues
when would a percutaneous transhepatic cholangiogram be used instead of ERCP
duodenal obstruction or previous surgery
for hilar stenting
functions of endoscopic ultrasound
- characterising pancreatic masses
staging tumours
fine needle aspiration of tumours and cysts
excluding biliary microcalculi
chronic liver disease
liver disease that persists beyond 6 months
