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GI PATHOLOGY > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

What are the major functions of the liver?

A

Synthesis
Filtration/detoxification
Immune function
Storage

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2
Q

What does the Liver synthesis?

A 
Clotting factors
Bile acids
Carbs
Proteins (albumin)
Lipids (cholesterol)
Hormones
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3
Q

What are the detoxifying roles of the liver?

A

Ammonia –> Urea
Drug detoxification
Metabolism of bilirubin
Breakdown of hormones

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4
Q

What does the liver store?

A

Glycogen
Vit A, B12, D, K
Cu, Fe

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5
Q

What are the LFTs?

A 
Bilirubin 
Aminotransferases 
AlkPhos
GGT
Albumin
INR/prothrombin time
Creatinine
Platelets
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6
Q

What is the pre-hepatic cause of elevated bilirubin?

A

Haemolysis

Impaired transport

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7
Q

What is the hepatic cause of elevated bilirubin?

A

Defective uptake
Defective conjugation
Defective excretion

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8
Q

What is the post-hepatic cause of elevated bilirubin?

A

Obstruction in biliary ducts

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9
Q

What is the pathway of bilirubin?

A

Haem metabolism
Sensecent RBC in spleen
Bound to albumin
Conjugated by the liver

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10
Q

What are the aminotransferases?

A

ALT, AST

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11
Q

Which is the most specific aminotransferase?

A

ALT

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12
Q

What does AST/ALT > 1 suggest?

A

ALD/liver damage

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13
Q

When is Alkaline phosphatase raised?

A

Obstruction or liver infiltration

Bone dis, pregnancy

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14
Q

How is Gamma GT used?

A

Elevated in alcohol, NSAID use

Can confirm liver source of raised ALP

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15
Q

What does Low albumin suggest?

A

Chronic Liver Disease
Kidney disease
Malnutrition (rare)

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16
Q

What does INR tell us?

A

Degree of liver disfunction

Staging liver disease

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17
Q

What does creatinine tell us?

A

Kidney function
Survival from liver disease
Need for transplant?

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18
Q

How does liver disease cause low platelet count?

A

Portal hypertension causing splenomegaly = hypersplenism

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19
Q

Symptoms of liver failure

A

Jaundice
Ascites
Varices
Hepatic encephalopathy

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20
Q

When is bilirubin detectable?

A

Plasma bilirubin > 34umol/L

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21
Q

What is the DDx for jaundice?

A

Carotenemia

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22
Q

Pre-hepatic jaundice will likely present with what?

A

History of anaemia
Acholuric jaundice
Splenomegaly
Pallor

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23
Q

Hepatic jaundice will likely present with what?

A 
Risk factors for Liver disease
Decompensation
Spider naevi
Ascites
Asterixis
24
Q

Post-hepatic jaundice will likely present with what?

A

Abdominal pain
Cholestasis (high coloured urine, pale stool)
Palpable mass, GB

25
Q

What investigations would be given to a patient presenting with jaundice?

A

Liver Screen

USS abdomen

26
Q

Main benefit of ERCP over MRCP?

A

ERCP has the potential to perform therapy during the investigation

27
Q

What complications are associated with ERCP?

A

Sedation issues
Pancreatitis
Cholangitis
Sphincterectomy - bleeding

28
Q

What is the role of EUS in patients with jaundice?

A

Finding pancreatic masses
Staging
Fine needle aspiration
Excluding biliary microcalculi

29
Q

How is chronic liver disease defined?

A

Liver disease persisting for >6 months

30
Q

What is the largest cause of cirrhosis?

31
Q

What are 5 causes of cirrhosis?

A 
Autoimmune
Alcohol
Haemochromatosis, Wilson's
Viral hepatitis
NAFLD
Drugs
CF
Cryptogenic
32
Q

What is the presentation of compensated CLD?

A

Screening test - abnormality in LFTs

33
Q

What is the presentation of decompensated CLD?

A

Ascites
Variceal bleeding
Hepatic encephalopathy

34
Q

When can ascites be detected physically?

A

1500cc

shifting dullness

35
Q

How is ascites confirmed?

36
Q

What are the clinical features of ascites?

A 
Spiders naevi, palmar erythema
Abdominal veins
Umbilical nodule 
JVP elevation
Flank hematoma
37
Q

New onset ascites must always be evaluated how?

A

Diagnostic paracentesis

38
Q

What studies are performed in an ascitic paracentesis?

A 
Protein and albumin conc.
Cell count, differential
SAAG
Culture
Glucose
Amylase
39
Q

SAAG levels in ascitic paracentesis tell us what?

A

> 1.1g/dL - portal HTN related

<1.1g/dL - non portal HTN related

40
Q

What is SAAG?

A

Serum-ascites albumin gradient

41
Q

A SAAG ratio > 1.1g/dl is suggestive of what?

A 
Portal hypertension
CHF
Constrictive pericarditis
Massive liver Mets
Budd-Chiarri syndrome
42
Q

A SAAG ratio < 1.1g/dl is suggestive of what?

A 
Malignancy
TB
Chylous ascitis
Pancreatic/biliary issues
Nephrotic syndrome
43
Q

Treatment options of ascites?

A 
Diuretics
Large volume paracentesis
TIPSS
Aquaretics
Liver transplant
44
Q

What are the locations of the porto-systemic anastamoses?

A 
Skin (caput medusae)
Oesophageal/gastric
Rectal
Posterior abdominal wall
Stromal
45
Q

How is a variceal bleed treated?

A

Resuscitation
IV access
Blood transfusion
Emergency endoscopy

46
Q

How is a variceal bleed fixed?

A

Endoscopic band Ligation

Terlipressin

47
Q

How is an uncontrolled variceal bleed fixed?

A

Sengstaken-Blakemore tube

TIPSS - Transjugular Intrahepatic Porto-systemic Shunt

48
Q

How is Hepatic encephalopathy graded?

A

Graded 1-4

49
Q

Hepatic encephalopathy is often precipitated by what?

A 
GI bleed
Infection
Constipation
Dehydration
Sedation
50
Q

How does hepatic encephalopathy present?

A

Foetor hepaticus (breath stank)
Aterixis
Confusion

51
Q

How is hepatic encephalopathy treated?

A

Laxatives, enemas

Neomycin (broad spec antiB)

52
Q

How does hepatocellular carcinoma present?

A 
Abdominal Mass
Abdominal pain
Weight loss
Bleeding from tumour
Liver disease symptoms
53
Q

Which tumour markers are raised in hepatocellular carcinoma?

54
Q

How is hepatocellular carcinoma diagnosed?

A

Tumour markers
USS
CT, MRI
Liver biopsy

55
Q

How is hepatocellular carcinoma treated?

A 
Hepatic resection
Liver transplant
Chemo (TACE)
Local ablation
Sorafenib
Tamoxifen

GI PATHOLOGY (20 decks)

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