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systems- GI > jaundice and chronic liver disease > Flashcards

jaundice and chronic liver disease Flashcards

1
Q

function of heart

A

pumps blood

allows blood to slosh about in its chambers

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2
Q

function of liver compared to heart

A

doesnt pump blood
allows blood to slosh about in its sinusoids
AND A WHOLE LOT MORE

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3
Q

whats the synthetic function of the liver?

A

Clotting factors
Bile acids
Carbohydrates
Gluconeogenesis, Glycogenolysis, Glycogenesis
Proteins
Albumin synthesis,
Lipids
Cholesterol synthesis, Lipoprotein and TG synthesis
Hormones
Angiotensinogen, insulin like growth factor

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4
Q

what is detoxification

A

physiological or medicinal removal of toxic substances from a living organism, including the human body, which is mainly carried out by the liver

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5
Q

what happens during detoxification?

A

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

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6
Q

what is the immune function of the liver?

A

Combating infections
Clearing the blood of particles and infections, including bacteria
Neutralizing and destroying all drugs and toxins

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7
Q

what is the storage function of the liver?

A

Stores glycogen
Stores Vitamin A, D, B12 and K
Stores copper and iron

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8
Q

how is bilirubin a liver function test?

A

Elevated as a result of :
Pre-hepatic: Haemolysis
Hepatic: Parenchymal damage
Post hepatic: Obstructive

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9
Q

how is aminotransferases a liver function test?

A

Enzymes present in hepatocytes
ALT more specific than AST
AST/ALT ratio can point towards ALD
Suggests parenchymal involvement

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10
Q

how is alkaline phosphatase a liver function test?

A

Enzyme present in bile ducts
Elevated with obstruction or liver infiltration
Also present in bone, placenta and intestines

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11
Q

how is gamma GT a liver function test

A

Non specific liver enzyme
Elevated with alcohol use
Useful to confirm liver source of ALP
Drugs like NSAID’s can raise levels

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12
Q

how is albumin a liver function test

A

Important test for synthetic function of liver
Low levels suggest chronic liver disease
Can be low in kidney disorders and malnutrition

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13
Q

how is prothrombin time a liver function test

A

Extremely important test for liver function

Tells degree of liver dysfunction

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

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14
Q

how is creatinine a liver function test

A

Essentially kidney function
Determines survival from liver disease
Critical assessment for need for transplant

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15
Q

how is platelet count a liver function test?

A

Liver is an important source of thrombopoietin
Cirrhosis results in splenomegaly
Platelets low in cirrhotic subjects as a result of hypersplenism
Indirect marker of portal hypertension

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16
Q

what are the symptos of a liver stopping to work?

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

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17
Q

what is jaundice?

A

Yellowing of the skin, sclerae, and other tissues caused by excess circulating bilirubin.

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18
Q

when is jaunduce detectable?

A

Detectable when total plasma bilirubin levels exceed 34 µmol/L

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19
Q

what is the differential diagnosis of jaundice?

A

carotenemia

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20
Q

what are the classifications of jaundice?

A

pre hepatic
hepatic
post hepatic

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21
Q

what happens in pre hepatic?

A

increased quantity of bilirubin

impaired transport

22
Q

what happens in hepatic

A

defective uptake of bilirubin
defective conjugation
defective excretion

23
Q

what happens in post hepatic

A

defective transport of bilirubin by the biliary ducts

24
Q

what are clues on history pre hepatic?

A

history of anaemia

acholuric jaundice

25
Q

what are clues on history hepatic

A

Risk factors for liver disease (IVDU, drug intake)

Decompensation (ascites, variceal bleed,encephalopathy)

26
Q

what are the clues on history post hepatic?

A

Abdominal pain

Cholestasis (Pruritus, pale stools, high coloured urine)

27
Q

clues on examination pre hepatic

A

Pallor

Splenomegaly

28
Q

whatare the clues on examination hepatic

A

Stigmata of CLD (spider naevi, gynaecomastia)
Ascites
Asterixis

29
Q

what are the clues on examination post hepatic

A

Palpable gall bladder

30
Q

what are the investigations for jaundice

A 
Liver screen
Hepatitis B & C serology
Autoantibody profile, serum immunoglobulins
Caeruloplasmin and copper
Ferritin and transferrin saturation
Alpha 1 anti trypsin
Fasting glucose and lipid profile

Most important test is Ultrasound of the abdomen

31
Q

why is ultrassound of the abdomen so good?

A

Differentiates extrahepatic and intrahepatic obstruction
Delineates site of obstruction
Delineates cause of obstruction
Documents evidence of portal hypertension
Preliminary staging of extent of disease e.g. cancer spread

32
Q

diiference between MRCP and ERCP

A 
MRCP
No radiation
No complications
5% claustrophobia
Can image outwith the ducts
ERCP
Radiation
Sedation
Complications (5%)
Failure rate (10%)
Only images ducts
Therapeutic option
33
Q

therapeutic ercp

A

Dilated biliary tree ± visible stones
± tumour

Acute gallstone pancreatitis

Stenting of biliary tract obstruction

Post-operative biliary complications

34
Q

complications of ERCP

A 
Sedation related	- respiratory
				- cardiovascular
Procedure related
Pancreatitis
Cholangitis
Sphincterotomy
Bleeding
Perforation
35
Q

uses of percutaneous transhepatic cholangiogram

A

ERCP not possible due to
duodenal obstruction
or previous surgery
Hilar stenting

36
Q

disadvantages of PTC

A

more invasive than ERCP

37
Q

function of endoscopic ultrasound

A

Characterising pancreatic masses

Staging of tumours

Fine needle aspirate (FNA) of tumours and cysts

Excluding biliary microcalculi

38
Q

definition of chronic liver disease

A

Liver disease that persists beyond 6 months

39
Q

give examples of a chronic liver disease?

A 
Chronic hepatitis
Chronic cholestasis
Fibrosis and Cirrhosis
Others e.g. steatosis
Liver tumours
40
Q

clinical presentation of cirrhosis

A 
Compensated chronic liver disease
Routinely detected on screening tests
Abnormality of liver function tests
Decompensated chronic liver disease
Ascites
Variceal bleeding
Hepatic encephalopathy
Hepatocellular carcinoma
41
Q

evidence of ascites?

A

Physical exam reveals dullness in flanks and shifting dullness (approx 1500cc).
Can be confirmed by U/S which can detect up to 100cc.
Corroborating evidence:
Spiders, palmar erythema, abdominal veins, fetor hepaticus
Umbilical nodule
JVP elevation
Flank haematoma

42
Q

what are routine checks for ascitic fluid analysis?

A

cell count
protein
albumin

43
Q

treatment options for ascites

A 
Diuretics
Large volume paracentesis
TIPS
Aquaretics
Liver transplantation
44
Q

what causes varices?

A

portal hypertension

45
Q

management of varices

A 
Resuscitate patient
Good IV access
Blood transfusion as required
Emergency endoscopy
Endoscopic band ligation
Add Terlipressin for control
Sengstaken-Blakemore tube for uncontrolled bleeding
TIPSS for rebleeding after banding
46
Q

what is Hepatic encephalopathy

A

Hepatic encephalopathy is a syndrome observed in patients with cirrhosis. Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease

47
Q

whats the commonest cause of liver cancer?

A

Hepatocellular carcinoma

48
Q

Hepatocellular carcinoma occurs in the background of

A

cirrhosis

49
Q

what is Hepatocellular carcinoma associated with

A

chronic hep b and c

50
Q

presentation of Hepatocellular carcinoma

A 
Decompensation of liver disease
Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour
51
Q

diagnosis of Hepatocellular carcinoma

A 
Tumour markers: AFP
Radiological tests
Ultrasound
CT scan
MRI
Liver biopsy done very rarely
52
Q

what is the treatment of Hepatocellular carcinoma

A 
Hepatic resection
Liver transplantation
Chemotherapy
Locally delivered: TACE (Transcatheter arterial chemo-embolization)
Systemic chemotherapy
Locally ablative treatments
Alcohol injection
Radiofrequency ablation
Sorafenib (Tyrosinase kinase inhibitor)
Hormonal therapy: Tamoxifen

systems- GI (40 decks)

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