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GI > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

Define Jaundice

A

Yellowing of the skin, sclerae and other tissues due to excess circulating bilirubin.

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2
Q

Describe classification of jaundice

A

Pre-Hepatic - Haemolysis
Hepatic - Defective uptake, conguagation or extertion)
Post-Hepatic defective transport by biliary duct

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3
Q

Functions of the liver

A
  • Production
  • Detoxification
  • Immune Function
  • Storage
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4
Q

What does the liver produce

A 
Clotting Factor Production
Bile Acid production
Carbohydrates (storage and conversion)
Albumin synthesis
Cholesterol Sythenthis
Hormones (angiotensiongen and insulin-like growth factor)
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5
Q

What does the liver detox

A

Urea –> Ammonia
Drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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6
Q

What does the liver store?

A

Glycogen
Vitamins A, D, B12 and K
Stores Copper and Iron

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7
Q

The immune function of the liver

A
  • Combats infection
  • Cleans the blood
  • Detox & Neutralisation of Drugs and Toxins
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8
Q

Symptoms of Liver Dysfunction

A

Jaundice
Acites
Variceal Bleeding
Hepatic encephalopathy (neuro)

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9
Q

Appearance of urine and stool in different in different classifcations of jaundice

A

Pre - Normal stool and urine
Hepatic - High coloured urine, normal stool
Post- pale stool, high coloured urine

Due to bilirubin pigment

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10
Q

Causes of Jaundice

A

Pre- haemolotic anaemia
Hepatic - IVDU, alcohol
Post - Cholestasis

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11
Q

Investigations of Jaundice

A

Bloods - LFTS
Abdo US - Screening
MRI/CT - confirmation

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12
Q

Definition of Chronic Liver Disease

A

Liver disease lasting longer than 6 months

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13
Q

Examples of Chronic Liver Disease

A

Hepatitis
Cholestais
Fibrosis and Cirrhosis
Liver Tumour

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14
Q

Define Cirrhosis

A

Hepatocytes lose function due to irreversible scarring of the liver

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15
Q

Causes of Cirrhosis

A

Alcohol abuse

Hep B & C

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16
Q

Presentation of Cirrhosis

A

Compensated Liver disease - found in LFTS and screening

Uncompensated Liver disease - Ascites, Variceal Bleeding and Hepatic encephalopahy

or as hepatocellular carcinoma.

17
Q

Define Acites, presentation and investigation

A

Accumulation of fluid in the peritoneal cavity causing abdominal swelling.

Dullness in flanks and shifting dullness. Confirmed with abdo US.

May also present with spider naevi, palmar erythema, abdominal varices, Fetor hepaticus (breath), JVP amplication, flank haemotoma and umbilical nodule.

18
Q

Define Fetor hepaticus

A

Portal hypertension causes porta-systemic shunting allows thiols (sulfur) to pass from the liver to the lungs. Breath of the dead.

19
Q

Effect of raised estrogen in chronic liver disease

A

Development of gynaecomasita, spider naevi and loss of body hair

20
Q

What diagnostic test should those with new onset acites have?

A

paracentesis - removal of fluid from the abdomen to test for

  • Protein and albumin concentration
  • Cell count
  • SAAG - serum-acites albumin gradient.

Transudative - hepatic disease
Exudative - malignancy

21
Q

Treatment of Acites

A

Diuretics
Large Volume Paracentesis
TIPS (trans-jugular intrahepatic portosystemic shunt)
Aquaretics (excretion of water without loss of electrolytes)
Liver Transplantation

22
Q

Site of Porto-systemic anatomoses

A 
Skin - Caput medusa
Oesophageal & Gastric
Rectal
Posterior abdominal wall
Stomal
23
Q

Management of Varices

A

Caused by portal hypertension

Resuscitation
Good IV access
Blood transfusion
Emergency endoscopy (band ligation)

24
Q

What is band ligation

A

Closing off the enlarged blood vessel at threat of rupture with the use of a band.

25
Q

What is Hepatic Encephalopathy. Presentation. Precursors. Treatment.

A

Confusion due to liver disease. May be precipiated with GI bleed, infection, constipation, dehydtration medication.

Signs - Liver Flap and Foetor hepaticus

Treatment - address underlying cause. e.g laxatives, antibiotics (broad spectrum).

26
Q

What is hepatic carcinoma? Presentation. Investigations and Treatment

A

Assciated with cirrhosis, chronic hep B&C.

Presents with abdominal mass and pain, weight loss, tumour bleeding and decompensation of liver disease

Investigation: Tumour Markers (AFP), US, CT and MRI, liver biospy (rare)

Treatment: Resection, transplant, chemo, local ablation, hormonal treatment.

GI (20 decks)

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