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GI > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

What does the liver synthesize?

A 
Clotting factors 
Bile acids 
Glycogen 
Albumin 
Cholesterol, lipoproteins and TG
Hormones (angiotensinogen, insulin like growth factor)
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2
Q

What does the liver store?

A

Glycogen
Vitamins (A, D, B12 & K)
Cu & Fe

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3
Q

What happens during the conjugation of bilirubin?

A

Solubilization

Initially it is bound to albumin (insoluble - unconjugated)
Liver makes it soluble (conjugated)

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4
Q

What are some liver function tests?

A

Bilirubin
Aminotransferases
Alkaline Phosphatase (raised in cholestasis, hepatitis, cirrhosis)
Albumin
Gamma GT (GGT - raised in liver injury / cholestasis)
Prothrombin time

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5
Q

What aminotransferases are measured? What can they point to?

A

AST & ALT (both enzymes present in hepatocytes)

High AST:ALT can indicate ALD

They suggest parenchymal involvement

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6
Q

What does elevated alkaline phosphatase indicate?

A

Obstruction or liver infiltration

Is elevated during pregnancy

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7
Q

What does low albumin suggest?

A

CLD

Important test for synthetic function of the liver

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8
Q

What is a prothrombin time test? What’s it useful for?

A

Tests whether thrombins are forming well

Important bc can stage the degree of liver disease, can help decide who needs transplant

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9
Q

What effect does liver cirrhosis have on the spleen?

A

Cirrhosis can cause splenomegaly because of portal hypertension

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10
Q

Clinical signs of liver failure?

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy (confusion / reduced cognitive function)

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11
Q

Classification of jaundice?

A

Pre-Hepatic (excess bilirubin/haemolysis/impaired transport)

Hepatic (defective uptake/conjugation/excretion of bilirubin)

Post Hepatic (defective transport by biliary ducts)

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12
Q

Signs that jaundice is hepatic in origin?

A

Risk factors for liver disease in history (IVDU/drugs)

Decompensation (ascites, variceal bleed, encephalopathy)

Asterixis (liver flap)

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13
Q

Signs that jaundice is post-hepatic in origin?

A

Abdominal pain

pruritis/pale stool/dark urine

Palpable gall bladder

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14
Q

Investigations for suspected liver failure?

A 
Hep B/C serology 
LFTs (AST/ALT/Albumin)
Bloods
Ferritin/transferrin
Alpha 1 antitrypsin
USS abdomen
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15
Q

Advantages of abdomen ultrasound? What can be seen?

A

Locate site of obstruction
Tells whether there is portal hypertension
Can detect masses in some cases

Cheap, no radiation

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16
Q

Procedure of ERCP vs MRCP?

A

ERCP uses an endoscope to visualize the bile ducts

MRCP uses an MRI machine to view the ducts

17
Q

How is ERCP used therapeutically?

A

Can be used to stent the biliary tract

Removal of gallstones in CBD

18
Q

What is choledocholithiasis?

A

Gallstones in the bile duct

19
Q

What are some complications of ERCP?

A

Sedation issues (cardio/resp)

Pancreatitis

Cholangitis

Bleeding/Perforation

20
Q

What is a Percutaneous Transhepatic Cholangiogram? When is it used?

A

PTC is an investigation that examines obstruction in the liver/bile duct. There is a dye injected into the liver and then x-rays are taken

It is used for more proximal obstructions/when ERCp isn’t possible due to obstruction etc.

21
Q

When is an endoscopic ultrasound usually performed?

A

Characterizing pancreatic masses

Tumour staging

Aspirations/biopsy assisting

22
Q

Causes of liver cirrhosis?

A 
Alcohol (#1 cause)
Autoimmune disease (Hep/PBC)
Haemochromatosis 
Hepatitis (B&C)
NAFLD
Drugs (MTX, amiodarone)
CF, Alpha1 antitrypsin deficiency 
Vascular problems (portal hypert.)
Sarcoidosis/etc.
23
Q

Types of chronic liver disease? Differences in presentation?

A

Compensated and decompensated

Decompensated should show more obvious signs, compensated may require testing to be detected

24
Q

Presentation of cirrhosis?

A 
Ascites 
Portal hypertension
Variceal bleeding 
Splenomegaly
Hepatic encephalopathy
25
Q

What are spider naevi due to?

A

Lack of testosterone metabolism in the liver - gets converted to estrogen

Red dots on skin and even feminization of patients

26
Q

Management of new-onset ascites?

A

Diagnostic paracentesis (drain fluid & test)

27
Q

Tests done after diagnostic paracentesis of ascites?

A

Protein and albumin

Cell count

SAAG (serum-ascites albumin gradient)

28
Q

If SAAG testing of ascites fluid shows gradient of >1.1 g/dl what are possible causes of ascites?

A

Portal hypertension

Or malignancy/heart failure causing portal hypertension

29
Q

If SAAG testing of ascites is <1.1 g/dl what may be causes of the ascites?

A 
Malignancy 
TB
Chylous ascites 
Pancreatic causes 
Biliary ascites 
Nephrotic syndrome
30
Q

Treatment options for ascites?

A 
Diuretics 
Large volume paracentesis 
TIPS
Aquaretics 
Liver transplant
31
Q

Cause of varicies?

Locations where they can occur?

A

Portal hypertension

Skin - caput medusa
Rectal
Oesophageal & gastric
Stomal

32
Q

What are varicies?

A

Swollen or enlarged veins

33
Q

Immediate management of varicieal bleeding?

A

Resuscitate patient - stop bleeding. Done via beta blocker to reduce portal hypertension & endoscopic band ligation if needed

Blood transfusion if needed
Endoscopy once patient is stable

34
Q

Treatment of varicies?

A

Endoscopic band ligation

Band the vein to close it, if band falls off band again until vein scarred enough so it won’t rupture again

35
Q

What is hepatic encephalopathy? Non-cognitive signs?

A

Confusion due to liver disease

Liver flap is an early sign

36
Q

Risk factors for hepatocellular carcinoma?

A

Cirrhosis

Chronic Hep B & C

37
Q

Presentation of hepatocellular carcinoma?

A

Decompensation of liver disease

Abdominal mass/pain
Weight loss
Bleeding from tumour

38
Q

Treatment options for hepatocellular carcinoma?

A

Hepatic resection
Liver transplant

Chemotherapy
Local ablation
Hormonal therapy (tamoxifen)

GI (46 decks)

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