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Alimentary System > Jaundice and Chronic Liver Disease/Hepato-Biliary Pathology > Flashcards

Jaundice and Chronic Liver Disease/Hepato-Biliary Pathology Flashcards

1
Q

What are the three classes of jaundice?

A

Pre-hepatic
Hepatic
Post Hepatic

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2
Q

What is the cause of jaundice?

A

Increase in circulating bilirubin due to altered metabolism

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3
Q

What part of haemoglobin is converted to bilirubin?

A

Haem part

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4
Q

What is involved in the pre-hepatic phase?

A

Breakdown of haemoglobin -> haem and globin, haem is converted to bilirubin

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5
Q

What is involved in the hepatic phase?

A

Uptake and conjugation of bilirubin by the hepatocytes and excretion of the conjugated bilirubin into the biliary system

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6
Q

What is involved in the post-hepatic phase?

A

Transport of conjugated bilirubin in the biliary system , breakdown in the intestine and reabsorption

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7
Q

What is cholestasis?

A

Accumulation of bile within the hepatocytes or bile canaliculi due to viral hepatitis, alcoholic hepatitis, liver failure or drugs

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8
Q

What are the types of hepatic jaundice?

A

Predictable - dose related

Unpredictable - not dose related

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9
Q

What causes hepatic jaundice?

A 
Intra-hepatic bile duct obstruction 
Due to:
Primary biliary cholangitis 
Primary sclerosing cholangitis 
Tumours of the liver
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10
Q

What is primary biliary cholangitis?

A

An organ specific auto-immune disease causing granulomatous inflammation involving the bile ducts, loss of intra-hepatic bile ducts and progression to cirrhosis

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11
Q

What can be detected in serum for diagnosis of primary biliary cholangitis?

A

Anti-mitochondrial auto-antibodies

Raised alkaline phosphatase

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12
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrous obliteration of the bile ducts causing loss of intra-hepatic bile ducts and progression to cirrhosis

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13
Q

Primary sclerosing cholangitis is associated with an increased risk of what?

A

Cholangiocarcinoma

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14
Q

What is the cause of post-hepatic jaundice?

A

Gallstones and diseases of the gall bladder causing extra hepatic obstruction

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15
Q

What is acute cholecystitis?

A

Acute inflammation of the gall bladder

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16
Q

What is caused by acute cholecystitis?

A

Empyema leading to the perforation of the gall bladder, biliary peritonitis and eventual progression to chronic inflammation in which pus is formed in the gall bladder

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17
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of the gall bladder

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18
Q

What are the causes of common bile duct obstruction?

A

Gallstones
Bile duct tumours
Benign strictures
External compression due to tumours

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19
Q

What are the effects of common bile duct obstruction?

A

Jaundice
No bile excreted into duodenum
Infection of bile proximal to the obstruction
Secondary biliary cirrhosis if obstruction is prolonged

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20
Q

What can cause an elevation in circulating bilirubin?

A

Haemolysis
Parenchymal Damage
Obstruction

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21
Q

How are amino transferases used to determine liver function?

A

ALT and AST can indicate liver injury but are not specific to it, if AST levels > ALT levels alcoholic liver disease is indicated
May also indicate parenchymal involvement

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22
Q

What is alkaline phosphatase and how is it used to determine liver function?

A

An enzyme present in the bile ducts which becomes elevated during obstruction or liver infiltration
However it is non-specific as it is also present in bone disease, placenta and the intestines

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23
Q

What is gamma-GT and how is it used to determine liver function?

A

A non-specific liver enzyme which is elevated with alcohol consumption and some drugs
Can be useful to confirm a liver source of ALP
If alkaline phosphatase and gamma-GT levels are moth raised then liver disease is indicated

24
Q

How is albumin useful in detecting liver disease?

A

Important test for synthetic function of the liver

Low levels suggest chronic liver disease, kidney disorders or malnutrition

25
Q

How is prothrombin time useful in detecting liver disease?

A

Important test for liver function, tells the extent and prognosis of liver function
Test of the clotting factors so if abnormal significant disease is indicated

26
Q

How is creatinine a useful test in the diagnosis of liver disease?

A

Creatinine tests kidney function, since kidney and liver function are closely related it helps to determine the prognosis of liver disease

27
Q

How is a platelet count a useful test in the diagnosis of liver disease?

A

Liver is an important source of thrombopoeitin, poor liver function will reduce bone marrow activity, also cirrhosis can result in splenomegaly - hypersplenism results in low platelets

28
Q

Give 5 things which would be tested for in the blood in investigation of liver disease

A 
Immunoglobulins - IgA, IgG, IgM 
Autoantibodies - AMA, ASMA, ANA
Caeruloplasmin copper 
Ferritin 
Alpha-1-antitrypsin 
Hepatitis serology 
Epstein Barr Virus 
Cytomegalovirus 
Leptospira 
Alphafoetoprotein
Fatty liver disease - fasting glucose or lipid profile
29
Q

What are the typical presentations of liver failure?

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

30
Q

When would a liver biopsy be indicated?

A

In unknown parenchymal disease or if an unknown focal liver lesion
If the aetiology of disease is known but more information is required on inflammation, fibrosis or cirrhosis

31
Q

What imaging investigations might be done in suspected liver failure?

A 
Ultrasound of liver and biliary tree 
CT of abdomen 
MRI of abdomen 
ERCP 
Endoscopic ultrasound 
MRCP
32
Q

Give the causes of acute liver injury

A 
Hepatitis 
Viral Hepatitis - A, B, C or E
Viruses 
Alcohol 
Drugs 
Bile duct obstruction
33
Q

What happens to the liver in viral hepatitis?

A

Live inflammation, cell damage and death

34
Q

What kinds of viral hepatitis might resolve and return to normal without treatment?

A

A or E

35
Q

What kinds of viral hepatitis can cause liver failure due to liver damage caused by severe hepatitis?

A

A, B or E

36
Q

What kinds of viral hepatitis can progress to chronic hepatitis and cirrhosis?

A

B or C

37
Q

What is alcoholic hepatitis?

A

Inflammatory response of the liver to alcohol causing acute inflammation, liver cell death and liver failure

38
Q

What can alcoholic hepatitis progress to?

A

Cirrhosis

39
Q

What are the causes of hepatic cirrhosis?

A 
Alcohol 
Hepatitis B or C 
Autoimmune hepatitis 
Primary biliary cholangitis 
Primary haemachromatosis 
Wilson's disease 
Obesity/diabetes mellitus 
Idiopathic
40
Q

What is hepatic cirrhosis

A

A diffuse process involving the whole liver causing loss of normal liver structure which is replaced by nodules of hepatocytes and fibrous tissue

41
Q

Give the complications of hepatic cirrhosis

A

Liver failure caused by altered liver function
Portal hypertension causing haemorrhage risk
Increased risk of hepatocellular carcinoma

42
Q

What are the histological types of liver tumours?

A

Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours also commonly occur in the liver

43
Q

How does hepatocellular carcinoma usually develop and what cells does it affect?

A

Generally develops with cirrhosis

Malignant tumour of the hepatocytes

44
Q

What is cholangiocarcinoma?

A

A malignant tumour of the bile duct epithelium

45
Q

What are the common liver disorders?

A 
Jaundice 
Liver failure 
Intrahepatic bile duct obstruction 
Cirrhosis 
Tumours
46
Q

What are the causes of cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

47
Q

What are the causes of intra-hepatic bile duct obstruction?

A

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours

48
Q

How might gall stones present?

A 
Asymptomatic 
Dyspeptic symptoms 
Biliary colic 
Acute cholecystitis 
Empyema 
Perforation 
Jaundice 
Gallstone ileus
49
Q

What investigations would be done if suspecting gallstones?

A 
MRCP 
EUS 
CT 
Amylase and lipase 
WCC
50
Q

What would be done if diagnosis of gallstones had been confirmed as therapeutic management?

A

PTC or ERCP

51
Q

What is the best surgical procedure for removal of gallstones?

A

Laparoscopic cholecystectomy

52
Q

What is choledocholithiasis?

A

Presence of at least one gall stone in the common bile duct

53
Q

How might choledocholithiasis present?

A

Post-cholecystectomy pain
Obstructive jaundice
Acute pancreatitis
Ascending cholangitis

54
Q

What is the management for choledocholithiasis?

A

Laparoscopic CBD exploration
ERCP
Transhepatic stone retrieval

55
Q

What are the risk factors for cholangiocarcinoma?

A 
Increasing age
Primary sclerosing cholangitis 
Congenital cystic disease 
Biliary enteric drainage 
Thorotrast (old contrast agent)
Hepatolithiasis 
Carcinogen exposure
56
Q

What are the histological types of ampullary tumours?

A

Adenoma

Adenocarcinoma

57
Q

What is the treatment for ampullary tumours?

A

Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy

Alimentary System (29 decks)

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