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HPB > Liver > Flashcards

Liver Flashcards

1
Q

what does jaundice refer to and what is the compound responsible

A

jaundice is the yellowish discolouration of the sclera and skin

due to hyperbilirubinaemia

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2
Q

what is bilirubin

A

bilirubin is the normal breakdown product of haem - so it is usually formed from the destruction of red blood cells

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3
Q

under normal circumstances, what is the normal pathway of bilirubin

A

normally it is conjugated within the liver to make it water soluble

it is then excreted via bile into the GI tract

the majority of which is removed from the body in faeces as stercobilin or through urine as urobilinogen

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4
Q

what are the 3 main types/groups of jaundice

A

pre-hepatic

hepatic

post-hepatic

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5
Q

what is pre-hepatic jaundice and how will it appear in the blood

A

occurs when there is excessive red blood cell breakdown which overwhelms the livers ability to conjugate bilirubin

results in a build up of unconjugated bilirubin in the bloodstream

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6
Q

what is intrahepatic jaundice and how will it appear in the blood

A

occurs when there is dysfunction of the hepatic cells - resulting in that part of the liver losing the ability to conjugate bilirubin

occurs when some hepatic cells are dysfunctional and some still work perfectly, therefore it shows as a mixed picture in the blood with both conjugated and unconjugated hyperbilirubinaemia

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7
Q

what is post hepatic jaundice and how will it appear in the blood

A

occurs when there is an obstruction of biliary drainage

bilirubin has been conjugated alright and therefore shows as a conjugated hyperbilirubinaemia

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8
Q

what are some pre-hepatic causes of jaundice

A

haemolytic anaemia

drugs and toxins

haemoglobinopathies e.g. sickle cell

malaria

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9
Q

what are some intra-hepatic causes of jaundice

A

alcoholic liver disease

viral hepatitis

iatrogenic; medication

hepatocellular carcinoma

drugs and toxins

primary sclerosing cholangitis

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10
Q

what are some post-hepatic causes of jaundice

A

intra-luminal causes; gallstones

cholangiocarcinoma

strictures

pancreatic cancer and abdominal masses

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11
Q

how will the stools differ in each type of jaundice and why

A

pre-hepatic jaundice = unconjugated bilirubin, not water soluble so unable to removed in urine. so stercobilin builds up in faeces and that is what gives it the brown colour - so in pre-hepatic jaundice you will see dark brown faeces due to increased stercobilin

intra-hepatic jaundice = mixed conjugated and unconjugated, therefore see normal/decreased brown colour of faeces

post-hepatic jaundice = conjugated bilirubin and blockage of bile duct, no bile into GI tract, therefore no stercobilin in faeces, loses all brown colour and appears clay coloured

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12
Q

how will the urine colour differ in each type of jaundice

A

pre-hepatic = unconjugated bilirubin, not water soluble and therefor no urobilinogen in urine, normal colour/acholuric

hepatic = mixed conjugated/unconjugated, urine appears normal/slightly darker

post-hepatic = conjugated bilirubin, blockage of bile tract, no bilirubin into GI tract, all removed through urine as urobilinogen, results in dark brown coloured urine

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13
Q

what specialist blood tests can you do to elicit information regarding the location or severity of the jaundice

A

bilirubin - quantify degree of suspected jaundice

albumin - check the livers synthesising function

AST and ALT - markers of hepatocellular injury

Alkaline Phosphatase - raised in biliary obstruction (can be raised in other things)

Gamma-GT - more specific for biliary obstruction than alkaline phosphatase

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14
Q

what imaging can be used in cases of jaundice

A

first line is usually a USS abdomen

magnetic resonance cholangiopancreatography (MRCP) can be used to visualise the biliary tree - typically performed if the jaundice is obstructive

liver biopsy

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15
Q

pathophysiology of simple liver cysts

A

thought to be due to congenitally malformed bile ducts that dont connect to the extrahepatic ducts

leads to a local dilatation filled with bile-like fluid

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16
Q

clinical features of simple liver cysts

A

normally asymptomatic and often detected incidentally on imaging

abdo pain, nausea and early satiety (due to compression of surrounding structures)

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17
Q

investigations and management of simple liver cysts

A

LFTs normal

USS remains imaging of choice

most cysts require no intervention

large ones may need follow up USS to check for growth

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18
Q

what is polycystic liver disease and what is it caused by

A

characterised by the presence of >20 cysts within the liver parenchyma

caused by either; autosomal dominant polycystic kidney disease (ADPKD) or autosomal dominant polycystic liver disease (ADPLD)

19
Q

clinical features of polycystic liver disease

A

usually asymptomatic

in those with symptoms, abdo pain and hepatomegaly as cysts grow in size

20
Q

what are the surgical interventions for liver cysts

A

US-guided aspiration - not routinely formed due to fluid re-accumulation

Laparoscopic de-roofing of cysts - for those experiencing symptoms

21
Q

what are cystic neoplasms and what is the most common type

A

premalignant lesions

most common type is cystadenomas

22
Q

what are the radiological features of a liver cyst that could indicate malignancy

A

septations

wall enhancement

nodularity

23
Q

what is the management of cystic neoplasms of the liver

A

liver lobe resection (pre malignant lesions)

24
Q

what causes Hydatid cysts

A

infection by tapeworm (Echinococcus granulosus)

25
Q

clinical features of hydatid cyst

A

usually asymptomatic

main symptom is vague abdo pain caused by the mass effect on surrounding structures

26
Q

investigations into all liver cysts

A

FBC and USS

27
Q

why should aspiration or biopsy be avoided in both cystic neoplasms and hydatid cysts

A

cystic neoplasms = avoid peritoneal seeding of malignancy

hydatid cyst = avoid rupture

28
Q

what are the four anatomical lobes of the liver called

A

right

left

caudate

quadrate

29
Q

how do liver abscesses occur

A

as a result of bacterial infection spreading from the biliary or GI tract e.g. cholecystitis, cholangitis

30
Q

what are the most common causative organisms in liver abscesses

A

E. coli

K. pneumoniae

S. constellatus

31
Q

clinical features of liver abscess

A

present with fever, rigors and abdo pain

on examination patients have RUQ tenderness and hepatomegaly

32
Q

what blood test along with clinical findings would indicate hydatid cysts more than any other pathology

A

eosinophilia

33
Q

investigations into liver abscess

A

LFTs - raised ALP

USS abdo

CT imaging with contrast

34
Q

management of liver abscesses

A

abx therapy

drained via image-guided aspiration of the abscess (either CT or USS)

surgery only indicated if the abscess has ruptured

35
Q

what is an amoebic abscess and what causes it

A

most common extra-intestinal manifestation of amebiasis infection, caused by the organism entamoeba histolytica

36
Q

what is the most common primary liver tumour

A

hepatocellular carcinoma (HCC)

37
Q

what is the pathophysiology of hepatocellular carcinoma and what is it most commonly due to

A

result of a chronic inflammatory process affecting the liver

most common cause worldwide is viral hepatitis, other causes include chronic alcoholism

38
Q

risk factors for hepatocellular carcinoma

A

viral hepatitis (hep B and C the most common)

high alcohol intake

advanced age

family history of liver disease

smoking

39
Q

clinical features of hepatocellular carcinoma

A

vague, non-specific symptoms; fatigue, fever, weight loss, lethargy

dull ache in RUQ is characteristic of HCC

advanced disease may present with ascites or jaundice

40
Q

lab tests for liver cancer

A

FBC

LFT

Platelets and clotting time

AFP - raised in 70% of cases

41
Q

imaging of liver cancer

A

USS is method of choice followed by staging CT

if diagnosis is in doubt an MRI with biopsy can be done

42
Q

management of liver cancer

A

surgery or transplantation are the only curative options

43
Q

what are the most common cancers that metastasise to the liver

A

bowel, breast, pancreas, stomach and lung

44
Q

what biomarker is most important in suspected hepatocellular carcinoma

A

AFP

HPB (4 decks)

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