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DPD Stuff > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What are the causes of high Bilirubin?

A

Pre hepatic
Hepatic
Post-hepatice

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2
Q

What is the structure of the liver lobules?

A

Portal triad -> Sinusiod/ space of Disse-> Central vein

Direction of blood flow
(Bile in opposite directions)

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3
Q

What does the space of Disse do?

A

Allows blood to get close to the hepatocytes

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4
Q

What is in the portal triad?

A

Portal vein from gut
Portal artery
Bile duct

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5
Q

What might you see on a liver ultrasound?

A

Tumour at head of the pancreas

Gallstones

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6
Q

What blood tests might you do after finding high BR?

A 
FBC/ Film (haemolysis)
Virology (hepatitis)
Amylase (pancreas)
Antibodies
Repeat BR fasting (hepatic disease)
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7
Q

What is the Van den Bergh test?

A

The van den Bergh reaction measures serum bilirubin via fractionation.

A direct reaction measures conjugated bilirubin.
The addition of methanol causes a complete reaction, which measures total bilirubin (conjugated plus unconjugated);

the difference measures unconjugated bilirubin (an indirect reaction).

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8
Q

What is paediatric jaundice a sign of?

A

Might be normal but the bilirubin should be unconjugated as the cause is usually liver immaturity coupled with a fall in the haemoglobin early in life.

If it doesn’t settle, other rare causes should be looked for including hypothyroidism, other causes of haemolysis (including a Coombes test or DAT), and the unconjugated bilirubin will be useful.

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9
Q

What is phototherapy?

A

Converts bilirubin into two other compounds, lumirubin and photobilirubin which are isomers that do not need conjugation for excretion.

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10
Q

How is Gilbert’s inherited?

A

Recessive

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11
Q

How many people carry the gene for Gilbert’s?

A

50%

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12
Q

What is the pathology of Gilbert’s?

A

UDP glucuronyl transferase activity reduced to 30%

Unconjugated bilirubin tightly albumin bound and does NOT enter urine.

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13
Q

What are the better indicators of liver functions?

A
  • Albumin
  • Clotting factors (PT, PTTK)
  • Bilirubin

Other tests are “enzymes”, not truly tests of liver function.

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14
Q

Which liver test is best for paracetamol overdose?

A

PT- quick

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15
Q

Differential for Abnormal LFTs, BR raised?

A

Pre hepatic (gilberts, haemolysis)

Hepatic (Viral or alcoholic hepatitis, cirrhosis)

Post hepatic (Gallstones, pancreatic cancer)

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16
Q

What does high AST/ALT plus marginal Alk Phos suggest?

A

Hepatic cause of liver issues (hepatocyte damage)

17
Q

What is the serology of Hep A?

A
  • Virus in faeces 2-6 weeks after infection- Infectious period
  • IgM 3-13 weeks after infection
  • IgG 5 weeks plus immunity
18
Q

What is hepatitis B serology?

A
  • 3 months- High Hep N antigen
  • 2-4 months antibodies strat increasing
  • After 6 months- antibodies and immunity- no second attack
19
Q

What is a Hep B carrier?

A

Some people don’t clear the antigen so they are carriers

20
Q

What are the histological features of alcoholic hepatitis?

A
  • Mallory denk bodies (cytoskeletons of destroyed hepatocytes)
  • Neutrophil inflammation
  • Bile accumulation in liver
  • Fatty change
  • Megamitochondria
21
Q

What is NASH associated with?

A
  • Insulin resistance

NASH (Non Alcoholic Steato Hepatitis)

22
Q

What are some signs of chronic stable liver disease?

A

Multiple spider naevi
Dupuytren’s contracture
Palmar erythema
Gynaecomastia

23
Q

What is the triad of portal hypertension?

A

Caput Medusae/ visible veins
Splenomegaly
Ascites

24
Q

How do we fix a ruptured oesphageal varix?

A
  • Terlipressin
  • Sengstaken–Blakemore tube (Apply pressure via balloon)
  • Emergency endoscopy and inject to close the bleed
  • X match and transfusion
25
Q

Small nodules and fat histologically denotes what in the liver?

A

Alcoholic hepatitis?

26
Q

What are sites of porto systemic anastomoses that can cause issues?

A
  • Oesophageal varices
  • Rectal varices
  • Umbilical vein recanalising
  • Spleno-renal shunt
27
Q

How do we fix portal hypertension?

A

TIPS
Transjugular intrahepatic portosystemic shunt

Drops portal pressure BUT can cause encephalopathy

28
Q

What do excoriation marks suggest with a patient having a background of liver issues?

A

Bile duct obstruction

Caused by colourless bile salts into circulation

29
Q

What would increase alk phos?

A

Obstructive BR

30
Q

Where do some adenocarcinomas start?

A

Pancreas

31
Q

What is courvoisier’s law?

A

In the presence of jaundice, if the gall bladder is palpable, the cause is unlikely to be gall stones.

This is because a gall bladder with stones is usually small and fibrotic and incapable of being large.

DPD Stuff (23 decks)

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