Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Path > Liver Function CPC > Flashcards

Liver Function CPC Flashcards

1
Q

CASE 1
A 20-year old medical student is referred up because of abnormal LFTs.
Bilirubin 32 micromol/l (N 5-17)
1. What are the causes of a high bilirubin?

A

Pre-hepatic (Unconjugated) - Haemolysis - Do FBC and Film to look for this
Hepatic disease - Repeat LFT’s
Post hepatic (Conjugated) Raised AlkPhos - Obstuctive i.e. Gallstone or pancreas
Gilberts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CASE 1
A 20-year old medical student is referred up because of abnormal LFTs.
Bilirubin 32 micromol/l (N 5-17)

Other LFT’s normal

Cousin had case of jaundice once and normal liver biopsy

2) What should we do ?
A. Nothing
B. Repeat bilirubin fasting
C. Other blood tests
D. Abdo Ultrasound
E. CT abdomen
F. Liver Bx.
A

B) Repeat bilirubin fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CASE 1
A 20-year old medical student is referred up because of abnormal LFTs.
Bilirubin 32 micromol/l (N 5-17)

Repeated Blood tests while fasting

FBC normal

Normal film

LFT’s normal except Bilirubin has gone higher: 45

3) What does he have?

A

Gilberts Syndrome - Bilirubin high but every other LFT is normal. Bilirubin is made worse by fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gilberts Syndrome

4. How is it inherited ?
A. Recessive
B. Dominant
C. X-linked
D. No idea
A

A) Recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gilberts Syndrome

5. What percentage are carriers?
A. 10%
B. 20%
C. 50%
D. 70%
E. 80%
A

C) 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’s the pathology of Gilberts?

A

UDP glucuronyl transferase activity reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Will you find Bilirubinurea in gilberts?

A

No bilirubinurea as unconjugated bilirubin binds to albumin and doesn’t enter urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What difference in urine for obstructive jaundice

A

No/reduced Urobilinogen and dark urine

This is because bilirubin goes into gut and makes stools brown

In a normal person that bilirubin is reabsorbed and turned into urobilinogen which you pee out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Which is most representative of liver function?
A. Prothrombin time
B. Bilirubin
C. Alanine Aminotransferase (ALT)
D. Aspartate Aminotransferase (AST)
E. Alkaline phosphatise (Alk Phos)
F. Gamma Glutamyl Transferase (GGT)
A

A. Prothrombin time

Because all of the other ones leak out when liver is damaged

Whereas prothrombin time measures the activity of the liver producing the clotting factors

Albumin, Bilirubin, and Clotting factors also indicate liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. What is the most worrying sign in a patient who has taken a paracetamol overdose?

A. High AST and ALT
B. Prolonged PT
C. Jaundice
D. Raised GGT and ALP

A

B) Prolonged PT

If PT in seconds is greater than hours of OD, need liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chronic alcohol abuser aged 35 presents with jaundice, abdominal pain, nausea.

The bilirubin is 90 micromoles per litre (N 5-17).

  1. What is your differential diagnosis at this point ?
A

Pre-hepatic - Gilberts, Haemolysis

Hepatic - Viral/Alcoholic Hep, cirrhosis

Post hepatic - Gallstones, Pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chronic alcohol abuser aged 35 presents with jaundice, abdominal pain, nausea.

Liver function tests:

Bilirubin 90.
Alk Phos: 200 (<130)
AST: 1500 (<50)
ALT: 750 (<50)

  1. What diagnoses do these suggest is causing the jaundice?
    A. Pre-hepatic
    B. Hepatic
    C. Post-hepatic
A

B. Hepatic

In obstructive - ALP will have the biggest increase

In hepatic - AST/ALT will have the biggest increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chronic alcohol abuser aged 35 presents with jaundice, abdominal pain, nausea.

Evidence of ballooning, Mallory Denk bodies, and inflammation of the liver

  1. What treatment is needed?
A

Supportive
Stop alcohol
Nutrition
Vitamins - Pabrinex (Vitamins B and C) (Thiamine is the only one needed in this case, but the infusion has em all)

Occasionally steroids if liver inflammation found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic alcohol abuser aged 35 presents with jaundice, abdominal pain, nausea.

  1. Which of the following conditions is caused by vitamin B1 deficiency?
A. Rickets
B. Scurvy
C. Pernicious anaemia
D. Beri-Beri
E. Pellagra
F. Neural tube defects
A

D. Beri-Beri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chronic alcohol abuser aged 37

Two years later he has:

Multiple Spider Naevi
Dupuytren’s contracture
Palmar Erythema
Gynaecomastia

13. What do these signify?
A. Jaundice
B. Hepatitis
C. Chronic stable liver disease
D. Portal hypertension.
E. Liver failure
F. Obstruction of the bile ducts
A

C. Chronic stable liver disease

They won’t get better if they stop drinking, but they’ll be stable if they stop drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chronic alcohol abuser aged 40

  1. Five years later, this is seen on his abdomen.

Veins visible on abdomen

What is it and what causes it?

A

Visible veins - Caused by portal hypertension. Not Caput Medusae yet.

Caput Medusae when lots of Visible veins radiating out of the umbilicus

17
Q

Chronic alcohol abuser aged 40

  1. What else are you MOST likely to find on abdominal examination at this stage, given the visible vein on anterior abdominal wall?
A. Hepatomegaly
B. Splenomegaly
C. Bilateral palpable kidneys
D. A palpable bladder
E. An enlarged prostate gland on PR.
A

B. Splenomegaly

As portal hypertension leads to splenic vein pressure and back up in the spleen

18
Q

Chronic alcohol abuser aged 40

Examination revealed scrotal oedema and shifting dullness.

What does this suggest?

What would non shifting dullness suggest?

A

Ascites

Non shifting dullness is just normal fat

19
Q

Chronic alcohol abuser aged 40 with:

Visible veins
Splenomegaly
Ascites

17. What has happened ?
A. Jaundice
B. Hepatitis
C. Chronic stable liver disease
D. Portal hypertension.
E. Liver failure
F. Obstruction of the bile ducts.
A

D. Portal hypertension.

All 3 are signs of portal hypertension

20
Q

Chronic alcohol abuser aged 40 with:

Visible veins
Splenomegaly
Ascites

Admitted to drain ascites but developed a short flap shortly afterwards

18. What has happened ?
A. Jaundice
B. Hepatitis
C. Chronic stable liver disease
D. Portal hypertension.
E. Liver failure
F. Obstruction of the bile ducts.
A

E. Liver failure

Liver flap is a sign that brain is now being poisoned by something the liver should’ve cleared out (Assumed to be ammonia)

21
Q

What are the 4 aspects of liver failure

A

Failed synthetic function n (Hypoglycaemia)

Failed clotting factor and albumin (Easy bleeds/bruising)

Failed clearance of bilirubin (Jaundice)

Failed clearance of ammonia (Assumed to be cause of hepatic encephalopathy)

22
Q

How to manage liver failure?

A

Manage Hypoglycaemia

IV Vit K to help with bruising/bleeding

Treat encephalopathy with lactulose

Path (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions