Liver - jaundice

Question 1

Jaundice/Liver failure history - exposures

Answer 1

Exposures
- sex
- travel
- IV use incl tattoos
- Drugs + medications
- alcohol

Question 2

Non invasive liver screen

Answer 2

LFT
Immunoglobulins
Anti-nuclear antibodies including ds-DNA, anti-mitochondrial Ab, anti-smooth muscle, anti-livermucslekidney
Caeruloplasmin + copper
Ferritin/Transferrin
alpha-1-AT
BBV - HIV, hep B, hep C, EBV, CMV
HbA1c
US liver +/- Fibroscan

Question 3

Tests of liver function

Answer 3

Albumin
Clotting with INR

Question 4

Tumour makers

Answer 4

AFP = HCC
Ca 19-9 = pancreas
CEA = bowel
Ca15-3 = breast

Question 5

Hereditary Haemochromatosis

Answer 5

New jaundice/Liver Disease/new onset diabetes/ ED

Ferritin high
Transferrin >45%
Test HFE gene

Treatment: venesection (may underestimate HbA1c)

Question 6

Causes of jaundice; prehepatic

Answer 6

Haemolysis, Gilbert’s

Question 7

Causes of jaundice; hepatic

Answer 7

Viruses
Liver abscess
Drugs including paracetamol
Alcohol
HCC and liver mets
HH
Wilson’s
AI-hepatitis
A1AT deficiency

Question 8

Causes of jaundice; post-hepatic

Answer 8

Gallstones in CBD
PBC, PSC
Cholangiocarcinoma
Pancreatic Ca