liver pathology and addiction Flashcards
How many types of jaundice are there?
3: Pre-hepatic, intra-hepatic and post hepatic.
Where does pre-hepatic jaundice occur?
Pathology occurs before the liver. It is before bilirubin has been transported from the blood to the liver
Where does intra-hepatic (hepatocllular) jaundice occur?
pathology occurs inside the liver
Where does post-hepatic (obstructive) jaundice occur ?
It is disruption that stops the bile from draining from the liver/gallbladder into the GI system.
What findings would you expect in Pre-hepatic jaundice?
- ↑conjugated bilirubin
* ↑ total bilirubin
What findings would you expect in intra-hepatic/hepatocellular jaundice?
- Dark urine
- Pale stool
- ↑ Conjugated bilirubin
- ↑ Unconjugated Bilirubin
- ↑ total bilirubin
- ↑ ALP
What findings would you expect in post-hepatic/obstructive jaundice?
- Dark urine
- Pale stool
- ↑ conjugated bilirubin + normal unconjugated bilirubin
- ↑ total bilirubin
- ↑ ALP
What is Gilbert syndrome?
- Gilbert syndrome is an unconjugated hyperbilirubinemia
- occasional and short-lived episodes of jaundice
- As Gilbert’s syndrome usually only causes a slight increase in bilirubin levels, the yellowing of jaundice is often mild. The eyes are usually affected most.
- at least 30% of patients with Gilbert syndrome are asymptomatic, although nonspecific symptoms, such as abdominal cramps, fatigue, and malaise, are common.
What is crigler-najjarn syndrome?
- Crigler-najjar unconjugated hyperbilirubinemia
- In Crigler-Najjar syndrome, jaundice is apparent at birth or in infancy. Severe unconjugated hyperbilirubinemia can lead to a condition called kernicterus, which is a form of brain damage caused by the accumulation of unconjugated bilirubin in the brain and nerve tissues.
Name 6 causes of Pre-hepatic Jaudice?
- Crigler-Najjar
- Gilberts syndrome
- Haemolysis → Thasalaemia, Sickle cell
- Drugs → rifampicin
- Malaria
- Haemolytic uraemic syndrome.
What is haemolytic Uraemic Syndrome?
- Hemolytic-uremic syndrome (HUS) is a clinical syndrome characterized by progressive renal failure that is associated with microangiopathic hemolytic anaemia and thrombocytopenia.
- Hemolytic-uremic syndrome (HUS) predominantly occurs in infants and children after prodromal diarrhea
What is Thalassemia?
• Beta thalassemia syndromes are a group of hereditary disorders characterized by a genetic
deficiency in the synthesis of beta-globin chains.
- In the homozygous state, beta thalassemia ( thalassemia major) causes severe, transfusion-dependent anemia.
- In the heterozygous state, the beta thalassemia trait ( thalassemia minor) causes mild to moderate microcytic anemia.
Name 6 causes of intra-hepatic/hepatocellular Jaudice?
- Viral and drug induced hepatitis
- Alcholic Liver Disease
- Hepatic cirrhosis
- Primary biliary Cirrhosis
- Leptospirosis
- Physiological Neonatal jaundice
What is leptospirosis?
- Leptospirosis is a type of bacterial infection spread by animals. It’s caused by a strain of bacteria called leptospira
- In 90% of cases, leptospirosis only causes mild flu-like symptoms, such as a headache, chills and muscle pain.
Name 6 causes of Post-hepatic/obstructive jaundice?
- Gallstones in common bile duct
- Pancreatic cancer
- Schistosomiasis
- Biliary atresia
- Cholangiocarcinoma
- Mirizzi’s syndrome
What is Mirizzi’s syndrome?
• Mirizzi’s syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct (CBD) or common hepatic duct, resulting in obstruction and jaundice
What is biliary atresia?
- Biliary atresia, also known as extrahepatic ductopenia, progressive obliterative cholangiopathy or “Kotb disease” is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent.
- It can be congenital or acquired.
What is UNconjugated bilirubin?
- When old red cells pass through the spleen, macrophages eat them up and break down the heme into unconjugated bilirubin. This in a non-water soluble bilirubin that used albumin as transport to the liver.
- NOT WATER SOLUBLE
What is conjugated Bilirubin?
- Conjugated bilirubin is unconjugated bilirubin that the liver conjugates with glucuronic acid, making it soluble in water. This allows it to become bile and mix in the duodenum.
- WATER SOLUBLE
What is a wilsons disease?
- Wilson disease is an autosomal recessive disorder in which excessive amounts of copper accumulate in the body, particularly in the liver, brain, and eyes
- treat with D-penicillamine and trientine
What is haemachromatosis?
- Hemochromatosis is the abnormal accumulation of iron in parenchymal organs, leading to organ toxicity.
- It is the most common autosomal recessive genetic disorder and the most common cause of severe iron overload.
- treat with venesection.
