Liver Symposium Flashcards
What causes jaundice?
Increased circulating bilirubin due to altered metabolism/altered metabolism pathway of bilirubin
What are the classes of jaundice?
Pre-Hepatic
Hepatic
Post-Hepatic
What are the types of hepatic jaundice?
Predictable (dose related) and unpredictable
What are the causes of hepatic jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is the cause of pre-hepatic jaundice?
Increased release of haemoglobin from RBCs due to haemolysis
What is the cause of post-hepatic jaundice?
Gallstones
What is bilirubin?
A by-product of haemoglobin metabolism, haem part -> bilirubin
Bilirubin joins with albumin which the liver helps to solubilise so it can be
excreted in the bile
Why might bilirubin be elevated?
Haemolysis
Parenchymal damage
Obstruction
What amino-transferases can indicate liver injury?
ALT and AST
Is ALT or AST more specific?
ALT
If the AST levels > ALT levels, what is indicated?
Liver disease caused by alcohol
What is alkaline phosphatase and when might it be elevated?
Enzyme present in the bile ducts, elevated with obstruction or liver infiltration
When is Gamma-GT elevated?
With alcohol consumption and some drugs e.g. NSAIDs
If alkaline phosphatase and gamma-GT are both raised, what is indicated?
Liver disease
What do albumin tests show?
Synthetic function of the liver
Low levels of albumin suggest
chronic liver disease, kidney disorders or malnutrition
What symptom/sign can be seen in any condition causing a fall in albumin?
Oedema
What does prothrombin time determine?
The extent and prognosis of liver dysfunction
What is prothrombin time a test of?
Clotting factors
What does creatinine test and why is this important?
Tests kidney function
Important as the liver and kidneys are closely related and poor kidney function indicates a poorer prognosis of liver disease
Why is platelet count important in determining liver disease?
Liver is an important source of thrombopoetin, cirrhosis resulting in hyperplenism results in low platelets and indicates portal hypertension
Give 6 investigations which should be done when investigating liver disease
Immunoglobulins Autoantibodies Caeruloplasmin copper Ferritin Alpha-1 antitrypsin Hepatitis serology Epstein Barr Virus Cytomegalovirus Leptospira Alphafetoprotein Fasting glucose/lipid profile
What is the treatment for hepatic encephalopathy?
Bowel clear out
Antibiotics for underlying infection
Palliative care
Chemo/radiotherapy
What is the treatment for spontaneous bacterial peritonitis?
IV antibiotics
Ascitic fluid drainage
IV albumin infusion
What is the treatment for alcoholic hepatitis?
Palliative Treat underlying infections Treat encephalopathy Treat alcohol withdrawal Protect against GI bleeding Airway support/ITU care Steroids if severe - improve short term prognosis Nutritional supplements Thiamine
What is the treatment of steatohepatitis?
Weight loss and exercise
What is the treatment of obstructive jaundice?
ERCP / PTC
What is the treatment of ascites?
Diuretics
Paracentesis
TIPS
Aquaretics
What is the treatment of portal hypertension?
Resuscitation Blood transfusion Endoscopic band ligation Sengstaken-Blakemore tube for uncontrolled bleeding TIPS for re-bleeding
What is the treatment of chronic hepatitis B?
Interferon
Tenofovir
Entecavir
Lamivudine and Adefovir
What is the treatment of hepatitis C?
6 or 12 month treatment
Weekly subcutaneous injection of pegylated interferon
Daily Ribavirin tablets
Protease inhibitor for genotype 1 patients
What are the possible treatments of gallstones?
Dissolution
Lithotripsy
Laparoscopic cholecystectomy
Cholecystotomy
What are the possible treatments for common bile duct stones?
Laparoscopic/open exploration of CBD
ERCP
Trans-hepatic stone retrieval
What are the possible treatments for cholangiocarcinoma?
Surgical bypass Stenting Radio/chemotherapy PDT Surgery - only potentially curative option
