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Alimentary System > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

What causes jaundice?

A

Increased circulating bilirubin due to altered metabolism/altered metabolism pathway of bilirubin

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2
Q

What are the classes of jaundice?

A

Pre-Hepatic
Hepatic
Post-Hepatic

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3
Q

What are the types of hepatic jaundice?

A

Predictable (dose related) and unpredictable

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4
Q

What are the causes of hepatic jaundice?

A

Cholestasis

Intra-hepatic bile duct obstruction

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5
Q

What is the cause of pre-hepatic jaundice?

A

Increased release of haemoglobin from RBCs due to haemolysis

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6
Q

What is the cause of post-hepatic jaundice?

A

Gallstones

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7
Q

What is bilirubin?

A

A by-product of haemoglobin metabolism, haem part -> bilirubin

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8
Q

Bilirubin joins with albumin which the liver helps to solubilise so it can be

A

excreted in the bile

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9
Q

Why might bilirubin be elevated?

A

Haemolysis
Parenchymal damage
Obstruction

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10
Q

What amino-transferases can indicate liver injury?

A

ALT and AST

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11
Q

Is ALT or AST more specific?

A

ALT

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12
Q

If the AST levels > ALT levels, what is indicated?

A

Liver disease caused by alcohol

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13
Q

What is alkaline phosphatase and when might it be elevated?

A

Enzyme present in the bile ducts, elevated with obstruction or liver infiltration

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14
Q

When is Gamma-GT elevated?

A

With alcohol consumption and some drugs e.g. NSAIDs

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15
Q

If alkaline phosphatase and gamma-GT are both raised, what is indicated?

A

Liver disease

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16
Q

What do albumin tests show?

A

Synthetic function of the liver

17
Q

Low levels of albumin suggest

A

chronic liver disease, kidney disorders or malnutrition

18
Q

What symptom/sign can be seen in any condition causing a fall in albumin?

A

Oedema

19
Q

What does prothrombin time determine?

A

The extent and prognosis of liver dysfunction

20
Q

What is prothrombin time a test of?

A

Clotting factors

21
Q

What does creatinine test and why is this important?

A

Tests kidney function
Important as the liver and kidneys are closely related and poor kidney function indicates a poorer prognosis of liver disease

22
Q

Why is platelet count important in determining liver disease?

A

Liver is an important source of thrombopoetin, cirrhosis resulting in hyperplenism results in low platelets and indicates portal hypertension

23
Q

Give 6 investigations which should be done when investigating liver disease

A 
Immunoglobulins 
Autoantibodies 
Caeruloplasmin copper 
Ferritin 
Alpha-1 antitrypsin 
Hepatitis serology 
Epstein Barr Virus 
Cytomegalovirus 
Leptospira 
Alphafetoprotein 
Fasting glucose/lipid profile
24
Q

What is the treatment for hepatic encephalopathy?

A

Bowel clear out
Antibiotics for underlying infection
Palliative care
Chemo/radiotherapy

25
Q

What is the treatment for spontaneous bacterial peritonitis?

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

26
Q

What is the treatment for alcoholic hepatitis?

A 
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
27
Q

What is the treatment of steatohepatitis?

A

Weight loss and exercise

28
Q

What is the treatment of obstructive jaundice?

A

ERCP / PTC

29
Q

What is the treatment of ascites?

A

Diuretics
Paracentesis
TIPS
Aquaretics

30
Q

What is the treatment of portal hypertension?

A 
Resuscitation 
Blood transfusion 
Endoscopic band ligation 
Sengstaken-Blakemore tube for uncontrolled bleeding 
TIPS for re-bleeding
31
Q

What is the treatment of chronic hepatitis B?

A

Interferon
Tenofovir
Entecavir
Lamivudine and Adefovir

32
Q

What is the treatment of hepatitis C?

A

6 or 12 month treatment
Weekly subcutaneous injection of pegylated interferon
Daily Ribavirin tablets
Protease inhibitor for genotype 1 patients

33
Q

What are the possible treatments of gallstones?

A

Dissolution
Lithotripsy
Laparoscopic cholecystectomy
Cholecystotomy

34
Q

What are the possible treatments for common bile duct stones?

A

Laparoscopic/open exploration of CBD
ERCP
Trans-hepatic stone retrieval

35
Q

What are the possible treatments for cholangiocarcinoma?

A 
Surgical bypass 
Stenting 
Radio/chemotherapy 
PDT 
Surgery - only potentially curative option

Alimentary System (29 decks)

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