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GI System > Liver Symposium: Viral liver disease/alcohol related problems/liver transplantation issues > Flashcards

Liver Symposium: Viral liver disease/alcohol related problems/liver transplantation issues Flashcards

1
Q

What is jaundice?

A

Yellowing of the skin, sclerae and other tissues e.g. eyes, caused by excess circulating bilirubin

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2
Q

At what level of bilirubin can jaundice become detectable?

A

Total plasma bilirubin levels exceed 34μmol/L

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3
Q

What is the lifespan of a RBC?

A

120 days

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4
Q

What happens to the haem part of the RBC after it dies?

A

Converted to Biliverdin (Unconjugated – Insoluble form) and then in the Liver it is converted to Bilirubin (Conjugated – Soluble form)

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5
Q

Where is unconjugated Bilirubin found?

A

Pre-hepatic

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6
Q

Where is conjugated Bilirubin found?

A

Hepatic & Post-hepatic`

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7
Q

What type of jaundice is most likely to occur in an obstructive condition?

A

Post-hepatic

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8
Q

Where is most conjugated bilirubin excreted?

A

Stool

A little to the kidney for urine

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9
Q

What will occur in pre-hepatic jaundice?

A

Increased quantity of bilirubin (Haemolysis) and impaired transport No urine change

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10
Q

What will there have been a history of in pre-hepatic jaundice?

A

Anaemia
Acholuric jaundice
Pallor
Splenomegaly

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11
Q

What will occur in hepatic jaundice?

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion e.g. Liver failure

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12
Q

What are the signs of hepatic jaundice?

A

Stigmata of CLD e.g. Spider naevi
Gynaecomastia
Ascites
Asterixis (Flapping tremor)

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13
Q

What occurs in post-hepatic jaundice?

A

Defective transport of bilirubin by the biliary ducts

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14
Q

What are signs of post-hepatic jaundice?

A

Abdominal pain
Cholestasis e.g. Pruritis (Itching - Bile salts deposit in the skin as the duct is blocked), Pale stools & High coloured urine)

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15
Q

How does a palpable gallbladder occur in post-hepatic jaundice?

A

Obstruction in the bile duct past the cystic duct, can’t go anywhere and will back up causing an enlarged Gall Bladder Due to gall stones of liver cancer

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16
Q

What is Gilbert’s syndrome?

A

Genetic defect that results in a rise in unconjugated bilirubin and this bilirubin rises with fasting

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17
Q

In relation to jaundice, what is dark urine and pale stool indicative of?

A

Obstructive jaunduce

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18
Q

What should be checked in the history in relation to jaundice?

A

Occupation, Travel abroad, Contacts with jaundice, Sexual relations, Shellfish consumption, Injections & Drugs

19
Q

What time will be elevated with liver disease?

A

Prothrombin time (Factors II, V, VII & IX)

20
Q

What six hepatic causes are there for deranged LFTs?

A 
Alcoholic cirrhosis/hepatitis
Viral hepatitis
PBC
Non-alcoholic Fatty Liver Disease (NAFLD)
Metastatic cancer
Drug induced
21
Q

What is a post-hepatic cause for deranged LFTs?

A

CBD stone

Carcinoma of the pancreas

22
Q

What tests should be done for Haemachromatosis?

A

Ferritin
Fe2+
Transferrin saturation

23
Q

In what cases is a Hepatitis A (IgM) serology seen?

A

Acute liver disease

24
Q

When should an AFP test be done?

A

Suspected liver cancer

25
Q

What tests should be done for fatty liver disease?

A 
Fasting glucose (Diabetes)
Lipid profile (Hyperlipidaemia)
26
Q

Why is urine clear in pre-hepatic jaundice?

A

Unconjugated bilirubin insoluble in water
Unconjugated bilirubin circulates bound to albumin
Albumin is too large to fit through the glomerulus

27
Q

Why is urine dark in cholestatic jaundice?

A

Urine is dark because conjugated bilirubin is soluble in water, it circulates unbound and is free to pass through glomerulus
Stools are pale because stercobilinogen does not reach the stool

28
Q

What is a good treatment for decompensated cirrhosis?

A

Liver transplant

29
Q

What are the differences between ERCP & MRCP?

A

ERCP - Radiation, Sedation, Complication (Sedation or Procedure related), Failure rate, Only images ducts & Therapeutic option
ERCP is both diagnostic and therapeutic
MRCP - No radiation/complications, Claustrophobia & Images with outwith ducts

30
Q

What steps should be taken in managing obstructive jaundice?

A

Relief of obstruction
Prevent complication
Prevent recurrence

31
Q

What should be done when treating ascending cholangitis?

A

Prompt drainage

Control infection

32
Q

What is ascending cholangitis?

A

Biliary tree infection

33
Q

What is hepatitis?

A

Inflammation of the liver

34
Q

What are the causes of hepatitis?

A

Viral/Bacterial
Drugs
Chemicals
Toxins

35
Q

When does hepatitis A occur, how is it transmitted and how is it diagnosed?

A

Occurs sporadically or in epidemic form
Transmitted by Faecal-Oral, Sexual or Blood
Acutely diagnosed by IgM antibodies

36
Q

When does hepatitis B occur, how is it transmitted and how is it prevented?

A

Sporadic, endemic and epidemic
Blood, Sexual and Faecal-Oral
Prevention - Vaccination, Blood product screening, Clean needles, Discourage IDU, Alter sexual practices & Safe disposal of sharps

37
Q

How should Hepatitis B be treated?

A

Interferon
Tenfovier, entecavir
Lamivudine and Adefovir (Viral mutations occur)

38
Q

How does Hepatitis C present’?

A

Most asymptomatic until cirrhotic

May have normal LFTs

39
Q

What can Hepatitis C result in?

A

Liver failure or Hepatoma

40
Q

How is Hepatitis C transmitted and treated?

A

Transmitted - IDU, Tattoo, Sexual, Unknown & Blood products
Treated - 6-12 month treatment of direct anti-viral drugs

41
Q

How does Hepatitis E present and what is its treatment?

A

Self-limiting with no long-term sequelae

No specific treatment or effective vaccine made yet

42
Q

What type of biliary tract lesions are there?

A

Lumen - Gallstones & Polyps
Wall - Cholangiocarcinoma & Benign structre
External pressure - Pancreatic cancer, Pancreatitis & Lymph nodes

43
Q

What are the contraindications for liver transplant?

A

Advanced cardiopulmonary disease

Extra-hepatic malignancy

GI System (38 decks)

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