MedEd liver and biliary disease 1 Flashcards
what does haeme break down into?
unconjugated bilirubin and iron
how is bilirubin carried in blood?
bound to albumin
where is bilirubin conjugated?
liver
what enzyme conjugates bilirubin?
UDPGT
what are the 2 causes of pre hepatic jaundice?
haemolysis
gilbert’s
what are some causes of hepatic jaundice
hepatitis- viral, alcoholic, AI, drug
cirrhosis
what are some causes of obstructive jaundice
liver mass gallstone PBC pancreatic cancer cholangiocarcinoma drug causing ileus
in what jaundice do you get dark urine?
obstructive jaundice
pre hepatic haemolytic jaundice
what does dark urine, pruritus and pale stool indicate?
obstructive jaundice
what is raised in prehepatic jaundice in lfts?
only bilirubin
what is raised in hepatic jaundice on lfts?
ast and alt
what is raised in obstructive jaundice on lfts?
alp and ggt
what are some causes of hepatitis?
viral alcohol autoimmune drugs NASH
what is raised in lfts in hepatitis?
ast and alt
how does hepatitis present?
RUQ pain jaundice hepatomegaly joint pain nausea fatigue dark urine
how may hepatitis progress?
acute hep then recovery
acute hep then liver failure
acute hep goes to chronic goes to cirrhosis goes to liver failure
what is the progression of alcoholic liver disease? describe symptoms
steatosis (fatty liver)- after few days heavy drinking, no symptoms
alcoholic hepatitis- after long term alcohol use but laso after binge, nausea, anorexia, weight loss, hepatomegaly
cirrhosis- scarring and fibrosis of liver
what ix are done for alcoholic hep and what do you see?
fbc- macrocytic anaemia lfts- ast/alt (ratio >2), high bilirubin, high GGT, low albumin clotting- high PT hepatic USS liver biopsy- shows mallaory bodies
what is seen on liver biopsy in alcoholic hepatitis?
mallory bodies
what is a time sensitive marker of significan liver dmaage?
PT
how is alcoholic hep managed?
manage for withdrawal- chlordiazepoxide
nutrition- pabrinex to prevent wernicke-karsakoff
weight loss
stop smoking
how does non alcoholic fatty liver disease progress?
steatosis
steatohepatitis
cirrhosis
why might someone get nafld?
obesity, diabetes, hyperlipidaemia, hypetension etc
what signs might you see in nafld and why?
insulin resistance eg acanthosis nigricans, polyuria and polydipsia
what types of hepatitis is acute?
A and E
whats the prognosis for hep A and E?
full recovery
how are hep A and E transmissed and how do you remember this?
fAEcal oral
are hep B and C acute or chronic
acute or chronic
C most commonly is Chronic
B usually just acute
what is important to remember about hep D?
can only have it if you’ve had hep B
what surface antigen does hep b have?
HBsAg
what core antigen does hep b have?
HBcAg
what is a surface vs core antigen
surface= on surface of virus and exposed to blood core= inside the virus and not exposed to blood
what antibody should someone with hep b vaccination have?
HBsAb
what antibody is only present if someone has been infected with hep b?
HBcAb
whats is anti HBs v anti HBc
anti HBs= antibody for hep B surface antigen
anti HBc= anitbody for hep B core antigen
what class is the core antibody for hep b?
IgM
what is cirrhosis?
normal liver replaced by fibrosis and nodules of regenerating hepatocytes
what are signs of chronic stable liver disease?
clubbing spider naevi (3 or more) dupuytrens contracture erythema gynacomastia
what is a complication of cirrhosis?
portal hypertension
what are signs of portal hypertension?
caput medusae
lower oesophageal varices
ascites
splenomegaly
how is cirrhosis managed?
treat cause eg viral hep
6 monthly USS
endoscopy every 3 yrs
what are some complications of cirrhosis?
encephalopathy
variceal bleeds
spontaneous bacterial peritonitis
what is a complication of ascites?
spontaenous bacterial peritonitis
how is hepatic encephalopathy managed?
treat precipitating event eg GI bleed
short term low protein diet
oral lactulose, rifaximin, phosphate enema
avoid sedatives
how does the liver clear ammonia?
breaks it down into urea
how is ascites managed?
sodium restriction
diuretics
paracentesis if needed
how is SBP managed?
abx- metronidazole and cefuroxime
how are varicies managed?
primary prohylaxis- beta blocker is small EVL if big
ruptured- ABCDE, IV fluids/bloods, terlipressin and abx and EVL after resus (surgically band the varices)
secondary prohylaxis- non selective beta blocker
TIPs procedure
what abx are given for SBP?
metronidazole and cefuroxime
what is cholelithiasis?
gallstone in gallbladder
what is biliary colic?
pain caused by gallstones
pain+ cholelithiasis
what is acute cholecystitis?
cholelithiasis, inflammation and secondary infection
