Trafford block one notes Flashcards
What is Gamma GT?
a marker of hepatic obstruction, it is raised in alcohol abuse e.g every fresher has raised gamma GT
When do levels of ALP rise?
rises in hepatic obstruction but also in bone disorders. A
In what patient group is ALP physiologically high?
Children: transient hyperphosphatasmeia due to growth so higher osteoblast function. It is also higher in pregnant women in the third trimester
What symptoms indicate cholangitis e.g sepsis in biliary duct?
Biliary Colic right upper quadrant pain with associated jaundice and fever
Pain in pancreatitis starts from where and radiates to where?
severe epigastric pain that radiates to the back.
why is painless jaundice worrying?
Indicates liver or pancreatic cancer. Especially head of the pancreas
Two symptoms of portal hypertension
Splenomegaly and acites
Rise in ALT and AST greater than rise in Alk Phos?
hepatocellular damage
RISE in ALT and AST less than rise in Alk Phos?
obstructive cause
Is liver cancer usually primary or secondary?
secondary
test done in patients with painless obstructive jaundice over 40?
exclude carcinoma of head of the pancreas via imaging
What should you suspect if you can palpate the gall bladder, and is this common?
Very rare, you should suspect cholangiocarcinoma
What does a rise in ALP suggest?
Biliary tree pathology
What level of bilirubin do you need for jaundice?
50 or more
Haemolytic jaundice signs and symptoms
Liver function normal. Glucuronyl transferase is saturated. rise in unconjugated and conjugated bilirubin. Dark urine but no pale stools as there will still be bilirubin going into the GI tract
Hepatocellular jaundice.
Bilirubin fored at a normal rate but the liver can’t excrete it. e.g hepatitis, cirrosis, steatohepatitis. Unconjugated bilirubin increase. Small increase in conjugated possible. ALT will be greatly increased.
Jaundice in babies
Neonatal jaundice when bilirubin higher than 85 micromoles per letre. Happenes in 60% full term and 80% preterm. Due to slow glucuronyl transferase activation. Rise in unconjugated is normal. Rise in conjugated is pathological and always toxic, this is actually a sign of biliary tree obstruction.
What does itching, dark urine, pale stools and generally feeling unwell indicate? what would you find in biochemistry?
Obstructive jaundice, possibly cancer or gall stone. Rise in conjugated bilirubin, soluble so goes into urine, not going into GI tract so pale stools. ALP will be high
Next step if obstructive jaundice and high ALP?
MRCP
What aspects of history to focus on if hepatocellular damage is suspected?
Alcohol history, drugs, cigarettes and sexual history.
Jaundice examination:
Sclera, scratches for prurities (bile salts under skin cause itching), evidence of weight loss and troisiers node for cancer (left supraclavicular)
Hep A
Never chronic, faeco-oral spread
Difference between IgM and IgG
IgM in acute and IgG chronic
Info on Hep B:
Blood, sex, vertical transmition. Endemic in Africa and Asia. Increase risk of liver cancer. Prognosis determined by rate of fibrosis progression and viral turnover. Tests: Anti-C IgM for acute. Presence of HBsAg determines chronic.
