Week 10b: Hepatobiliary Disorders Flashcards
which test is an indicator of hepatobillary disease/alcohol abuse?
GGT
which 2 tests are a measure of liver cell production failure?
- low serum albumin
- prolonged prothrombin time
any condition in which substances that are normally excreted in the bile are retained
cholestasis
intrahepatic cholestasis
- biliary cirrhosis
- primary sclerosing cholangitis
extrahepatic cholestasis
- increased pressure in the large bile ducts
- obstruction of the large bile ducts, cholelithiasis, common duct strictures or obstructing neoplasms
cholestasis will result in which lab finding?
elevated serum alkaline phosphatase
the substance that gives bile its colour
bilirubin
free (indirect) bilirubin
insoluble in plasma and transported attached to plasma albumin
conjugated (direct) bilirubin
is soluble in the bile and secreted into the bile
elevated indirect bilirubin may indicate?
hemolysis
elevated direct bilirubin may indicate?
hepatobiliary disorder
prehepatic jaundice
- involves unconjugated bilirubin
- major cause: excessive hemolysis of RBCs
Intrahepatic jaundice
- involves conjugated bilirubin
- caused by disorders that directly affect the ability of the liver to remove bilirubin from the blood or conjugate it so it can be removed in the bile
post hepatic jaundice
- involves conjugated bilirubin
- occurs when the bile flow is obstructed between the liver and the intestine
direct hepatotoxic injury Wille cause which lab findings?
- marked elevations in ALT, AST and bilirubin
- minimally elevated alkaline phophatase
what occurs during the prodromal or preicterus period of acute viral hepatitis?
- general malaise, myalgia, arthralgia, easy fatiguability, anorexia, nausea, vomiting, diarrhea and/or constipation
- abdominal pain on the right side
- chills and fever
- elevated AST and ALT
icterus period of acute viral hepatitis
- follows the prodromal phase by 1-2 weeks
- jaundice is less likely to occur with HCV infection
- rise in bilirubin causes severe pruritus and liver tenderness
what occurs during the convalescent period of acute viral hepatitis?
return of appetite and disappearance of jaundice
what is the surface antigen in hepatitis B ?
HBsAg
HBsAg
appears before the onset of symptoms in Hep B, peaks during the overt disease, declines to undetectable levels in 3-6 months. Persistence beyond 6 months indicates chronic hepatitis
What is the core antigen in Hep B?
HBcAg: indicates active viral replication
What is the pre-core/core antigen in Hep B?
HBeAg
For Hep B, HBIG is usually given within..?
7 days of exposure
what are the serological anti bodies that are tested during Hep B?
- anti-HBs
- anti-HBc
- anti HBe
alcohol induced liver disease can cause?
hypoglycaemia
fatty liver
accumulation of fat in the hepatocytes (steatosis)
alcoholic hepatitis
intermediate stage between fatty changes and cirrhosis. Involves inflammation and necrosis of the liver cells
Alcoholic cirrhosis
onset of end-stage alcoholic liver disease. Involves fine uniform nodules on the liver’s surface.
caput medusae is associated with ?
cirrhosis
hepatorenal syndrome
- a manifestation of liver failure
- involves progressive azotemia, increased serum creatinine levels and oliguria
hepatic encephalopathy
results in neural disturbances, confusion, coma and convulsions because ammonia is neurotoxic
what is a very early sign of hepatic encephalopathy
asterixis
what are some common causes of acute pancreatitis?
- gallstones
- alcohol abuse
- hyperlipidemia
- hyperparathyroidism
- infections
- abdominal and surgical trauma
- drugs such as steroids and thiazide diuretics
Lab findings in acute pancreatitis?
serum lipase and amylase levels are typically elevated
Clinical manifestations of acute pancreatitis
- cyanosis, dyspnea
- decreased or absent bowel sounds
- low grade fever, leukocytosis
- hypotension, tachycardia
- jaundice
- flushing
- abnormal lung sounds (crackles)
- discolouration of abdominal wall (Turner’s or Cullen’s sign)
- signs of shock
bruising of the flanks
turner’s sign
superficial edema and bruising in the SC tissue around the umbilicus
Cullen’s sign
