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Z Year 3 Misc > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What are 5 causes of high bilirubin?

A
  1. haemolysis
  2. gallstones
  3. cholangitis
  4. sickle cell
  5. alcoholic liver disease
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2
Q

What is in the portal triad?

A
  • Bile duct

- Branch of hepatic artery and portal vein

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3
Q

What happens in first pass metabolism?

A
  1. Oxygen from hepatic artery
  2. Blood gunge from digestive system from portal vein
  3. Hepatocytes filter
  4. Clean stuff in central vein
  5. Waste products go the other way and end up in bile duct
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4
Q

Where does the central vein go?

A

to heart and IVC

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5
Q

Where does the central vein go?

A

to heart and IVC

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6
Q

How do you think about high bilirubin causes?

A
  1. pre-hepatic
  2. hepatic disease
  3. post-hepatic
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7
Q

What are post-hepatic causes of high bilirubbin?

A
  • obstructive jaundice
    1. gallstones (painful)
    2. pancreatic cancer (painless)
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8
Q

What are pre-hepatic causes of high bilirubin?

A
  • unconjugated bilirubin

- haemolysis

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9
Q

What reaction measures serum bilirubin via fractionation?

A

Van de Bergh reaction

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10
Q

What does the direct reaction measure?

A

conjugated bilirubin

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11
Q

What does the indirect reaction measure?

A

unconjugated bilirubin

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12
Q

How does the Van den bergh reaction work?

A

addition of methanol causes a complete reaction, which measures total bilirubin (conjugated plus unconjugated)

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13
Q

What sort of jaundice could be normal?

A

peadiatric jaundice

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14
Q

In paediatric jaundice what type of bilirubin should be high and why?

A

unconjugated as the cause is usually liver immaturity coupled with fall in haemoglobin early in life

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15
Q

What should you do if the peadiatric jaundice does not setlle?

A

look for:

  1. hypothyroidism
  2. other causes of haemolysis (Coombes test or DAT)
  3. unconjugated bilirubin will be useful
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16
Q

How do you treat paediatric jaundice?

A

phototherapy

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17
Q

How does phototherapy work?

A

converts bilirubin into two other compounds: lumirubin and photobilirubin which are isomers that do not need conjugation for excretion

18
Q

Which LFTs will be high in obstructive jaundice?

A

alk phos

19
Q

If all the LFTs are normal but fasting bilirubin is high what might this suggest?

A

gilberts syndrome (very common)

20
Q

How is Gilbert’s syndrome inherited?

A
  • Recessive

- 50% carry gene

21
Q

What is the pathophysiology of Gilbert’s syndrome?

A
  1. UDP glucuronyl transferase activity reduced to 30%

2. Unconjugated bilirubin tightly albumin bound and does NOT enter urine (so not high bilirubin urine) - but high plasma

22
Q

What test is the most representative of liver function?

A

Prothrombin time (if bad bad outcome)

23
Q

How is the function of the liver tested?

A
  1. Albumin
  2. Clotting factors (PT, PTTK)
  3. Bilirubin
    - Other tests are “enzymes” not truly tests of liver function
24
Q

What does it mean if AST and ALT is super high?

A

hepatocyte damage

25
Q

If alk phos is high but not super high what does this mean?

A

excludes obstructive jaundice

26
Q

How does HepA work?

A

get once - no carrier disease

27
Q

How does HepB work?

A
  1. some carriers
  2. start making HBe antigen and HBs antigen and measured in blood
  3. then start to make antibiodies
28
Q

What does it mean if there are just surface antibodies (Anti-HBs)?

A

vaccinated

29
Q

What does it mean is they have all three antibodies (Anti-HBc, Anti-HBs, Anti HBe)?

A

must have been infected with live virus at some point

30
Q

Which antibodies will a carrier of HepB never make?

A

surface antigen (anti-HBs)

31
Q

What are the defining histological features of alcoholic hepatitis?

A
  1. liver cell damage
  2. inflammation
  3. fibrosis (use a stain)
32
Q

What are the associated histological features of alcoholic hepatitis?

A
  1. fatty change

2. megamitochondria

33
Q

What is NASH?

A
  • non-alcoholic steato-hepatitis

- history is that don’t drink alcohol

34
Q

What is the treatment of alcoholic hepatitis?

A
  1. supportive
  2. stop alcohol
  3. nutrition
  4. vitamins (esp B1 and thiamine)
  5. occasionally steroids
35
Q

What does vitamin def gives you beri beri?

A

B1

36
Q

What does vitamin def gives you rickets?

A

vitD

37
Q

What does vitamin def gives you scurvy?

A

vitC

38
Q

What does vitamin def gives you perincious anaemia?

A

B12

39
Q

What does vitamin def gives you pellargra?

A

B3

40
Q

What does vitamin def gives you neural tube defects?

A

folic acid

Z Year 3 Misc (11 decks)

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