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Alimentary System: Pathology SA > Jaundice and Chronic Liver Disease: Investigations, Treatment and Management > Flashcards

Jaundice and Chronic Liver Disease: Investigations, Treatment and Management Flashcards

1
Q

When the Liver stops working what is the main symptoms that occur

A

Jaundice
Ascities
Variceal Bleeding
Hepatic encephalopathy

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2
Q

What is the cause of jaundice

A

Excess circulating bilirubin (exceed 34 µmol/L)

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3
Q

What is the overall symptoms of jaundice

A

Yellowing of the skin, sclerae (white outer layers or the eye ball)
and other tissues

and high yellow coloured urine

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4
Q

What is the three classification of jaundice

A

Pre-hepatic - Unconjugated bilirubin before the liver

Hepatic - conjugated bilirubin in the liver

Post Hepatic - conjugated bilirubin after the liver

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5
Q

What is the cause of pre hepatic jaundice

A

Increased quantity of bilirubin - heamolysis

Impaired transport

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6
Q

What is the cause of hepatic jaundice

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

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7
Q

What is the cause of post hepatic jaundice

A

Defective transport of bilirubin by the biliary ducts

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8
Q

What classification of jaundice acholuric jaundice

A

Prehepatic due to excessive circulation of unconjugated bile and no bile pigments in the blood

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9
Q

What are the specific symptoms of pre hepatic jaundice

A

History of anaemia:
Dysnopea
Chest pain
Fatigue

Pallor
Splenomegaly

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10
Q

IVDU and drug intake have the highest risk factor for what kind of Jaundice

A

Hepatic jaundice

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11
Q

What is the symptoms of hepatic jaundice

A

Ascites - accumulation of fluid in peritoneal cavity

Variceal bleed - dilated blood vessels

encephalopathy

Spider naevi,

Gynaecomastia (moobs)

Asterixis - flapping tremor

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12
Q

What is the symptoms of post hepatic jaundice

A 
Abdominal pain
Pruritus
pale stools (normal colour if before liver)
High coloured urine
Palpable gallbladder
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13
Q

What is testes for in Liver screen investigations to check the health of your liver

A

Hepatitis B & C serology

Autoantibody profile,

serum immunoglobulins

Caeruloplasmin and copper (cooper storage)

Ferritin and transferrin saturation (iron storage)

Alpha 1 anti trypsin

Fasting glucose and lipid profile

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14
Q

What is the different imaging investigation used in the diagnosis of liver disease and jaundice

A

Ultrasound of abdomen

CT/MRI scan

Endoscopic retrograde cholangiopancreatography (ERCP)

Magnetic resonance cholangiopancreatography (MRCP)

Percutaneous Transhepatic Cholangiogram

Endoscopic Ultrasound (EUS)

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15
Q

Why is ultrasound of the abdomen the most important investigation

A

Differentiates extrahepatic and intrahepatic obstruction

finds the cause and extent of obstruction

Documents evidence of portal hypertension

Preliminary staging of extent of disease e.g. cancer spread

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16
Q

What is Endoscopic retrograde cholangiopancreatography (ERCP)

A

Technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.

Offer therapeutic option as well as imaging

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17
Q

What is the disadvantages of ERCP

A

Radiation
Sedation

Complications (5%)

Failure rate (10%)

Only images ducts

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18
Q

Define MRCP

A

is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems

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19
Q

What is the advantages and disadvantages to MRCP

A

Noninvassive procedure
No radiation
No complications
Can image outwith the ducts

clautraphobia - 5%
Only offer diagnosis

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20
Q

What is ERCP used to treat

A

Dilated biliary tree (due to visible stones or tumour)

Chlodocholithiasis - Acute gallstone pancreatitis

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21
Q

How does ERCP perform therapeutic

A

Sphincterotomy
(An operation to cut the muscle between the common bile duct and the pancreatic duct. The operation uses a catheter and a wire to remove gallstones or other blockages)

stenting of biliary duct obstruction

stone retrieval basket

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22
Q

What is the complication of ERCP

A

Pancreatitis

Cholangitis - infection of the bile duct

Bleeding

Perforation

Sedation complications leading to respiratory and cardiovascular problems

23
Q

What happens in the PCT imaging

A

Done under local anesthesia by a radiologist
thin needle is inserted through the skin (percutaneous) and through the liver (transhepatic) into a bile duct

more invasive than ERCP so used when ERCP cant be carried out due to obstruction or previous surgery
or to perform Hilar stenting

24
Q

What is the functions of Endoscopic ultrasound

A

Characterising pancreatic masses

Staging of tumours

Fine needle aspirate (FNA) of tumours cysts, small stones (but not biliary microcalculi)

25
Q

Define chronic liver disease

A

Liver disease persisting beyond 6 months - cirrhosis

26
Q

What is the aetiologies of Cirrhosis

A 
Alcohol 
Autoimmune 
Heamocrhomatosis 
Chronic Viral Hepatitis B, C
Non- Alcoholic Fatty Liver Disease
Drugs 
Cystic fibrosis 
Vascular problems - portal hypertension
Cryptogenic
27
Q

What is the pathology of cirrhosis

A

Chronic liver injury occurs causing infiltrating lymphocytes
this causes fibrosis as extracellular matrix proteins gather blocking the sinusoids of the liver therefore increasing resistance to blood flow so liver cant receive nutrients or oxygen from the blood

Cirrhosis occurs as a diffuse process involving whole liver as hepatocytes death is replaced by nodules of hepatocytes that are separated by the broad band of fibrous tissue
leading to loss of normal liver structure

28
Q

What further complications arise from chronic liver disease

A

Ascites

Variceal bleeding

Hepatic encephalopathy

Hepatocellular carcinoma (liver cancer)

29
Q

What is ascites

A

accumulation of fluid in the peritoneal cavity - swollen abdomen

30
Q

What is found on physical examination of someone with ascites

A

Shifting dullness

Dulness in flanks

Spiders naevia

Palmar Erythema,

Abdominal veins

Fetor hepaticus -
Umbilical nodule

JVP elevation

Flank haematoma

31
Q

How does fetor hepaticas occur

A

also known as breath of the dead or hepatic foetor, is a condition seen in portal hypertension where portosystemic shunting allows thiols to pass directly into the lungs

32
Q

Spider naevi sis caused by what hormone imbalance

A

Increased oestrogen levels in the blood

33
Q

How is acitites diagnosed

A

Diagnostic paracentesiss -needle is inserted into the peritoneal cavity and ascitic fluid is removed

34
Q

What is investigated in diagnostic paracentesis

A

Protein & albumin concentration

Cell count and differential

SAAG (serum-ascites albumin gradient)

35
Q

What is the treatment options of Ascites

A

Diuretics

Large volume paracentesis

TIPS

Aquaretics
(drug that promotes excretion of water without electrolyte loss)

Liver transplantation

36
Q

What happens in a TIPS procedure

A

Transjugular intrahepatic portosystemic shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein therefore decreasing portal hypertension

37
Q

What causes variceal haemorrhage

A

Portal hypertension

small blood vessels cant handle alot of pressure there for burst as a consequence

38
Q

Where are varicel bleeds most likely to occur then

A

Portosystemic anastomoses:

Skin 
Oesophageal 
Rectal
Posterior abdominal wall 
Stomal
39
Q

What is caput medusa

A

varices appearing on the skin

40
Q

What is the management of Varcies

A

Emergency endoscopy: Endoscopic band ligation - tying ligate lightly around blood vessel to stop bleeding

If re- bleeding after endoscopy - TIPS

Terlipressin - vasoactive drug used in the management of low blood pressure helps control vacies

Sengstaken-Blakemore tube
(medical device inserted through the nose or mouth for management of hemorrhage due to esophageal varices)

41
Q

Define hepatic encephalopathy

A

Confusion due to liver disease

increased ammonium in the blood going to the brain

42
Q

What are precipitants that with liver disease lead to hepatic encephalopathy

A

GI bleed, infection, constipation, dehydration, medication esp. sedation

43
Q

What is the management of hepatic encephalopathy

A

Treat underlying cause

Constipation:
Laxatives – phosphate enemas and lactulose

Infection:
Neomycin, Rifaximin-broad spectrum non absorbed antibiotic

44
Q

What is repeated addmission with Hepatic encephalopathy an indicator of

A

Liver transplant

45
Q

What is additional symptoms with hepatic encephalopathy

A

Flapping tremor – asterixis

foetor hepaticus - dead breath

46
Q

What is the aetiology Hepatocellular carcinoma (liver cancer)

A

Cirrhosis

Chronic Hepatitis B and C

47
Q

What is the symptoms Hepatocellular carcinoma

A

Liver disease

Abdominal mass

Abdominal pain

Weight loss

Bleeding from tumour

48
Q

What Image investigations are used for the diagnosis of hepatocellual carcinoma

A

Ultrasound
CT scan
MRI

(liver biopsy rarely done)

49
Q

What is the tumour marker for hepatocellular carcinoma

A

AFP

50
Q

What is the treatment options for hepatocellualr carcinoma

A

Hepatic resection

Liver transplantation

Chemotherapy

Locally ablative

Sorafenib (Tyrosinase kinase inhibitor)

Hormonal therapy: Tamoxifen

51
Q

What is the two forms of chemotherapy in the treatment of hepatocellualr carcinoma

A

Locally delivered: TACE (Transcatheter arterial chemo-embolization)

Systemic chemotherapy

52
Q

What are the two forms of ablative therapy treatment in herpatocellular carcinoma

A

Alcohol injection

Radiofrequency ablation

53
Q

How can hepatic resection occur

A

Chop off one half of the liver due to the individual blood supply of the liver lobes

Alimentary System: Pathology SA (27 decks)

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