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GI AM > Jaundice and chronic liver disease > Flashcards

Jaundice and chronic liver disease Flashcards

1
Q

What are the roles of the liver?

A

Synthesis
Detoxification
Immune function
Storage funtion

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2
Q

What does the liver synthesise?

A 
Clotting factors
Bile acids
Carbohydrates
Proteins
Lipids
Hormones
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3
Q

How is the liver involved in detoxification?

A

Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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4
Q

What is the immune role of the liver?

A

Combating infections
Clearing blood pf particles and infections
Neutralising and destroying all drugs and toxicities

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5
Q

What does the liver store?

A

Glycogen
Vit A, D, B12, K
Copper and iron

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6
Q

What is bilirubin?

A

Byproduct of ham metabolism generated by old/dying RBCs in the spleen

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7
Q

What is the cycle of bilirubin?

A

Initially bound to albumin- unconjugated form

Liver then solubilises it to its conjugated form

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8
Q

What can cause elevated bilirubin?

A

Prehepatic- haemolytic
Hepatic- parenchymal damage
Post hepatic- obstruction

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9
Q

What are aminotransferases?

A

Enzymes in hepatocytes

Present in parenchyma

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10
Q

What does elevated aminotransferase indicate?

A

Parenchymal damage

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11
Q

What does a high AST/ALT ratio indicate?

A

Alcoholic liver disease

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12
Q

What is alkaline phosphatase?

A

Enzyme of the bile ducts

Not specific to liver

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13
Q

When is alkaline phosphatase raised?

A

Obstruction of liver infiltration

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14
Q

Where is alkaline phosphatase present?

A

Liver
Bone
Intestines
Placenta

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15
Q

What is gamma GT?

A

Non specific liver enzyme

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16
Q

What is gamma GT used for?

A

To confirm high alkaline ohoshatase levels are due to liver pathology

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17
Q

What is albumin?

A

Protein produced by liver

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18
Q

What does low albumin indicate?

A

Chronic liver disease

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19
Q

What does prothrombin time indicate?

A

Degree of liver damage

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20
Q

What is prothrombin time used to calculate?

A

Stage of liver disease and priority of transplant patients

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21
Q

What is creatinine used to determine?

A

Kidney function and survival odds from liver disease

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22
Q

When is the platelet count low?

A

In cirrhotic patients as a result of hypersplenism

Indirect marker of portal hypertension

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23
Q

What is jaundice?

A

Yellowing of skin, sclerae and other tissues due to excess circulating bilirubin

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24
Q

What are the 3 forms of jaundice?

A

Pre hepatic
Hepatic
Post hepatic

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25
Q

What are the causes of pre hepatic jaundice?

A

Increased bilirubin from haemolytic

Impaired transport to liver

26
Q

Want are the hepatic causes of jaundice?

A

Defective uptake of bilirubin- defective conjugation or secretion

27
Q

What is the post hepatic cause of jaundice?

A

Defective transport by biliary system

28
Q

What is the presentation of pre hepatic jaundice?

A

History of anaemia
Pallor
Splenomegaly
Acholuric jaundice

29
Q

What is choleric jaundice?

A

Jaundice caused by excess circulating unconjugated bilirubin

30
Q

What is the presentation of hepatic jaundice?

A 
Risk factors for liver disease
Decompensation
Ascites
Asterixis
Spider navel
Gynacomastia
31
Q

What is the presentation of post hepatic jaundice?

A 
Abdo pain
Pruritus
Pale stools
High coloured urine
Palpable gallbladder
32
Q

What investigations are done for jaundice?

A

Liver screen
Ultrasound
MRCP

33
Q

What tests are done in a liver screen for jaundice?

A 
Hep B and C serology
Autoantibody profile, serum Its
Caeruloplasmin and copper
Ferritin and transferrin
Alpha1 antitrypsin
Fasting glucose and liver profile
34
Q

What is the purpose of doing an ultrasound for jaundice?

A

Can see site and cause of obstruction

Cheap, safe and noninvasive

35
Q

How is jaundice treated?

A

Via ECRP

36
Q

What can ECRP treat?

A

Dilated biliary tree
Acute gallstone pancreatitis
Post op biliary complications
Biliary tract obstruction

37
Q

How is acute gallstone pancreatitis treated?

A

Removal via sphincetrectomy or breakdown of stones via ECRP

38
Q

How is biliary tract obstruction treated?

A

Stenting

39
Q

What is chronic liver disease?

A

Liver disease persisting for over 6 months

40
Q

What are some examples of chronic liver disease?

A 
Chronic hepatitis
Chronic cholestasis
Fibrosis and cirrhosis
Liver tumours
Others...
41
Q

What is cirrhosis?

A

Advanced fibrosis replaces functional parenchyma and prevents movement of blood into and out of the liver

42
Q

What is the presentation of compensated chronic liver disease?

A

Abnormality of LFTs

43
Q

What is the presentation of decompensated chronic liver disease?

A

Ascites
Variceal bleeding
Hepatic encephalopathy

44
Q

What is hepatic encephalopathy?

A

Confusion brought on by liver disease

45
Q

What causes hepatic encephalopathy?

A 
GI bleeds
Infecton
Constipation
Dehydration
Medication
46
Q

What is the presentation of hepatic encephalopathy?

A

Confusion
Flapping tremor
Foetor hepaticas (bad breath)

47
Q

What is the treatment of hepatic encephalopathy?

A

Treat underlying cause

Repeat admissions- indication for liver transplant

48
Q

What is hepatocellular carcinoma associated with?

A

Chronic Hep B and C

cirrhosis

49
Q

How is hepatocellular carcinoma diagnosed?

A 
Tumour marker tests in those with cirrhosis
Ultrasound
CT
MRI
Liver biopsy in rare cases
50
Q

What is the curative treatment for hepatocellilar carcinoma?

A

Hepatic resection

Transplant

51
Q

What are the palliative treatments for hepatocellualr carcinoma?

A

Chemo
Local ablative treatments- alcohol injection, radio frequency ablation
Sorafenib
Hormonal therapy

52
Q

What is ascites?

A

Accumulation of fluid in peritoneal cavity

53
Q

What is found on a physical exam with ascites?

A

Dullness in flanks and shifting dullness

54
Q

What is the presentation of ascites?

A

Spider navel, palmar erythema, abdomen veins, fetter hepaticas
Umbilical nodule
JVP elevation
Flank haematoma

55
Q

What investigations are carried out for ascites?

A

Protein and albumin concentration of fluid
Cell count of fluid
Serum ascites albumin gradient

56
Q

How is ascites treated?

A

Diuretic
Large volume paracentesis
Liver transplant in serious cases

57
Q

What are varices?

A

Abnormally dilated vessel with tortuous course

58
Q

What is the cause of varices?

A

Portal hypertension

59
Q

How are varices treated?

A

Resusitation- possible blood transfusions
Endoscopic ban ligation
Control bleeding

60
Q

Where do you get varices?

A

Oesophagus
Stomach
Rectum
Umbilicus

GI AM (34 decks)

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