Flashcards in Diseases of the hepatobiliary system Deck (99)
What is the commonest sign of liver disease?
When is jaundice visible?
When bilirubin >40umol/l
What is pre-hepatic jaundice?
Too much bilirubin produced
- Haemolytic anaemia
What is hepatic jaundice?
Too few functioning liver cells
- Acute diffuse liver cell injury
- End stage chronic liver disease
- Inborn errors
What is post hepatic jaudice?
Bile duct obstruction
- stone, stricture, tumour – bile duct, pancreas
What kind of bile is in excess in pre-hepatic jaundice?
Unconjugated – bound to albumin, insoluble, not excreted
- patient notices yellow eyes/skin only
What kind of bile is in excess in hepatic jaundice?
- patient notices yellow eyes and dark urine
What kind of bile is in excess in post-hepatic jaundice?
conjugated - soluble, excreted, but can’t get into gut
- patient notices yellow eyes, pale stool and dark urine
Which liver enzymes leak from hepatocytes?
ALT and AST
What does a mild increase of ALT/AST over a long time indicate?
Chronic liver disease
What do very high levels of ALT/AST indicate?
Severe acute liver disease.
What does Alk Phos leak from?
What does a high alk phos reading indicate?
Obstructive jaundice and chronic biliary disease.
What does raised conjugated bilirubin without extrahepatic duct obstruction indicate?
Disease of hepatocytes or intraheptic bile ducts.
Why might albumin be low?
Has long half life so levels may be low in chronic liver insufficiency.
How are clotting factors measured?
PT and INR
What is INR?
International normalised ratio - ratio of pt's clotting time to normal control.
Why might PT/INR be prolonged?
Severe liver injury
Obstructive jaundice - can't absorb fat soluble vitamins
What is the first histopathological sign of obstructive jaundice?
Bile in the liver parenchyma
- jaundice in the skin, patient is yellow
What are the other histopathological signs of obstructive jaundice?
Portal tract expansion
Ductular reaction – proliferation of ductules around the edge
Bile salts and
- copper cant get out
- Accumulate in hepatocytes
(bile salts in skin – patient is itchy)
What is the first investigation in someone with jaundice?
USS to check for bile duct dilation.
If ducts not dilated biopsy performed.
What are most non-obstructive cases of jaundice due to?
What is the clinical definition of hepatitis?
Liver enzymes raised, any cause
What is the histopathological defenition of hepatitis?
Inflammation seen on biopsy.
What does the clinical presentation of hepatitis depend on?
The amount of hepatocytes that are injured/killed and how well the remaining ones can regenerate.
What are the commonest causes of acute hepatitis in the UK?
What are the other causes of acute hepatitis?
- A, B & E
Seronegative (i.e. idiopathic)
What are the histopathological features of mild acute hepatitis?
Hepatocytes vary in cells
What are the histopathological features of severe acute hepatitis?
Confluent panacinar necrosis