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Y4 GI / Surgery > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

(102 cards)

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1
Q

Put these in order for bilirubin metabolism

  • Conjugated bilirubin
  • Urobilinogen
  • Heme
  • Unconjugated bilirubin
  • Biliverdin
  • Bile
A

Heme > biliverdin > unconjugated bilirubin > conjugated bilirubin > bile > urobilinogen > faeces

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2
Q

In what organism is bilirubin conjugated in?

A

Liver

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3
Q

Jaundice is due to excess what?

A

Hyperbiliriubinaemia and deposition of bile pigments

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4
Q

Jaundice is visible when the bilirubin is above what level?

A

50

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5
Q

How is jaundice categorised?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

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6
Q

What type of jaundice is associated with bilirubin levels of 5-17, 50-350, 100-750?

A

5-17 pre-hepatic
50-350 intra-hepatic
100-750 post-hepatic

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7
Q

What is the AST, ALT and ALP in pre, intra and post hepatic jaundice?

A

Pre-hepatic: normal ALP, normal AST, normal ALT
Intra-hepatic:&raquo_space;AST,&raquo_space;ALT, ALP
Post-hepatic: >AST, >ALT,&raquo_space;ALP

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8
Q

What type of jaundice has dark urine and pale stools?

A

Post-hepatic obstructive

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9
Q

Congenital disorder causing episodic jaundice when unwell or drink carefully describes what syndrome?

A

Gilbert’s syndrome

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10
Q

Does Gilbert’s syndrome cause a rise in conjugated or unconjugated bilirubin?

A

Unconjugated

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11
Q

What colour is urine in pre-hepatic jaundice?

A

Normal

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12
Q

What type of jaundice does sickle-cell anaemia cause?

A

Pre-hepatic

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13
Q

What type of jaundice does a file duct stricture cause?

A

Obstructive post-hepatic

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14
Q

What type of jaundice does pancreatic cancer and cholangiocarcinoma cause?

A

Obstructive post-hepatic

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15
Q

What type of jaundice does alpha-1 antitrypsin deficiency cause?

A

Intra hepatic

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16
Q

What type of jaundice does Budd Chiari syndrome cause?

A

Intra-hepatic

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17
Q

What type of jaundice does viral hepatitis cause?

A

Intra-hepatic

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18
Q

What type of jaundice could a blood transfusion cause?

A

Pre-hepatic

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19
Q

What type of jaundice does primary biliary cirrhosis and primary sclerosing cholangitis cause?

A

Post-hepatic

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20
Q

Type of jaundice has haemochromatosis cause?

A

Intra-hepatic

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21
Q

What type of jaundice does haemolytic anaemia cause?

A

Pre-hepatic

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22
Q

What is Courvoisier sign?

A

In a patient with painless jaundice + enlarged gallbladder the cause is unlikely to be gallstone (presume biliary/pancreatic neoplasm causing obstruction)

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23
Q

What type of jaundice would sphincter of Oddi dysfunction cause?

A

Obstructive post-hepatic

Mx surgical / botox

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24
Q

What is the function of bile?

A

To absorb that in the gut

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25
What type of jaundice could statins cause?
Intra-hepatic
26
What type of jaundice could paracetamol cause?
Intra-hepatic
27
Which liver enzyme reflects hepatocyte trauma?
ALT
28
What does ALT stand for?
Alanine aminotransferase
29
What does AST stand for?
Aspartate aminotransferase
30
Albumin, bilirubin and PT/INR are all tests of what?
Test of intrinsic synthetic liver function
31
What causes a raised GGT?
Liver disease, cholestatic disease, drugs, alcohol
32
What part of the hepatobiliary system does a raised ALP suggest dysfunction of?
The biliary tree
33
Does NAFLD cause a higher ALP or AST?
ALT higher than AST
34
What is the management of NAFLD?
Weight loss + control risk factors
35
What is the commonest viral hepatitis in the UK?
HCV
36
What type of viral hepatitis is chronic?
HCV
37
How would acute viral hepatitis present?
N+V, fatigue, myalgia, headache, jaundice, hepatomegaly, RUQ pain
38
What types of viral hepatitis are associated with HCC? Which is most strongly associated?
HBV, HCV, HBV | HCV
39
What types of viral hepatitis are associated with cirrhosis?
HBV, HCV, HDV
40
Which types of viral hepatitis are blood-borne and which are faecal oral spread?
``` HAB FOS HBV BB HCV BB HDV BB HEV FOS ``` HBV also sex
41
When is the HBsAg present after infection? What does it indicate?
1-6 months | Prolonged past 6 months implies HBV carrier
42
When is the HBeAg present after infection? What does it indicate?
1-3 months after acute infection | Indicates high infectivity
43
When investigating HCV, if the blood tests show a hepatitic picture what test would you do next? What test would do you
First check HCV Ab, if thats positive check RNA PCR
44
What would blood tests show to indicate active HCV infection? For past infection?
Active: positive HCV Ab, positive RNA PCR Past: positive HCV Ab, negative RNA PCR
45
Learn HBV serology
Soz g just go learn it
46
What is HBV serology in someone who is vaccinated?
Negative core Ab Negative surface Ag Positive surface Ab
47
What is HBV serology in someone with previous HBV infection?
Positive core Ab Negative surface Ag Positive surface Ag
48
What is HBV serology in someone with chronic HBV?
Positive core Ab Positive surface Ag Negative surface Ab
49
How is cirrhosis functionally classified?
Compensated or decompensated
50
Where does varices present?
Oesophagus Caput medusae Haemorrhoids
51
What effect does cirrhosis have on: - LFTs - Albumin - PT - WCC - PLT count - CRP
- Raised LFTs - Low albumin - High PT - Low WCC - Low PLTs - CRP normal
52
Why is there low platelets in cirrhosis?
Platelet sequestration due to hypersplenism
53
What is a fibroscan?
US measures fibrosis of the liver
54
What does a liver screen test? Unsure if you really need to know this but read it to be aware of it
``` Ferritin Viral hepatitis serology Autoimmune (AHA, AMA, SMA) AFP Alpha 1 anti-typsin Caeruloplasmin if <40yr ```
55
What drug is given to manage itch in cirrhosis?
Colestyramine
56
Accumulate of toxic substances eg ammonia nitrogenous waste normally removed by the liver that cross the BBB causes ...
Hepatic encephalopathy | graded 1-4
57
What surgical procedure is used for refractory ascites?
TIPSS | Procedure has a risk of hepatic encephalopathy
58
Hepatocellular carcinoma is a complication of cirrhosis. How is this monitored for?
Every 6 months US + AFP
59
What is the management of a coagulopathy due to cirrhosis?
Give vitamin K | If actively bleeding give FFP
60
Haemochromatosis is a disorder of _____ metabolism, there is increased intestinal absorption. What is the inheritance pattern? Where is it deposited?
Iron Autosomal recessive Joints / heart / liver
61
In haemochromatosis there is an increased risk of what type of cancer?
HCC
62
What dermatological presentation can haemochromatosis cause?
Slate grey skin Or bronzed (Or jaundiced)
63
What is the 1st + 2nd line management of haemochromatosis?
1st lifelong regular venesection | 2nd desferrioxamine
64
Alpha 1 anti-trypsin deficiency is due to a lack of protease inhibitor normally produced by the liver. What is the inheritance pattern? What 2 disease processes occur as a result?
AR | Emphysema + cirrhosis
65
Wilson's disease is a disorder of biliary ____ excretion. It causes _____ deposited in _____ and _____. What is the inheritance pattern?
Copper Liver + basal ganglia AR
66
What effect does Wilson's disease have on - Urinary copper - Caeruloplasmin - Serum copper - LFTs
High urinary copper Low caeruloplasmin Low serum copper High LFTs
67
What sign can be seen on examination of the face in Wilson's disease?
Kayser-Fleisher rings | around iris due to copper deposition in cornea
68
What is the management of Wilson's disease?
Penicillamine | chelates copper
69
Intralobular bile duct inflammation is caused by what disorder?
Primary biliary cirrhosis
70
What autoantibodies are raised in PBC?
AMA | M2 IgM
71
What is the management of PBC?
Ursodeoxycholic acid
72
What are the 3 Ms in PBC?
Middle age female IgM anti-AMA
73
Are lipids raised (eg xanthelasma) in PBC or PSC?
PBC
74
What autoantibodies are raised in PSC? primary sclerosing cholangitis
anti-SMA | also ANA, +- ANCA
75
Which causes pruritus - primary sclerosing cholangitis or primary biliary cirrhosis?
Both | may see excoriations due to intense itch
76
What causes a raised ALP - primary sclerosing cholangitis or primary biliary cirrhosis?
Both
77
What test is done for primary sclerosing cholangitis diagnosis?
MRPC - see beaded strictures
78
What can cause ascending cholangitis - primary sclerosing cholangitis or primary biliary cirrhosis?
PSC
79
What is the management of PSC primary sclerosing cholangitis?
Transplant for severe end stage disease
80
'Autoantibodies direct at hepatocyte surface antigens' is the description of what disease?
Autoimmune hepatitis
81
What autoantibodies are associated with autoimmune hepatitis? Which LFTs are off?
anti-SMA smooth muscle Ab anti-ANA >ALT >AST
82
Shifting dullness on examination is a sign of what?
Ascites
83
What drug is used in the management of autoimmune hepatitis?
Steroids
84
What colour is fluid on US?
Dark
85
How does cirrhosis cause ascites?
Fibrosis causes backpressure portal hypertension causes vasodilation of splanchnic arteries
86
In ascites where is excess fluid?
In peritoneal cavity
87
What investigation and calculation is used to help determine the cause of ascites?
Ascitic tap AKA paracentesis | SAAG
88
Following ascitic tap, if SAAG is low does this indicate exudate or transudate?
Low SAAG = exudate | High SAAG = transudate
89
In ascites, does malignancy cause a high or low SAAG?
Low SAAG = exudate
90
In ascites, does nephrotic syndrome cause a high or low SAAG?
Low SAAG = exudate
91
In ascites, does cirrhosis cause a high or low SAAG?
High SAAG transudate
92
In ascites, does HF cause a high or low SAAG?
High SAAG transudate
93
What is the 1st line management of ascites?
Spironolactone
94
What acute complication of ascites would cause sudden deterioration?
Spontaneous bacterial peritonitis
95
How is spontaneous bacterial peritonitis diagnosed?
Ascitic tap AKA paracentesis | WCC >250 + 90% neutrophils
96
What is the management of spontaneous bacterial peritonitis?
IV piperacillin or tazobactam
97
What is the management of an incidental finding of bacterial peritonitis on ascitic tap?
IV co-trimoxazole
98
Acute liver failure + encephalopathy + jaundice =
Fulminant hepatic failure
99
Hepatic encephalopathy is a complication of decompensated cirrhosis, it usually occurs in patients with _____ liver failure.
Chronic
100
How does hepatic encephalopathy present?
Mood/behaviour change, sleep disturbance, dyspraxia Next confusion, drowsy, slurred speech, liver flap Next stupor Next coma
101
What is the management of hepatic encephalopathy
IV lactulose, regular enemas, IV rifamixin
102
What should you look out for on blood tests in methanol poisoning?
Hi osmolal gap

Y4 GI / Surgery (11 decks)

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