Jaundice

Question 1

List some of the things produced by the liver.

Answer 1

Clotting factors
Bile acids

Question 2

Which processes relating to carbohydrates does the liver help with carrying out?

Answer 2

Gluconeogenesis
Glycolysis
Glycogenesis

Question 3

What role does the liver have to do with proteins?

Answer 3

Synthesis of albumin

Question 4

What role does the liver has to do with lipids?

Answer 4

Cholesterol synthesis
Production of Lipoprotein
Triglyceride synthesis

Question 5

Which organ is the main detoxifier?

Answer 5

Liver

Question 6

How does the liver have a role in detoxification?

Answer 6

Detoxifies drugs
Bilirubin metabolism
Breakdown of insulin and hormones
Produces urea from ammonia

Question 7

How does the liver have an immune function?

Answer 7

Combats infections, clears blood particles of infection and bacteria

Question 8

The liver has a large storage function.
List the things stored in the liver.

Answer 8

Glycogen
Vitamins B12, A, D, K
Copper
Iron

Question 9

How is bilirubin produced?

Answer 9

It’s a breakdown product from haeme in RBC’s

Question 10

What is bilirubin initially bound to?

Answer 10

Albumin

Question 11

What is bilirubin known as when it is bound to albumin?

Answer 11

Unconjugated bilirubin

Question 12

How does unconjugated bilirubin become conjugated bilirubin?

Answer 12

Liver helps to solubilise it, conjugating the bilirubin to become water soluble

Question 13

Name three types of bilirubin elevation.

Answer 13

Pre-hepatic
Hepatic
Post-hepatic

Question 14

How can pre-hepatic elevation of bilirubin occur?

Answer 14

Increased haemolysis of RBC’s

Question 15

How can hepatic bilirubin elevation occur?

Answer 15

Liver damage

Question 16

How can post-hepatic bilirubin be eleavted?

Answer 16

Bilirubin does not reach intestines

Question 17

What is carried out if there is an elevation in bilirubin?

Answer 17

Test for aminotransferases

Question 18

What are aminotransferases?

Answer 18

Enzymes present in hepatocytes

Question 19

What is more specific- ALT or AST?

Answer 19

ALT

Question 20

Which condition can the ALT:AST ratio help to diagnose?

Answer 20

Alcoholic liver disease

Question 21

Where is alkaline phosphatase predominantly produced?

Answer 21

Bile ducts

Question 22

When may alkaline phosphatase be elevated?

Answer 22

Bile duct obstruction or liver infiltration

Question 23

When is Gamma GT, a non-specific liver enzyme, elevated?

Answer 23

Elevated with alcohol use

Question 24

What does it mean if Gamme GT and alkaline phosphatase are both elevated?

Answer 24

It is a biliary disease

Question 25

Give an example of a type of drug which can increase levels of Gamma GT.

Answer 25

NSAIDs

Question 26

What is tested to check the synthetic function of the liver?

Answer 26

Albumin

Question 27

What does low albumin suggest?

Answer 27

Chronic liver disease

Question 28

When may albumin levels also be low?

Answer 28

Kidney disorders and malnutrition

Question 29

What would testing the prothrombin time of the liver tell us?

Answer 29

Degree of liver dysfunction.

Question 30

What would you need to test to determine survival from liver disease and also for critical assessment of liver transplant?

Answer 30

Creatinine READ NOT CREATINE

Question 31

Which blood test would need to be carried out when testing for liver disease?

Answer 31

Platelet count

Question 32

The liver produces thrombopoietin. What is it?

Answer 32

Hormone which regulates production of platelets.

Question 33

What would low platelet levels suggest?

Answer 33

Cirrhosis

Question 34

What can low platelet counts be an indirect indicator of?

Answer 34

Portal hypertension

Question 35

What does jaundice cause to happen physically?

Answer 35

Yellowing to eyes and skin

Question 36

Why does jaundice cause yellow eyes and skin?

Answer 36

Excess circulating bilirubin

Question 37

Bilirubin levels are only detectable when?

Answer 37

When total plasma bilirubin > 34umol/L

Question 38

What is the differential diagnosis for jaundice?

Answer 38

Carotenemia

Question 39

Where do RBC's die?

Answer 39

Spleen

Question 40

In prehepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

Answer 40

Unconjugated

Question 41

In hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

Answer 41

Conjugated

Question 42

In post hepatic jaundice, will the bilirubin be mostly conjugated or unconjugated?

Answer 42

Conjugated

Question 43

Upon taking a history, what are some things that are suggestive of pre-hepatic jaundice?

Answer 43

History of anaemia Acholuric jaundice

Question 44

Upon taking a history, what are some things that are suggestive of hepatic jaundice?

Answer 44

Risk factors for liver disease e.g. IVDU, drug intake Decompensation history (ascites, variceal bleed and encephalopathy)

Question 45

Upon taking a history, what are some things that are suggestive of post-hepatic jaundice?

Answer 45

Abdominal pain Cholestasis

Question 46

Ascites?

Answer 46

Collection of fluid in abdomen

Question 47

Variceal bleed?

Answer 47

Bleeding of varices found throughout the gastrointestinal tract, such as in the oesophagus, stomach, and rectum

Question 48

Encephalopathy?

Answer 48

Damage or disease that affects the brain

Question 49

Upon examination, what may indicate pre-hepatic jaundice?

Answer 49

Pallor Large splenomegaly* (note this can happen w hepatic and post-hepatic too) *Enlargement of spleen

Question 50

Upon examination, what may indicate hepatic jaundice?

Answer 50

Ascites Asterixis Stigmata of Chronic Liver disease e.g. spider naevi, gynaecomastia

Question 51

Upon examination, what may indicate post-hepatic jaundice?

Answer 51

Palpable gall bladder

Question 52

List some of the investigations used for patients w suspected jaundice.

Answer 52

-Chronic liver screening via Hepatitis A & C Serology and autoimmune profiling. -Check copper and iron levels -Alpha 1 antitrypsin deficiency -Fasting glucose and lipid profile for diabetes

Question 53

What is the most important test to distinguish where the jaundice is coming from?

Answer 53

Abdomen Ultrasound

Question 54

Which test is better to identify gallstones- ERCP or MRCP?

Answer 54

ERCP

Question 55

Which test involves radiation- ERCP or MRCP?

Answer 55

ERCP MRCP= MRI

Question 56

What can therapeutic ERCP be useful for?

Answer 56

-Dilated biliary tree -Acute gallstone pancreatitis -Stenting of biliary tract obstruction --Post-operative biliary complications

Question 57

What are some of the complications for ERCP?

Answer 57

Pancreatitis Cholangitis Sedation related cardio and resp problems Risk of bleeding and perforation

Question 58

What can endoscopic ultrasounds help with?

Answer 58

-Characterising pancreatic masses -Staging of tumours -Fine needle aspirate of cysts and tumours

Question 59

What is required to confirm diagnosis of liver conditions?

Answer 59

Liver biopsy