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Year 1 - Gastrointestinal (DP) > Jaundice > Flashcards

Jaundice Flashcards

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0
Q

What is iron stored bound to?

A

Ferritin

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1
Q

What is the role of albumin?

A

Transports lipophilic substances (FFAs, bilirubin, thyroid hormones)

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2
Q

What is copper bound to for transport?

A

Caeruloplasmin

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3
Q

What are the normal ranges for LFTs?

A 
ALT: 5-35 U/L
AST: 5-35 U/L
ALP: 30-150 U/L
GGT: 11-51 U/L (Men) and 7-33 U/L (Women)
Bilirubin: 3-17 micromol/L
Albumin: 35-50 g/L
PT: 10-14 secs
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4
Q

What defines acute liver disease?

A 
Any insult causing damage
In a previously normal liver
Less than 6 months duration
Causing:
- Encephalopathy
- Prolonged coagulation
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5
Q

Clinical features of acute liver disease?

A 
Jaundice
Lethargy
Nausea
Anorexia
RUQ pain
Itch
Arthralgia
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6
Q

What are the causes of acute viral liver disease?

A 
Hepatitis viruses:
- A (travellers and shellfish)
- B + C (blood borne)
- D 
- E (sausage and travellers)
CMV
EBV
Toxoplasmosis
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7
Q

What are the other causes of acute liver disease?

A 
Drugs
Hypoperfusion
Cholangitis
Alcohol
Malignancy
Chronic LD
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8
Q

What is Budd-Chiari?

A 
Hepatic vein clot
Results in venous infarct:
- Liver pain
- Ascites
- Jaundice
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9
Q

When is Budd-Chiari common?

A

In young women on the oral contraceptive pill

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10
Q

What are the two causes of acute liver disease in pregnancy?

A

Acute Fatty Liver in Pregnancy (AFLP)

Cholestasis of pregnancy

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11
Q

What immunological conditions can predispose to liver disease?

A

Autoimmune hepatitis

Primary biliary cirrhosis

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12
Q

What are some genetic conditions that can predispose to liver disease?

A

Wilson’s disease

Haemochromatosis

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13
Q

What investigations are carried out into jaundice/acute LD?

A

LFTs
PT
USS
Virology

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14
Q

What drugs can cause hepatic drug reactions?

A

Co-amoxiclav
Flucloxacillin
NSAIDs

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15
Q

What are the common causes of fulminant hepatic failure?

A

Paracetamol
Hep B
Drugs

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16
Q

What are the common causes of liver cirrhosis?

A 
Alcohol
NAFLD
Hep C
Primary biliary cirrhosis
Autoimmune hep
Hep B
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17
Q

What is the clinical context of NAFLD?

A 
Obesity
Type 2 Diabetes
High triglycerides
Low HDL
Hypertension
NASH
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18
Q

What mediated primary biliary cirrhosis?

A

CD4+ cells

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19
Q

How does primary biliary cirrhosis present?

A 
Middle aged woman
Symptoms
- Itch (no rash)
- Fatigue
- Xanthelasma
- Xanthoma
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20
Q

How do we diagnose PBC?

A

Positive AMA
Cholestatic LFTs
Liver biopsy

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21
Q

What are the extra hepatic manifestations of autoimmune hepatitis?

A 
Thyroiditis
Graves' disease
Chronic UC
Pernicious anaemia
Systemic sclerosis
ITP
SLE
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22
Q

How is autoimmune hepatitis diagnosed?

A

Increased AST and ALT
Increased IgG
Presence of ASMA

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23
Q

Is primary sclerosing cholangitis more common in men or women?

A

Men

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24
How do we diagnose primary sclerosing cholangitis?
Biliary tree imaging (ERCP)
25
What can cause portal hypertension?
``` Pre-hepatic - HPV thrombosis Intra-hepatic - Schistosomiasis - Cirrhosis ```
26
Signs of cirrhosis
``` Compensated: - Spider naevi - Palmar erythema - Clubbing - Gynaecomastia - Hepatomegaly - Splenomegaly - ?None Decompensated: - Jaundice - Ascites - Encephalopathy - Bruising ```
27
What is the primary diuretic for ascites?
Spironolactone
28
What is TIPS?
Trans-jugular Intrahepatic Porto-systemic Shunt
29
How do we treat mild spontaneous bacterial peritonitis?
PO Co-trimoxazole
30
How do we treat severe spontaneous bacterial peritonitis?
Piperacillin/Tazobactam IV Step down to PO Co-trimoxazole Terlipressin for vascular instability
31
What is required for Hep D to propagate?
A Hep B co-infection
32
What does the presence of HBsAg indicate?
Current infection - ?Acute - ?Chronic
33
What does the presence of Anti-HBs IgG indicate?
The patient has immunity to Hep B - ?Vaccine - ?Past infection
34
What is the presence of HbeAg an indicator for?
Replication and infectivity
35
When is Anti-HBe present?
When infectivity declines in a patient with Hep B
36
When can HBcAg be detected?
Never.
37
What does the presence of Anti-HBc IgM indicate?
The patient is suffering from an acute infection
38
What does the presence of Anti-HBc IgG indicate?
The patient is immune via a natural infection
39
What is HBV DNA used for?
To quantify viral load
40
How long must the patient be HBsAg positive for to be classed as a carrier?
Greater than six months
41
Roughly how long does it take for a chronic hepatitis infection to result in 1. Cirrhosis 2. Hepatocellular carcinoma?
1. Greater than 20 years | 2. Greater than 30 years
42
What are the treatment options for chronic HBV infection?
Option 1: - PegINF only - Sustained cure - More side effects Option 2: - Entecavir and Tenofovir - Safer - Not a cure - Resistance develops
43
In what structures do arterial and venous blood mix within the liver?
Sinusoids
44
How is each lobule arranged?
Hexagonal Central vein Portal triad at each corner
45
What direction do blood and bile flow in a lobule and what carries each?
``` Blood - Inwardly - Via sinusoids Bile - Outwardly - Via canaliculi ```
46
Where are hepatocytes positioned?
Between sinusoids
47
What is the structure of the hepatocyte plates?
Basolateral membrane - Faces pericellular space Apical membrane - Grooved by canaliculi
48
What cells are present in the sinusoidal spaces?
``` Endothelial cells (fenestrated for free solute movement) Kuppfer cells (resident macrophages) Stellate (Ito) cells (store vitamin A) ```
49
Why are cholangiocyte secretions alkaline?
Micelle formation Chyme neutralisation Enzymes Mucosal protection
50
What is hepatic bile composed of?
``` Primary bile acids Water and electrolytes Lipids Cholesterol IgA Bilirubin ```
51
What analgesia is used for biliary colic?
Morphine (also constricts sphincter of Oddi) Buprenorphine Pethidine
52
What are the three histological zones in a hepatic lobule?
Periportal Midacinar Pericentral
53
What is the limiting plate?
Interface between portal tract and the parenchyma
54
What is the histological appearance of liver cirrhosis?
Bands of fibrosis separate hepatocytes | Macronodular or micronodular (alcoholic)
55
How does paracetamol toxicity appear histologically?
Confluent necrosis in zone 3
56
Why do patients with cirrhosis suffer from ascites?
Hypoalbuminaemia Secondary hyperaldosteronism Portal hypertension
57
Why do cirrhosis patients suffer from purpura, bleeding and bruising?
Decreased clotting factors
58
What does decreased Kuppfer cell function result in?
Infections
59
What are the features of alcoholic hepatitis (histology)?
``` Hepatocyte necrosis Neutrophils Mallory bodies - Inclusions - Highly eosinophilic Pericellular fibrosis ```
60
What autoantibodies are present in autoimmune hepatitis?
Smooth muscle Nuclear LKM
61
What are Kayser-Fleischer rings a sign of?
Wilson's disease
62
What are the histological types of hepatocellular carcinoma?
Hepatocytic | Cholangio
63
What is the clinical setting of a patient with cholesterol gallstones?
Female Obese Diabetes Genetic
64
What can gallstones result in?
``` Cholecystitis Mucocoele Empyema Carcinoma Ascending cholangitis Obstructive jaundice Gallstone ileus Pancreatitis ```
65
What are Rokitansky-Aschoff sinuses a feature of?
Chronic cholecystitis
66
What is cholangiocarcinoma associated with?
UC | Primary sclerosing cholangitis
67
Increased serum amylase, sudden onset abdo pain and severe shock.
Acute pancreatitis
68
What are the complications of acute pancreatitis?
``` Death Shock Pseudocyst formation Abscess formation Hypocalcaemia Hyperglycaemia ```
69
What is the aetiology of chronic pancreatitis?
``` Alcohol Cholelithiasis CF Hyperparathyroidism Familial ```
70
What is pancreatic carcinoma associated with?
Smoking Diabetes Familial pancreatitis
71
What cardiovascular complications can result of GI surgery?
Haemorrhage MI DVT
72
How does postoperative haemorrhage present?
Overt Tachycardia Hypotension Oliguria
73
What increases the risk of postoperative DVT?
``` Age over 40 Previous DVT Major surgery Obesity Malignancy ```
74
How does DVT present as a complication?
``` Low grade Fever High grade fever Calf/thigh tenderness Increased leg diameter Shiny skin ```
75
What are the respiratory complications of GI surgery?
Atelectasis Pneumonia PE
76
How do atelectasis and pneumonia result postoperatively?
Lung tissue collapse Anaesthesia causes hypersecretion and inhibits cilia Postop pain prevents coughing Stomach contents are aspirated
77
What is ileus?
Paralysis of intestinal motility
78
What can cause ileus?
``` Bowel handling Peritonitis Retroperitoneal injury Immobilisation Hypokalaemia Drugs ```
79
What symptoms does ileus have?
Vomiting Abdominal distension Dehydration Silent abdomen
80
What is anastomotic dehiscence and where can it occur?
Intestinal Vascular Urological
81
How do the three kinds of anastomotic dehiscence present?
``` Intestinal - Peritonitis - Abscess - Ileus - Fistula Vascular - Bleeding - Haematoma Urological - Urine leak - Urinoma ```
82
What can cause adhesions?
Inflammation and ischaemia
83
How can adhesions be prevented?
No powder on gloves Avoid infection Laparoscopy Sodium hyaluronidate
84
A solid hepatic lesion in elderly patients is likely to be what?
Secondary tumour
85
A solid hepatic lesion in patients with chronic liver disease is likely to be what?
Primary malignancy
86
In young, non-cirrhotic patients what is a hepatic lesion likely to be?
Haemangioma
87
What types of benign liver lesions are common?
Haemangioma Focal modular hyperplasia Adenoma Liver cysts
88
What is the most common benign liver lesion?
Haemangioma
89
What is the clinical presentation of focal modular hyperplasia?
Young women Not sex hormone related Often asymptomatic
90
How does focal modular hyperplasia appear?
Central scar with unusually large artery | Radiating branches
91
What are the clinical features of a hepatic adenoma?
More common in females Associated with contraceptive hormones RUQ pain
92
What are the types of cystic lesions?
``` Simple Hyatid Atypical Polycystic Pyogenic/Amoebic abscess ```
93
What is a simple cyst?
Liquid collection surrounded by epithelium
94
Does a simple cyst communicate with the biliary tree?
No
95
What is an echinoccocus granulosus?
Hyatid cyst
96
How does a hyatid cyst present?
Disseminated | Erosion into adjacent structures/vasculature
97
Marsupialization and albendazole are used to treat what kind of cyst?
Hyatid
98
What do embryonic ducal plate malformations of the Intrahepatic biliary tree cause?
Polycystic liver disease
99
What are Von Meyenburg Complexes?
Microhamartomas in the liver Bile duct malformations Remnants develop into small hepatic cysts
100
What further problems can arise from gallstones?
``` Colic Cholecystitis Jaundice Pancreatitis Bowel obstruction ```
101
Where does biliary colic pain radiate to?
Back | Shoulder
102
What is biliary colic associated with?
Indigestion | Nausea
103
What are the differential diagnoses of severe epigastric pain apart from biliary colic?
Peptic ulcer Oesophageal spasm MI Acute pancreatitis
104
Treatment of acute cholecystitis?
IV antibiotics and fluids Nil by mouth Ultrasound
105
How do we diagnose CBD pathology?
``` Symptoms - Itch - Nausea - Anorexia - Jaundice Abnormal LFTs ```
106
What is the treatment of gallstone ileus?
Urgent laparotomy | Small bowel enterotomy
107
How does a cholangiocarcinoma present?
``` Late Jaundice Weight loss Anorexia Lethargy ```
108
What viral infections can increase the risk of pancreatic cancer?
Mumps Coxsackie B Hepatitis
109
What metabolic factors increase the risk of pancreatic cancer?
Hyperparathyroidism | Hyperlipoproteinaemia (Types 1 and 4)
110
What examination signs are suggestive of pancreatic cancer?
``` Tenderness Peritonism Distension Bowel sound change Skin marks ```
111
What features on a conventional x Ray may suggest pancreatic cancer?
Pleural effusion | Sentinel loop
112
What complications of pancreatic cancer may be picked up on a CT scan?
``` Fluid Necrosis Ascites Bleeding Abscess ```
113
What is the Glasgow Prognostic Score?
``` PaO2 < 8kPa Age > 55 Neutrophils > 15x10^9/L Calcium < 2mmol/L Renal Function (Urea > 16mmol/L) Enzymes (AST/ALT > 200iU/L or LDG > 600iU/L) Albumin < 32g/L Sugar (Glucose > 10mmol/L) ``` Any three means acute severe pancreatitis
114
What are the symptoms of pseudo cysts?
``` Pain Nausea Vomiting Jaundice Weight loss ```
115
What is the Beger procedure?
Duodenum preserving pancreatic head resection and reconstruction
116
What can cause biliary obstructions?
Oedema Calcification Fibrosis Pancreatic head tumour
117
What is an exocrine pancreatic tumour and where is it located?
Adenocarcinoma Head Body Tail
118
What are the three kinds of endocrine pancreatic tumours?
Gastrinoma Insulinoma Glucagonoma
119
The Whipple procedure?
A pancreaticoduodenectomy
120
What are ANCA and what condition are they seen in?
Anti neutrophilic cytoplasmic antibodies | Primary sclerosing cholangitis

Year 1 - Gastrointestinal (DP) (8 decks)

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