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Flashcards in Jaundice and Chronic Liver Disease Deck (45):
1

What does the liver store?

Glycogen
Vitamin A, D, B12, K
Copper and Iron

2

What is jaundice?

Yellowing of skin, sclera and other tissues

3

What is the cause of jaundice?

Excess circulating bilirubin

4

At what level does bilirubin become detectable?

Exceeds 34 micro mol/L

5

What are the 3 classifications of jaundice?

Pre hepatic
Hepatic
Post hepatic

6

What is pre hepatic jaundice?

Increased quantity of bilirubin
Impaired transport

7

What is hepatic jaundice?

Defective uptake of bilirubin
Defective conjugation
Defective excretion

8

What is post hepatic jaundice?

Defective transport of bilirubin by the biliary ducts

9

What are the clinical signs of pre hepatic jaundice?

Pallor
Splenomegaly
History of anaemia
Acholuric jaundice

10

What are the clinical signs of hepatic jaundice?

Ascites
Asterixis
Stigmata of CLD (spider nave, gynaecomastia)
Risk factors of liver disease
Decompensation
Highly coloured urine

11

What are the clinical signs of post hepatic jaundice?

Palpable gall bladder
Abdominal pain
Cholestasis
Highly coloured urine
Pale stools

12

What are the investigations used to diagnose jaundice?

Liver screen
Abdominal ultrasound
CT
MRI

13

What does ERCP stand for?

Endoscopic retrograde cholangio pancreatography

14

What does MRCP stand for?

Magnetic retrograde cholangio pancreatography

15

What are the differences between ERCP and MRCP?

MRCP uses no radiation
MRCP has no complications
MRCP has no sedation

16

What are the uses of ERCP?

Stenting of biliary tract obstruction
Acute gallstone pancreatitis
Dilated biliary tree (stone/tumour removal)

17

What are the complications of ERCP?

Sedation related (resp/cardio)
Bleeding
Perforation
Pancreatitis
Cholangitis

18

What does PTC stand for?

Percutaneous transhepatic cholangiogram §

19

What are the uses of EUS?

Characterising pancreatic masses
Tumour staging
Fine needle aspiration of tumours and cysts

20

What is the definition of chronic liver disease?

Liver disease that persists beyond 6 months

21

What are the symptoms of hepatocellular carcinoma?

Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour

22

What are the investigations for hepatocellular carcinoma?

Ultrasound
CT
MRI
Tumour markers (alpha feto protein)

23

What is the treatment for hepatocellular carcinoma?

Hepatic resection
Liver transplantation
Chemotherapy
Hormonal therapy

24

What are the symptoms of hepatic encephalopathy?

GI bleed
Infection
Constipation
Dehydration
Foetor hepaticus

25

What is the treatment for hepatic encephalopathy?

Laxatives
Neomycin
Rifaximin broad spectrum non absorbed antibiotic

26

What causes variceal haemorrhage?

Portal hypertension

27

Where are the areas associated with variceal haemorrhages?

Skin -caput medusa
Oesophageal and gastric
Rectal
Posterior abdominal wall
Stomal

28

How do you manage variceal haemorrhage?

Resuscitate patient
Good IV access
Blood transfusion
Emergency endoscopy (band ligation)

29

What is an ascite?

Abdominal distension due to fluid?

30

What are the clinical features of an ascite>

Dullness in flanks
Shifting dullness
Flank haematoma
JVP elevation
Umbilical nodule
Palmar erythema
Foetor hepaticus
Spider naevi

31

How are ascites diagnosed?

Diagnostic paracentesis
Protein and albumin concentrations
Cell count and differential
SAAG (serum ascites alumni gradient)

32

How are ascites treated?

Diuretics
Large volume paracentesis
TIPS
Aquaretics
Liver transplantation

33

What are the causes of cirrhosis?

Alcohol
Hepatits B and C
Non alcoholic fatty liver disease
Drugs
Cystic fibrosis
Autoimmune

34

What are the pathological changes in a cirrhotic liver?

Sinusoids will convert to abnormal cell, starts laying down collagen, chokes off sinusoid, increases pressure

35

What is the presentation of cirrhosis?

Abnormal liver function tests
Ascites
Variceal bleeding
Hepatic encephalopathy
Hepatocellular carcinoma

36

What is bilirubin?

Byproduct of haeme metabolism
Initially bound to albumin (unconjugated)
Liver will solubilise it (conjugated)

37

What are the aminotransferase?

Enzymes present in hepatocytes

38

What is alkaline phosphatase?

Enzyme present in bile ducts

39

When is alkaline phosphatase elevated?

Obstruction orr liver infiltration

40

What is gamma GT?

Non specific liver enzyme
Confrims liver source of ALP

41

When is gamma GT elevated?

Alcohol use
Drugs like NSAID's

42

What do low levels of albumin suggests?

Chronic liver disease
Kidney disorders
Malnutrition

43

What is prothrombin time?

Tells the degree of liver dysfunction and to stage liver disease

44

How is creatine used?

Determines survival from liver disease

45

When is platelet count low in liver disease?

Cirrhosis patients (as a result of hyperslenism)