Flashcards in Jaundice and Chronic Liver Disease Deck (45):
What does the liver store?
Vitamin A, D, B12, K
Copper and Iron
What is jaundice?
Yellowing of skin, sclera and other tissues
What is the cause of jaundice?
Excess circulating bilirubin
At what level does bilirubin become detectable?
Exceeds 34 micro mol/L
What are the 3 classifications of jaundice?
What is pre hepatic jaundice?
Increased quantity of bilirubin
What is hepatic jaundice?
Defective uptake of bilirubin
What is post hepatic jaundice?
Defective transport of bilirubin by the biliary ducts
What are the clinical signs of pre hepatic jaundice?
History of anaemia
What are the clinical signs of hepatic jaundice?
Stigmata of CLD (spider nave, gynaecomastia)
Risk factors of liver disease
Highly coloured urine
What are the clinical signs of post hepatic jaundice?
Palpable gall bladder
Highly coloured urine
What are the investigations used to diagnose jaundice?
What does ERCP stand for?
Endoscopic retrograde cholangio pancreatography
What does MRCP stand for?
Magnetic retrograde cholangio pancreatography
What are the differences between ERCP and MRCP?
MRCP uses no radiation
MRCP has no complications
MRCP has no sedation
What are the uses of ERCP?
Stenting of biliary tract obstruction
Acute gallstone pancreatitis
Dilated biliary tree (stone/tumour removal)
What are the complications of ERCP?
Sedation related (resp/cardio)
What does PTC stand for?
Percutaneous transhepatic cholangiogram §
What are the uses of EUS?
Characterising pancreatic masses
Fine needle aspiration of tumours and cysts
What is the definition of chronic liver disease?
Liver disease that persists beyond 6 months
What are the symptoms of hepatocellular carcinoma?
Bleeding from tumour
What are the investigations for hepatocellular carcinoma?
Tumour markers (alpha feto protein)
What is the treatment for hepatocellular carcinoma?
What are the symptoms of hepatic encephalopathy?
What is the treatment for hepatic encephalopathy?
Rifaximin broad spectrum non absorbed antibiotic
What causes variceal haemorrhage?
Where are the areas associated with variceal haemorrhages?
Skin -caput medusa
Oesophageal and gastric
Posterior abdominal wall
How do you manage variceal haemorrhage?
Good IV access
Emergency endoscopy (band ligation)
What is an ascite?
Abdominal distension due to fluid?
What are the clinical features of an ascite>
Dullness in flanks
How are ascites diagnosed?
Protein and albumin concentrations
Cell count and differential
SAAG (serum ascites alumni gradient)
How are ascites treated?
Large volume paracentesis
What are the causes of cirrhosis?
Hepatits B and C
Non alcoholic fatty liver disease
What are the pathological changes in a cirrhotic liver?
Sinusoids will convert to abnormal cell, starts laying down collagen, chokes off sinusoid, increases pressure
What is the presentation of cirrhosis?
Abnormal liver function tests
What is bilirubin?
Byproduct of haeme metabolism
Initially bound to albumin (unconjugated)
Liver will solubilise it (conjugated)
What are the aminotransferase?
Enzymes present in hepatocytes
What is alkaline phosphatase?
Enzyme present in bile ducts
When is alkaline phosphatase elevated?
Obstruction orr liver infiltration
What is gamma GT?
Non specific liver enzyme
Confrims liver source of ALP
When is gamma GT elevated?
Drugs like NSAID's
What do low levels of albumin suggests?
Chronic liver disease
What is prothrombin time?
Tells the degree of liver dysfunction and to stage liver disease
How is creatine used?
Determines survival from liver disease