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Alimentary System > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

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1
Q

What are the production functions of the liver?

A 
Producing:
Clotting factors 
Bile acids 
Glucose control in blood:
Glucagon 
Cholesterol synthesis Lipoprotein and TG synthesis 
Production of hormones
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2
Q

Which carbohydrate cycles happen in the liver?

A

glucogenesis

glycogenesis

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3
Q

What is the production of bile acids essential for?

A

The digestion of fats

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4
Q

Which hormones does the liver produce?

A

Angiotensin

Insulin like growth factor

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5
Q

What are the detoxification functions of the liver?

A

Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and other hormones

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6
Q

What are the basic LFTs?

A 
Bilirubin 
Aminotransferases: 
ALT and AST
Alkaline phosphatase 
Gamma GT 
Albumin 
Prothrombin time 
Creatinine 
Platelet count
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7
Q

What is bilirubin a by product of?

A

Haeme metabolism

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8
Q

Where is heme metabolised?

A

Spleen

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9
Q

Where is haeme taken to?

A

To the liver

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10
Q

What does liver do to haeme?

A

Helps to solubilise it

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11
Q

What is a pre-hepatic cause for elevated bilirubin?

A

Haemolysis (excess RBC)

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12
Q

What is a hepatic cause for elevated bilirubin?

A

Liver damage (when the problem is actually in the liver)

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13
Q

What is a post-hepatic reason for elevated bilirubin?

A

Blockage in the hepatic ducts

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14
Q

Where is aminotransferase present?

A

In hepatocytes

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15
Q

If there is liver damage what will aminotransferase results show?

A

Elevation of these enzymes

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16
Q

What are the 2 types of aminotransferases?

A

AST

ALT

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17
Q

Where is alkaline phosphatase?

A

Cells lining bile ducts

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18
Q

When is alkaline phosphatase level elevated?

A

When there is obstruction or liver infiltration

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19
Q

In what other organs is alkaline phosphatase present?

A

Bone

Placenta

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20
Q

What is Gamma GT?

A

Non-specific liver enzyme

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21
Q

When is gamma GT elevated?

A

With alcohol abuse

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22
Q

What drugs can raise gamma GT?

A

NSAID’s

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23
Q

What albumin an important test for?

A

Liver function

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24
Q

What do low levels of albumin suggest?

A

Chronic liver disease

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25
Which LFT is used to determine the stage of liver disease and the qualification for liver transplantation?
Prothrombin time
26
What is platelet count an indirect marker of?
Portal hypertension
27
What are the 4 main symptoms for liver failure?
Jaundice Ascites Variceal bleeding Hepatic encephalopathy
28
What is ascites?
Fluid in the abdomen
29
What is jaundice as a symtpom?
Yellowing of the skin due excess of circulating bilirubin
30
What is hepatic encephalopathy?
Confusion due to ammonia crossing the blood brain barrier
31
At what bilirubin levels is jaundice detectable?
When total plasma bilirubin levels exceed 34 umol/L
32
What is a differential diagnosis for jaundice?
Carotenemia
33
Which sign determines that is cannot be anything other than jaundice?
Yellowing of the sclera
34
What are pre-hepatic clues of jaundice on clinical examination?
Pallor Splenomegaly History of anaemia Alcholuric jaundice
35
What are hepatic clues of jaundice on clinical examination?
Ascites Asterixis Risk factors for liver disease
36
What are post-hepatic clues of jaundice on clinical examination?
Palpable gall bladder Abdominal pain Colestasis
37
What is the first line investigation for jaundice?
USS
38
What are the pros of an ultrasound scan?
``` Cheap No radiation Portable and widely available Good for gallstone viewing Examines organs ```
39
What are the cons of CT and MRI scans?
Expensive - MRI Radiation - CT Requires a scanner High specificty
40
What is ERCP?
Endoscopy procedure that travels to the bottom of the bile duct and injects dye
41
What are some complications of ERCP?
Pancreatitis
42
What does physical examination with ascites reveal?
Dullness in flanks | And shifting dullness
43
What is cirrhosis
Repair of liver damage by scar tissue
44
What are some causes of cirrhosis?
``` Alcohol Autoimmnue - PBC, PSC Hameochromatosis Chronic viral hepatitis Non-alcoholic fatty liver disease Drug Cystic fibrosis ```
45
Why is an USS very good for ascites?
It is good at detecting small amounts of fluid in the abdomen
46
What are other signs of chronic liver disease?
``` Ascites Spider Neiva Palmar erythema Abdominal veins Fetor hepaticus Umbilical nodule JVP elevation Flank haematoma ```
47
Is all ascites due to liver disease?
No
48
What procedure should be given to all patients with new-onset ascites?
Diagnostic paracentesis
49
What is diagnostic paracentesis?
Where a needle is inserted into the abdomen to gain a sample of fluid in the abdominal cavity
50
What are the treatments for ascites?
Diuretics Large volume drainage Aquaretics Liver transplantation
51
What does SAAG stand for?
Serum-ascites albumin gradient
52
What does SAAG >1.1g/dl suggest?
Portal hypertension CHF Constrictive pericarditis Myxedema Massive liver metastases
53
What does SAAG <1.1 g/dl suggest?
``` Malignancy Tuberculosis Pancreatic Biliary ascites Nephrotic syndrome Serositis ```
54
What are variceal haemorrhages a consequence of?
Portal hypertension
55
Where are the porto-systemic anastomoses in the body where variceal haemorrhage can occur?
Oesophagus Umbilicus Bare area of the liver Ano-rectal junction
56
What is the management of variceal haemorrhages?
``` Resuscitation Good IV access Blood transfusions as required Emergency endoscopy Band ligation ```
57
What is hepatic encephalopathy?
Confusion due to liver disease
58
What causes HE?
Ammonia crossing the blood brain barrier
59
How is HE graded?
1-4
60
How is HE treated?
By treating the underlying cause
61
What is the commonest cause of HE?
Constipation
62
What does hepatocellular carcinoma occur in the background of?
Cirrhosis | Chronic HBV and HCV
63
What is the presentation of hepatocellular carcinoma?
``` Decompensation of liver disease Abdominal mass Abdominal pain Weight loss Bleeding ```
64
How is the diagnosis for hepatocellular carcinoma made?
``` Alpha fetoprotein USS CT RI Liver biopsy - rarely done ```
65
What is the treatmet options for hepatocellular carcinoma?
``` Hepatic resection Liver transplantation Chemotherapy Locally ablative treatments Sorafenib Hormonal therapy ```

Alimentary System (29 decks)

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