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GI PATHOLOGY > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

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1
Q

What are the major functions of the liver?

A

Synthesis
Filtration/detoxification
Immune function
Storage

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2
Q

What does the Liver synthesis?

A 
Clotting factors
Bile acids
Carbs
Proteins (albumin)
Lipids (cholesterol)
Hormones
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3
Q

What are the detoxifying roles of the liver?

A

Ammonia –> Urea
Drug detoxification
Metabolism of bilirubin
Breakdown of hormones

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4
Q

What does the liver store?

A

Glycogen
Vit A, B12, D, K
Cu, Fe

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5
Q

What are the LFTs?

A 
Bilirubin 
Aminotransferases 
AlkPhos
GGT
Albumin
INR/prothrombin time
Creatinine
Platelets
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6
Q

What is the pre-hepatic cause of elevated bilirubin?

A

Haemolysis

Impaired transport

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7
Q

What is the hepatic cause of elevated bilirubin?

A

Defective uptake
Defective conjugation
Defective excretion

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8
Q

What is the post-hepatic cause of elevated bilirubin?

A

Obstruction in biliary ducts

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9
Q

What is the pathway of bilirubin?

A

Haem metabolism
Sensecent RBC in spleen
Bound to albumin
Conjugated by the liver

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10
Q

What are the aminotransferases?

A

ALT, AST

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11
Q

Which is the most specific aminotransferase?

A

ALT

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12
Q

What does AST/ALT > 1 suggest?

A

ALD/liver damage

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13
Q

When is Alkaline phosphatase raised?

A

Obstruction or liver infiltration

Bone dis, pregnancy

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14
Q

How is Gamma GT used?

A

Elevated in alcohol, NSAID use

Can confirm liver source of raised ALP

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15
Q

What does Low albumin suggest?

A

Chronic Liver Disease
Kidney disease
Malnutrition (rare)

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16
Q

What does INR tell us?

A

Degree of liver disfunction

Staging liver disease

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17
Q

What does creatinine tell us?

A

Kidney function
Survival from liver disease
Need for transplant?

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18
Q

How does liver disease cause low platelet count?

A

Portal hypertension causing splenomegaly = hypersplenism

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19
Q

Symptoms of liver failure

A

Jaundice
Ascites
Varices
Hepatic encephalopathy

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20
Q

When is bilirubin detectable?

A

Plasma bilirubin > 34umol/L

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21
Q

What is the DDx for jaundice?

A

Carotenemia

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22
Q

Pre-hepatic jaundice will likely present with what?

A

History of anaemia
Acholuric jaundice
Splenomegaly
Pallor

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23
Q

Hepatic jaundice will likely present with what?

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A 
Risk factors for Liver disease
Decompensation
Spider naevi
Ascites
Asterixis
24
Q

Post-hepatic jaundice will likely present with what?

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A

Abdominal pain
Cholestasis (high coloured urine, pale stool)
Palpable mass, GB

25
What investigations would be given to a patient presenting with jaundice?
Liver Screen | USS abdomen
26
Main benefit of ERCP over MRCP?
ERCP has the potential to perform therapy during the investigation
27
What complications are associated with ERCP?
Sedation issues Pancreatitis Cholangitis Sphincterectomy - bleeding
28
What is the role of EUS in patients with jaundice?
Finding pancreatic masses Staging Fine needle aspiration Excluding biliary microcalculi
29
How is chronic liver disease defined?
Liver disease persisting for >6 months
30
What is the largest cause of cirrhosis?
Alcohol
31
What are 5 causes of cirrhosis?
``` Autoimmune Alcohol Haemochromatosis, Wilson's Viral hepatitis NAFLD Drugs CF Cryptogenic ```
32
What is the presentation of compensated CLD?
Screening test - abnormality in LFTs
33
What is the presentation of decompensated CLD?
Ascites Variceal bleeding Hepatic encephalopathy
34
When can ascites be detected physically?
1500cc | shifting dullness
35
How is ascites confirmed?
USS
36
What are the clinical features of ascites?
``` Spiders naevi, palmar erythema Abdominal veins Umbilical nodule JVP elevation Flank hematoma ```
37
New onset ascites must always be evaluated how?
Diagnostic paracentesis
38
What studies are performed in an ascitic paracentesis?
``` Protein and albumin conc. Cell count, differential SAAG Culture Glucose Amylase ```
39
SAAG levels in ascitic paracentesis tell us what?
>1.1g/dL - portal HTN related | <1.1g/dL - non portal HTN related
40
What is SAAG?
Serum-ascites albumin gradient
41
A SAAG ratio > 1.1g/dl is suggestive of what?
``` Portal hypertension CHF Constrictive pericarditis Massive liver Mets Budd-Chiarri syndrome ```
42
A SAAG ratio < 1.1g/dl is suggestive of what?
``` Malignancy TB Chylous ascitis Pancreatic/biliary issues Nephrotic syndrome ```
43
Treatment options of ascites?
``` Diuretics Large volume paracentesis TIPSS Aquaretics Liver transplant ```
44
What are the locations of the porto-systemic anastamoses?
``` Skin (caput medusae) Oesophageal/gastric Rectal Posterior abdominal wall Stromal ```
45
How is a variceal bleed treated?
Resuscitation IV access Blood transfusion Emergency endoscopy
46
How is a variceal bleed fixed?
Endoscopic band Ligation | Terlipressin
47
How is an uncontrolled variceal bleed fixed?
Sengstaken-Blakemore tube | TIPSS - Transjugular Intrahepatic Porto-systemic Shunt
48
How is Hepatic encephalopathy graded?
Graded 1-4
49
Hepatic encephalopathy is often precipitated by what?
``` GI bleed Infection Constipation Dehydration Sedation ```
50
How does hepatic encephalopathy present?
Foetor hepaticus (breath stank) Aterixis Confusion
51
How is hepatic encephalopathy treated?
Laxatives, enemas | Neomycin (broad spec antiB)
52
How does hepatocellular carcinoma present?
``` Abdominal Mass Abdominal pain Weight loss Bleeding from tumour Liver disease symptoms ```
53
Which tumour markers are raised in hepatocellular carcinoma?
AFP
54
How is hepatocellular carcinoma diagnosed?
Tumour markers USS CT, MRI Liver biopsy
55
How is hepatocellular carcinoma treated?
``` Hepatic resection Liver transplant Chemo (TACE) Local ablation Sorafenib Tamoxifen ```

GI PATHOLOGY (20 decks)

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