Jaundice and chronic liver disease

Question 1

What are the synthetic functions of the liver?

Answer 1

• Proteins, Albumin synthesis
• Bile acids
• Lipids, Cholestrol synthesis, Lipoprotein
• Hormones, Insulin growth factor
• Clotting factors

Question 2

What are the detoxifications functions of the liver

Answer 2

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

Question 3

What is the immune function of the liver?

Answer 3

• Removing of bacteria, pathogens, particles from the blood
• Combat infection
• Neutrilisng and destroying all toxins in the blood

Question 4

What are the storage functions of the liver?

Answer 4

• Storage of Vitamins A,D, B12 and K
• Storage of Iron and copper
• Storage of glycogen

Question 5

Where is bilirubin generated and how is it generated?

Answer 5

• Product of heam metabolism

- Generated by RBC’s in the spleen

Question 6

How does bilirubin initially travel to the liver?

Answer 6

• In the blood circulation bound to albumin

Question 7

What is Amino-transferases? (ALT)

Answer 7

• Enzymes present in the Liver
• Elevated ALT is suggestive of Liver damage
• Suggestive of Viral or drug induced hepatits

Question 8

What is Amino-phosphatase? (ASP)

Answer 8

• Enzyme present in the bile ducts
• ## Usually elevated with bile obstruction

Question 9

What is Gamma GT?

Answer 9

• Non specific liver enzyme
• Normally elevated and used to track alcohol use
• ## Used to confirm ASP/ALT source is actually liver

Question 10

What is prothrombin time?

Answer 10

• Prothrombin generated by the liver is essential to clotting
• An elevated prothrombin time is suggestive of hepatic damage, Cirrhosis

Question 11

At what Bilirubin level does a patient begin to develop jaundice

Answer 11

• 34 umol/L

Question 12

What is the most important test for jaundice?

Answer 12

• Abdominal ultrasound

Question 13

What are the benifits of an Abdominal ultrasound compared to that of a CT/MRI

Answer 13

• Cheaper
• No radiation
• Portable
• Good for gallstones

Question 14

What are the beniftis/weaknesses of using MRCP rather than ERCP?

Answer 14

MRCP
-  No radiation
- No Sedation
- No complications 
- No theraputic option
ERCP
- Sedation
- Radiation
- Complications 
- Stone extraction

Question 15

Potential complications of ERCP?

Answer 15

• Pancreatitis
• Cholangitis
• ## Perforation

Question 16

An elevated AST, PPT is suggestive of what?

Answer 16

• Hepatic issues

Question 17

An elevated ASP and conjugated bilirubin is suggestive of what?

Answer 17

• Obstruction of extrahepatic bile pathways

Question 18

What are some of the causes of Liver Cirrhosis

Answer 18

• Alcohol
• Heamchromatosis
• Primary biliary cholangitis
• Primary sclerosing cholangitis
• Hepatits B & C
• Sarcoidosis
• Drug toxicity, Amiradone, MXT
• Anti 1 typsin 1 deficancy
• CF
• -

Question 19

What are the reasons for transplatation?

Answer 19

• Chronic liver disease
• Liver malignancy
• Hepatocellular carcinoma
• Acute Liver failure

Question 20

Contraindications for transplant?

Answer 20

• Active extra-hepatic malignancy
• Active infection
• Active substance, alcohol abuse
• ## Brain death