Jaundice and Chronic Liver Disease

Question 1

What are the synthetic functions of the liver?

Answer 1

Clotting factors
Bile acids
Carbohydrates
Proteins
Lipids
Hormones

Question 2

What are the detoxification functions of the liver?

Answer 2

Urea production from ammonia
Drug detoxification
Bilirubin metabolism
Breakdown of insulin and hormones

Question 3

What are the immune functions of the liver?

Answer 3

Combat infections
Clear blood of particles/infections inc. bacteria
Neutralise + destroy all drugs and toxins

Question 4

What is the storage function of the liver?

Answer 4

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

Question 5

What are the liver function tests?

Answer 5

Bilirubin
Aminotransferases
Gamma GT
Albumin
Prothrombin time
Creatinine
Platelet count

Question 6

What does elevated bilirubin suggest?

Answer 6

Pre-hepatic: haemolysis
Hepatic: parenchymal damage
Post-hepatic: obstructive

Question 7

What does elevated gamma GT suggest?

Answer 7

alcohol use

drugs e.g. NSAIDS

Question 8

What does low levels of albumin suggest?

Answer 8

Chronic liver disease

May be low in kidney disorders/malnutrition

Question 9

What is prothrombin time test used for?

Answer 9

Indicates degree of liver dysfunction

Determines who needs a liver transplant

Question 10

What is creatinine test used for?

Answer 10

Determines survival from liver disease - helpful in deciding who gets transplant

Question 11

What does low platelet count suggest?

Answer 11

Cirrhosis

Indirect marker of portal hypertension

Question 12

What are the symptoms that occur when the liver stops working?

Answer 12

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

Question 13

What causes jaundice?

Answer 13

Excess circulating bilirubin

Question 14

What is pre-hepatic jaundice?

Answer 14

Increased quantity of bilirubin

Impaired transport

Question 15

What is hepatic jaundice?

Answer 15

Defective uptake of bilirubin
Defective conjugation
Defective excretion

Question 16

What is post-hepatic jaundice?

Answer 16

Abdominal pain

Cholestasis

Question 17

What are the clinical signs of pre-hepatic jaundice?

Answer 17

Pallor

Splenomegaly

Question 18

What are the clinical signs of hepatic jaundice?

Answer 18

Stigmata of CLD
Ascites
Asterixis

Question 19

What are the clinical signs of post-hepatic jaundice?

Answer 19

Palpable gall bladder

Question 20

What are the investigations for jaundice?

Answer 20

Hep B and C serology
Autoantibody profile
Caeruloplasmin and copper
Ferritin and transferrin saturation
alpha 1 anti trypsin
Fasting glucose and lipid profile
Abdomen USS

Question 21

What are the causes of cirrhosis?

Answer 21

Alcohol
Autoimmune
Haemochromatosis
Chronic viral hep B and C
NAFLD
Drugs
CF, wilsons
Vascular problems
Cryptogenic

Question 22

What are the clinical features of ascites?

Answer 22

Dullness in flanks and shifting dullness
confirmed by USS
palmar erythema
abdominal veins
umbilical nodule
JVP elevation
Flank haematoma

Question 23

What are the treatment options for ascites?

Answer 23

Diuretics
Large volume paracentesis
TIPS
Aquaretics
Liver transplant

Question 24

How do varices occur?

Answer 24

Due to portal hypertension

Medical emergency

Question 25

How are varices managed?

Answer 25

``` Resuscitate patient Good IV access Blood transfusion Emergency endoscopy Endoscopic band ligation Terlipressin for control Sengstaken-Blakemore tube for uncontrolled bleeding TIPSS for rebleeding after banding ```

Question 26

What are the signs of hepatocellular carcinoma?

Answer 26

``` Decompensation of liver disease Abdominal mass Abdominal pain Weight loss Bleeding from tumour ```

Question 27

How is hepatocellular carcinoma diagnosed?

Answer 27

``` Tumour markers: AFP USS CT MRI Liver biopsy (rare) ```

Question 28

What is the treatment for hepatocellular carcinoma?

Answer 28

``` Hepatic resection Liver transplant Chemotherapy Alcohol injection, radiofrequency ablation Sorafenib Hormonal therapy: tamoxifen ```