Jaundice and Chronic Liver Disease/Hepato-Biliary Pathology Flashcards Preview

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Flashcards in Jaundice and Chronic Liver Disease/Hepato-Biliary Pathology Deck (57):
1

What are the three classes of jaundice?

Pre-hepatic
Hepatic
Post Hepatic

2

What is the cause of jaundice?

Increase in circulating bilirubin due to altered metabolism

3

What part of haemoglobin is converted to bilirubin?

Haem part

4

What is involved in the pre-hepatic phase?

Breakdown of haemoglobin -> haem and globin, haem is converted to bilirubin

5

What is involved in the hepatic phase?

Uptake and conjugation of bilirubin by the hepatocytes and excretion of the conjugated bilirubin into the biliary system

6

What is involved in the post-hepatic phase?

Transport of conjugated bilirubin in the biliary system , breakdown in the intestine and reabsorption

7

What is cholestasis?

Accumulation of bile within the hepatocytes or bile canaliculi due to viral hepatitis, alcoholic hepatitis, liver failure or drugs

8

What are the types of hepatic jaundice?

Predictable - dose related
Unpredictable - not dose related

9

What causes hepatic jaundice?

Intra-hepatic bile duct obstruction
Due to:
Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver

10

What is primary biliary cholangitis?

An organ specific auto-immune disease causing granulomatous inflammation involving the bile ducts, loss of intra-hepatic bile ducts and progression to cirrhosis

11

What can be detected in serum for diagnosis of primary biliary cholangitis?

Anti-mitochondrial auto-antibodies
Raised alkaline phosphatase

12

What is primary sclerosing cholangitis?

Chronic inflammation and fibrous obliteration of the bile ducts causing loss of intra-hepatic bile ducts and progression to cirrhosis

13

Primary sclerosing cholangitis is associated with an increased risk of what?

Cholangiocarcinoma

14

What is the cause of post-hepatic jaundice?

Gallstones and diseases of the gall bladder causing extra hepatic obstruction

15

What is acute cholecystitis?

Acute inflammation of the gall bladder

16

What is caused by acute cholecystitis?

Empyema leading to the perforation of the gall bladder, biliary peritonitis and eventual progression to chronic inflammation in which pus is formed in the gall bladder

17

What is chronic cholecystitis?

Chronic inflammation and fibrosis of the gall bladder

18

What are the causes of common bile duct obstruction?

Gallstones
Bile duct tumours
Benign strictures
External compression due to tumours

19

What are the effects of common bile duct obstruction?

Jaundice
No bile excreted into duodenum
Infection of bile proximal to the obstruction
Secondary biliary cirrhosis if obstruction is prolonged

20

What can cause an elevation in circulating bilirubin?

Haemolysis
Parenchymal Damage
Obstruction

21

How are amino transferases used to determine liver function?

ALT and AST can indicate liver injury but are not specific to it, if AST levels > ALT levels alcoholic liver disease is indicated
May also indicate parenchymal involvement

22

What is alkaline phosphatase and how is it used to determine liver function?

An enzyme present in the bile ducts which becomes elevated during obstruction or liver infiltration
However it is non-specific as it is also present in bone disease, placenta and the intestines

23

What is gamma-GT and how is it used to determine liver function?

A non-specific liver enzyme which is elevated with alcohol consumption and some drugs
Can be useful to confirm a liver source of ALP
If alkaline phosphatase and gamma-GT levels are moth raised then liver disease is indicated

24

How is albumin useful in detecting liver disease?

Important test for synthetic function of the liver
Low levels suggest chronic liver disease, kidney disorders or malnutrition

25

How is prothrombin time useful in detecting liver disease?

Important test for liver function, tells the extent and prognosis of liver function
Test of the clotting factors so if abnormal significant disease is indicated

26

How is creatinine a useful test in the diagnosis of liver disease?

Creatinine tests kidney function, since kidney and liver function are closely related it helps to determine the prognosis of liver disease

27

How is a platelet count a useful test in the diagnosis of liver disease?

Liver is an important source of thrombopoeitin, poor liver function will reduce bone marrow activity, also cirrhosis can result in splenomegaly - hypersplenism results in low platelets

28

Give 5 things which would be tested for in the blood in investigation of liver disease

Immunoglobulins - IgA, IgG, IgM
Autoantibodies - AMA, ASMA, ANA
Caeruloplasmin copper
Ferritin
Alpha-1-antitrypsin
Hepatitis serology
Epstein Barr Virus
Cytomegalovirus
Leptospira
Alphafoetoprotein
Fatty liver disease - fasting glucose or lipid profile

29

What are the typical presentations of liver failure?

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

30

When would a liver biopsy be indicated?

In unknown parenchymal disease or if an unknown focal liver lesion
If the aetiology of disease is known but more information is required on inflammation, fibrosis or cirrhosis

31

What imaging investigations might be done in suspected liver failure?

Ultrasound of liver and biliary tree
CT of abdomen
MRI of abdomen
ERCP
Endoscopic ultrasound
MRCP

32

Give the causes of acute liver injury

Hepatitis
Viral Hepatitis - A, B, C or E
Viruses
Alcohol
Drugs
Bile duct obstruction

33

What happens to the liver in viral hepatitis?

Live inflammation, cell damage and death

34

What kinds of viral hepatitis might resolve and return to normal without treatment?

A or E

35

What kinds of viral hepatitis can cause liver failure due to liver damage caused by severe hepatitis?

A, B or E

36

What kinds of viral hepatitis can progress to chronic hepatitis and cirrhosis?

B or C

37

What is alcoholic hepatitis?

Inflammatory response of the liver to alcohol causing acute inflammation, liver cell death and liver failure

38

What can alcoholic hepatitis progress to?

Cirrhosis

39

What are the causes of hepatic cirrhosis?

Alcohol
Hepatitis B or C
Autoimmune hepatitis
Primary biliary cholangitis
Primary haemachromatosis
Wilson's disease
Obesity/diabetes mellitus
Idiopathic

40

What is hepatic cirrhosis

A diffuse process involving the whole liver causing loss of normal liver structure which is replaced by nodules of hepatocytes and fibrous tissue

41

Give the complications of hepatic cirrhosis

Liver failure caused by altered liver function
Portal hypertension causing haemorrhage risk
Increased risk of hepatocellular carcinoma

42

What are the histological types of liver tumours?

Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic tumours also commonly occur in the liver

43

How does hepatocellular carcinoma usually develop and what cells does it affect?

Generally develops with cirrhosis
Malignant tumour of the hepatocytes

44

What is cholangiocarcinoma?

A malignant tumour of the bile duct epithelium

45

What are the common liver disorders?

Jaundice
Liver failure
Intrahepatic bile duct obstruction
Cirrhosis
Tumours

46

What are the causes of cholestasis?

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

47

What are the causes of intra-hepatic bile duct obstruction?

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours

48

How might gall stones present?

Asymptomatic
Dyspeptic symptoms
Biliary colic
Acute cholecystitis
Empyema
Perforation
Jaundice
Gallstone ileus

49

What investigations would be done if suspecting gallstones?

MRCP
EUS
CT
Amylase and lipase
WCC

50

What would be done if diagnosis of gallstones had been confirmed as therapeutic management?

PTC or ERCP

51

What is the best surgical procedure for removal of gallstones?

Laparoscopic cholecystectomy

52

What is choledocholithiasis?

Presence of at least one gall stone in the common bile duct

53

How might choledocholithiasis present?

Post-cholecystectomy pain
Obstructive jaundice
Acute pancreatitis
Ascending cholangitis

54

What is the management for choledocholithiasis?

Laparoscopic CBD exploration
ERCP
Transhepatic stone retrieval

55

What are the risk factors for cholangiocarcinoma?

Increasing age
Primary sclerosing cholangitis
Congenital cystic disease
Biliary enteric drainage
Thorotrast (old contrast agent)
Hepatolithiasis
Carcinogen exposure

56

What are the histological types of ampullary tumours?

Adenoma
Adenocarcinoma

57

What is the treatment for ampullary tumours?

Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy