Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Junior Surgery- GI > Jaundice and Liver function assessment > Flashcards

Jaundice and Liver function assessment Flashcards

1
Q

What is the definintion of jaundice?

A

Yellowing of the skin, sclerae, and other tissues caused by excess circulating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At what bilirubin level does jaundice become clinically evident?

A

Serum levels exceed 51 micromol/L (3 mg/dL).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are red blood cells broken down?

A

Macrophages breakdown haem into bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is bilirubin conjugated with?

A

Glucouronic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What transports unconjugated bilirubin in the blood?

A

Albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is bilirubin secreted into after it has been conjugated with glucuronic acid?

A

Into bile and then the intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens to conjugated bilirubin when it enters the bowel?

A

Glucuronic acid is removed by intestinal bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens to bilirubin once the glucuronic acid has been removed by bacteria?

A

Converted to urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens to urobilinogen in the intestine?

A
  • Absorbed from the gut -> to kidney
  • Oxidised to stercobilinogen -> faeces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is urobilinogen converted to in the kidneys?

A

Urobilin - characteristic colour of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are causes of unconjugated hyperbilirubinaemia?

A
  • Overproduction - Haemolysis, ineffective erythropoesis
  • Impaired hepatic uptake - Drugs, ischaemic hepatitis
  • Impaired conjugation - Gilbert’s syndrome, Crigler-Najjar
  • Physiological neontala jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What sort of hyperbilirubinaemia occurs in pre-hepatic jaundice?

A

Unconjugated hyperbilirubinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of hyperbilirubinaemia occurs in gilbert’s syndrome?

A

Unconjugated hyperbilirubinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What types of jaundice cause conjugated hyper bilirubinaemia?

A
  • Hepatocellular dysfunction
  • Post-hepatic/Cholestatic jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are causes of hepatocellular jaundice?

A
  • Viral hepatitis
  • CMV
  • EBV
  • Drugs
  • Alcohol/Cirrhosis
  • Liver mets
  • Liver abscess
  • Haemochromatosis
  • Autoimmune hepatitis
  • Septicaemia
  • Leptospirosis
  • Syphilis
  • Alpha1-antitrypsin
  • Budd chiari
  • Wilson’s Disease
  • Right heart failure
  • Toxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are causes of post-hepatic jaundice?

A
  • PBC, PSC
  • Drugs
  • CBD gallstones
  • Pancreatic cancer
  • Compression of the bile duct
  • Cholangiocarcinoma
  • Choledochal cyst
  • Mirrizi’s syndrome
  • Caroli’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What blood tests are used to assess liver function?

A
  • Alanine transaminase (ALT)
  • Aspartate aminotransferase (AST)
  • Alkaline phosphatase (ALP)
  • Gamma-Glutamyltransferase (GGT)
  • Bilirubin
  • Albumin
  • Prothrombin time (PT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What tests are used to distinguish between hepatic and post-hepatic jaundice?

A
  • ALT
  • AST
  • ALP
  • GGT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What tests are used to assess livers synthetic function?

A
  • Bilirubin
  • Albumin
  • PT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is ALT a useful marker of?

A

Hepatocellular injury - found in high concentrations in hepatocytes and enters blood following hepatocellular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is ALP a useful marker of?

A

Cholestasis (Indirect marker ) - particularly concentrated in the liver, bile duct and bone tissues. It is raised in liver pathology due to increased synthesis in response to cholestasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What LFT results would indicate predominantly hepatocellular injury?

A
  • ALT - > 10-fold increase
  • ALP - <3-fold increase
23
Q

What LFT results would indicate cholestasis?

A
  • ALT - <10-fold increase
  • ALP - >3-fold increase
  • Raised GGT
24
Q

What are causes of an isolated rise in ALP?

A
  • Bony metastases / primary bone tumours (e.g. sarcoma)
  • Vitamin D deficiency
  • Recent bone fractures
  • Renal osteodystrophy
  • Paget’s Disease
25
Q

How would you distinguish between hepatocellular jaundice and cholestatic jaundice?

A

Compare to what degree the ALT and ALP are raised. If ALT is raised markedly compared to the ALP, this is primarily a hepatocellular pattern of injury. If ALP is raised markedly compared to ALT, this is primarily a cholestatic pattern of injury.

26
Q

What is a raised GGT indicative of?

A

Can be suggestive of biliary epithelial damage and bile flow obstruction.

It can also be raised in response to alcohol and drugs such as phenytoin.

A markedly raised ALP with a raised GGT is highly suggestive of cholestasis.

27
Q

What would a raised ALP in the absence of raised GGT suggest?

A

Non-hepatobiliary cause - Alkaline phosphatase is also present in bone and therefore anything that leads to increased bone breakdown can elevate ALP.

28
Q

What would jaundice with normal ALT/ALP levels suggest?

A

Pre-hepatic cause - Gilbert’s syndrome, haemolysis

29
Q

What are the livers main synthetic functions?

A
  • Conjugation and elimination of bilirubin
  • Synthesis of albumin
  • Synthesis of clotting factors
  • Gluconeogenesis
30
Q

What investigations can be used to test liver synthetic function?

A
  • Serum bilirubin
  • Serum albumin
  • Prothrombin time (PT)
  • Serum blood glucose
31
Q

What happens to an individuals stool and urine if they have unconjugated hyperbilirubinaemia?

A

Normal urine and normal stool

32
Q

What would the colour of someones stool be if they had hepatic jaundice?

A

Dark urine, normal stool

33
Q

What colour is the stool and urine in someone with post-hepatic jaundice?

A

Pale stool, dark urine

34
Q

What can cause albumin to fall?

A
  • Liver disease resulting in a decreased production of albumin (e.g. cirrhosis)
  • Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin
  • Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome
35
Q

What is PT, and what can it indicate in terms of liver disease?

A

Prothrombin time (PT) is a measure of the blood’s coagulation tendency, specifically assessing the extrinsic pathway.

In the absence of other secondary causes such as anticoagulant drug use and vitamin K deficiency, an increased PT can indicate liver disease and dysfunction.

36
Q

What does an ALT > AST tend to indicate when looking as the ALT/AST ratio?

A

Chronic liver disease

37
Q

What does an AST>ALT tend to indicate when looking as the ALT/AST ratio?

A
  • Cirrhosis
  • Acute alcoholic hepatitis
38
Q

What LFT profile might be present in someone with acute hepatocellular damage?

A
  • Markedly increased ALT
  • Normal/increased ALP
  • Normal/increased GGT
  • Increased/Markedly increased Bilirubin
39
Q

What LFT profile might you see in someone with Chronic hepatoceullular damage?

A

Normal or increase ALT, ALP, GGT and Bilirubin

40
Q

What LFT profile might you see in someone with Cholestasis?

A
  • Normal/increased ALT
  • Mardkedly increased ALP
  • Markedly Increased GGT
  • Markedly increased Bilirubin
41
Q

What are common causes of acute hepatoceullular damage?

A
  • Poisoning (paracetamol overdose)
  • Infection (Hepatitis A and B)
  • Liver ischaemia
42
Q

What are common causes of chronic hepatocellular injury?

A
  • Alcoholic fatty liver disease
  • Non-alcoholic fatty liver disease
  • Chronic infection (Hepatitis B or C)
  • Primary biliary cirrhosis
43
Q

What are rare causes of chronic heptocellular injury?

A
  • alpha-1 antitrypsin deficiency
  • Wilson’s disease
  • Haemochromatosis
44
Q

What tests are included in a liver screen?

A
  • LFTs
  • Coagulation screen
  • Hepatitis serology (A/B/C)
  • Epstein-Barr Virus (EBV)
  • Cytomegalovirus (CMV)
  • Anti-mitochondrial antibody (AMA)
  • Anti-smooth muscle antibody (ASMA)
  • Anti-liver/kidney microsomal antibodies (Anti-LKM)
  • Anti-nuclear antibody (ANA)
  • p-ANCA
  • Immunoglobulins – IgM/IgG
  • Alpha-1 Antitrypsin – Alpha-1 Antitrypsin deficiency
  • Serum Copper – Wilson’s disease
  • Ceruloplasmin – Wilson’s disease
  • Ferritin – Haemochromatosis
45
Q

If someone presented with jaundice, what would you want to ask them in the histroy?

A

Ask about

  • Blood transfusions
  • IV drug use
  • Body piercings/Tattoos
  • Sexual activity
  • Travel abroad
  • Family history
  • Contact with others with jaundice
  • Alcohol use
  • Fever/rigors
  • Surgery/anaesthetic history
  • Medications
46
Q

What clinical signs may be present in someone with jaundice?

A
  • Signs of chronic liver disease
  • Hepatic encephalopathy
  • Lymphadenopathy
  • Hepatomegaly
  • Splenomegaly
  • Ascites
  • Palpable gallbladder
  • Pale stool, dark urine
47
Q

What investigations would you consider doing in someone who presents with jaundice?

A
  • Bloods - FBC; Clotting; Blood film; Haemolysis testing - retic count/coomb’s; U+E’s, LFTs, Total protein, Albumin, Paracetamol levels, gamma-GT, Liver screening tests
  • Ultrasound - stones, bile ducts etc
  • MRCP/ERCP - gallstones
  • Liver biopsy
  • CT/MRI - metastastatic disease
48
Q

What are common causes of jaundice in someone with cirrhosis?

A
  • Sepsis
  • Malignancy - HCC
  • Alcohol
  • Drugs
  • GI bleeding
49
Q

What drugs can cause hepatocellular injury?

A
  • Paracetamol overdose
  • Isoniazid, rifampicin, pyrazinamide
  • MOAI
  • Sodium valproate
  • Halothane
  • Statins
50
Q

What drugs can cause cholestatic jaundice?

A
  • Fusidic acid, Co-amoxiclav, nitrofurantoin
  • Steroids
  • Flucloxacillin
  • Sulphonylureas
  • Prochlorperazine
  • Chlorpromazine
51
Q

What drugs can cause haemolytic jaundice?

A

Antimalarials

52
Q

What might a AST/ALT ratio of >/=2.5:1 indicate as a cause of deranged LFTs?

A

Alcoholic hepatitis

53
Q

What might an AST/ALT ratio = 1 indicate as the cause of deranged LFTs?

A

Associated with ischaemia (CCF and ischaemic necrosis and hepatitis)

Junior Surgery- GI (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions