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Flashcards in Liver Symposium Deck (35):
1

What causes jaundice?

Increased circulating bilirubin due to altered metabolism/altered metabolism pathway of bilirubin

2

What are the classes of jaundice?

Pre-Hepatic
Hepatic
Post-Hepatic

3

What are the types of hepatic jaundice?

Predictable (dose related) and unpredictable

4

What are the causes of hepatic jaundice?

Cholestasis
Intra-hepatic bile duct obstruction

5

What is the cause of pre-hepatic jaundice?

Increased release of haemoglobin from RBCs due to haemolysis

6

What is the cause of post-hepatic jaundice?

Gallstones

7

What is bilirubin?

A by-product of haemoglobin metabolism, haem part -> bilirubin

8

Bilirubin joins with albumin which the liver helps to solubilise so it can be

excreted in the bile

9

Why might bilirubin be elevated?

Haemolysis
Parenchymal damage
Obstruction

10

What amino-transferases can indicate liver injury?

ALT and AST

11

Is ALT or AST more specific?

ALT

12

If the AST levels > ALT levels, what is indicated?

Liver disease caused by alcohol

13

What is alkaline phosphatase and when might it be elevated?

Enzyme present in the bile ducts, elevated with obstruction or liver infiltration

14

When is Gamma-GT elevated?

With alcohol consumption and some drugs e.g. NSAIDs

15

If alkaline phosphatase and gamma-GT are both raised, what is indicated?

Liver disease

16

What do albumin tests show?

Synthetic function of the liver

17

Low levels of albumin suggest

chronic liver disease, kidney disorders or malnutrition

18

What symptom/sign can be seen in any condition causing a fall in albumin?

Oedema

19

What does prothrombin time determine?

The extent and prognosis of liver dysfunction

20

What is prothrombin time a test of?

Clotting factors

21

What does creatinine test and why is this important?

Tests kidney function
Important as the liver and kidneys are closely related and poor kidney function indicates a poorer prognosis of liver disease

22

Why is platelet count important in determining liver disease?

Liver is an important source of thrombopoetin, cirrhosis resulting in hyperplenism results in low platelets and indicates portal hypertension

23

Give 6 investigations which should be done when investigating liver disease

Immunoglobulins
Autoantibodies
Caeruloplasmin copper
Ferritin
Alpha-1 antitrypsin
Hepatitis serology
Epstein Barr Virus
Cytomegalovirus
Leptospira
Alphafetoprotein
Fasting glucose/lipid profile

24

What is the treatment for hepatic encephalopathy?

Bowel clear out
Antibiotics for underlying infection
Palliative care
Chemo/radiotherapy

25

What is the treatment for spontaneous bacterial peritonitis?

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

26

What is the treatment for alcoholic hepatitis?

Palliative
Treat underlying infections
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleeding
Airway support/ITU care
Steroids if severe - improve short term prognosis
Nutritional supplements
Thiamine

27

What is the treatment of steatohepatitis?

Weight loss and exercise

28

What is the treatment of obstructive jaundice?

ERCP / PTC

29

What is the treatment of ascites?

Diuretics
Paracentesis
TIPS
Aquaretics

30

What is the treatment of portal hypertension?

Resuscitation
Blood transfusion
Endoscopic band ligation
Sengstaken-Blakemore tube for uncontrolled bleeding
TIPS for re-bleeding

31

What is the treatment of chronic hepatitis B?

Interferon
Tenofovir
Entecavir
Lamivudine and Adefovir

32

What is the treatment of hepatitis C?

6 or 12 month treatment
Weekly subcutaneous injection of pegylated interferon
Daily Ribavirin tablets
Protease inhibitor for genotype 1 patients

33

What are the possible treatments of gallstones?

Dissolution
Lithotripsy
Laparoscopic cholecystectomy
Cholecystotomy

34

What are the possible treatments for common bile duct stones?

Laparoscopic/open exploration of CBD
ERCP
Trans-hepatic stone retrieval

35

What are the possible treatments for cholangiocarcinoma?

Surgical bypass
Stenting
Radio/chemotherapy
PDT
Surgery - only potentially curative option