MedEd liver and biliary disease 1

Question 1

what does haeme break down into?

Answer 1

unconjugated bilirubin and iron

Question 2

how is bilirubin carried in blood?

Answer 2

bound to albumin

Question 3

where is bilirubin conjugated?

Answer 3

liver

Question 4

what enzyme conjugates bilirubin?

Answer 4

UDPGT

Question 5

what are the 2 causes of pre hepatic jaundice?

Answer 5

haemolysis

gilbert’s

Question 6

what are some causes of hepatic jaundice

Answer 6

hepatitis- viral, alcoholic, AI, drug

cirrhosis

Question 7

what are some causes of obstructive jaundice

Answer 7

liver mass
gallstone
PBC
pancreatic cancer
cholangiocarcinoma 
drug causing ileus

Question 8

in what jaundice do you get dark urine?

Answer 8

obstructive jaundice

pre hepatic haemolytic jaundice

Question 9

what does dark urine, pruritus and pale stool indicate?

Answer 9

obstructive jaundice

Question 10

what is raised in prehepatic jaundice in lfts?

Answer 10

only bilirubin

Question 11

what is raised in hepatic jaundice on lfts?

Answer 11

ast and alt

Question 12

what is raised in obstructive jaundice on lfts?

Answer 12

alp and ggt

Question 13

what are some causes of hepatitis?

Answer 13

viral
alcohol
autoimmune
drugs
NASH

Question 14

what is raised in lfts in hepatitis?

Answer 14

ast and alt

Question 15

how does hepatitis present?

Answer 15

RUQ pain
jaundice
hepatomegaly
joint pain
nausea
fatigue 
dark urine

Question 16

how may hepatitis progress?

Answer 16

acute hep then recovery
acute hep then liver failure
acute hep goes to chronic goes to cirrhosis goes to liver failure

Question 17

what is the progression of alcoholic liver disease? describe symptoms

Answer 17

steatosis (fatty liver)- after few days heavy drinking, no symptoms
alcoholic hepatitis- after long term alcohol use but laso after binge, nausea, anorexia, weight loss, hepatomegaly
cirrhosis- scarring and fibrosis of liver

Question 18

what ix are done for alcoholic hep and what do you see?

Answer 18

fbc- macrocytic anaemia
lfts- ast/alt (ratio >2), high bilirubin, high GGT, low albumin
clotting- high PT
hepatic USS
liver biopsy- shows mallaory bodies

Question 19

what is seen on liver biopsy in alcoholic hepatitis?

Answer 19

mallory bodies

Question 20

what is a time sensitive marker of significan liver dmaage?

Answer 20

PT

Question 21

how is alcoholic hep managed?

Answer 21

manage for withdrawal- chlordiazepoxide
nutrition- pabrinex to prevent wernicke-karsakoff
weight loss
stop smoking

Question 22

how does non alcoholic fatty liver disease progress?

Answer 22

steatosis
steatohepatitis
cirrhosis

Question 23

why might someone get nafld?

Answer 23

obesity, diabetes, hyperlipidaemia, hypetension etc

Question 24

what signs might you see in nafld and why?

Answer 24

insulin resistance eg acanthosis nigricans, polyuria and polydipsia

Question 25

what types of hepatitis is acute?

Answer 25

A and E

Question 26

whats the prognosis for hep A and E?

Answer 26

full recovery

Question 27

how are hep A and E transmissed and how do you remember this?

Answer 27

fAEcal oral

Question 28

are hep B and C acute or chronic

Answer 28

acute or chronic C most commonly is Chronic B usually just acute

Question 29

what is important to remember about hep D?

Answer 29

can only have it if you've had hep B

Question 30

what surface antigen does hep b have?

Answer 30

HBsAg

Question 31

what core antigen does hep b have?

Answer 31

HBcAg

Question 32

what is a surface vs core antigen

Answer 32

``` surface= on surface of virus and exposed to blood core= inside the virus and not exposed to blood ```

Question 33

what antibody should someone with hep b vaccination have?

Answer 33

HBsAb

Question 34

what antibody is only present if someone has been infected with hep b?

Answer 34

HBcAb

Question 35

whats is anti HBs v anti HBc

Answer 35

anti HBs= antibody for hep B surface antigen | anti HBc= anitbody for hep B core antigen

Question 36

what class is the core antibody for hep b?

Answer 36

IgM

Question 37

what is cirrhosis?

Answer 37

normal liver replaced by fibrosis and nodules of regenerating hepatocytes

Question 38

what are signs of chronic stable liver disease?

Answer 38

``` clubbing spider naevi (3 or more) dupuytrens contracture erythema gynacomastia ```

Question 39

what is a complication of cirrhosis?

Answer 39

portal hypertension

Question 40

what are signs of portal hypertension?

Answer 40

caput medusae lower oesophageal varices ascites splenomegaly

Question 41

how is cirrhosis managed?

Answer 41

treat cause eg viral hep 6 monthly USS endoscopy every 3 yrs

Question 42

what are some complications of cirrhosis?

Answer 42

encephalopathy variceal bleeds spontaneous bacterial peritonitis

Question 43

what is a complication of ascites?

Answer 43

spontaenous bacterial peritonitis

Question 44

how is hepatic encephalopathy managed?

Answer 44

treat precipitating event eg GI bleed short term low protein diet oral lactulose, rifaximin, phosphate enema avoid sedatives

Question 45

how does the liver clear ammonia?

Answer 45

breaks it down into urea

Question 46

how is ascites managed?

Answer 46

sodium restriction diuretics paracentesis if needed

Question 47

how is SBP managed?

Answer 47

abx- metronidazole and cefuroxime

Question 48

how are varicies managed?

Answer 48

primary prohylaxis- beta blocker is small EVL if big ruptured- ABCDE, IV fluids/bloods, terlipressin and abx and EVL after resus (surgically band the varices) secondary prohylaxis- non selective beta blocker TIPs procedure

Question 49

what abx are given for SBP?

Answer 49

metronidazole and cefuroxime

Question 50

what is cholelithiasis?

Answer 50

gallstone in gallbladder

Question 51

what is biliary colic?

Answer 51

pain caused by gallstones | pain+ cholelithiasis

Question 52

what is acute cholecystitis?

Answer 52

cholelithiasis, inflammation and secondary infection