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GI - Year 2 > Jaundice and Chronic Liver Disease > Flashcards

Jaundice and Chronic Liver Disease Flashcards

1
Q

What are the synthetic functions of the liver?

A 
Clotting factors
Bile acids
Carbohydrates
Proteins
Lipids
Hormones
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2
Q

What are the detoxification functions of the liver?

A

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

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3
Q

What are the immune functions of the liver?

A

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

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4
Q

What is the storage function of the liver?

A 
Stores:
Glycogen
Vitamin A, D, B12 and K
Copper
Iron
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5
Q

What are the liver function tests?

A 
Bilirubin
Aminotransferases
Gamma GT
Albumin
Prothrombin time
Creatinine
Platelet count
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6
Q

What does elevated bilirubin suggest?

A

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

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7
Q

What does elevated gamma GT suggest?

A

alcohol use

drugs e.g. NSAIDS

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8
Q

What does low levels of albumin suggest?

A

Chronic liver disease

May be low in kidney disorders/malnutrition

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9
Q

What is prothrombin time test used for?

A

Indicates degree of liver dysfunction

Determines who needs a liver transplant

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10
Q

What is creatinine test used for?

A

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

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11
Q

What does low platelet count suggest?

A

Cirrhosis

Indirect marker of portal hypertension

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12
Q

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

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

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13
Q

What causes jaundice?

A

Excess circulating bilirubin

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14
Q

What is pre-hepatic jaundice?

A

Increased quantity of bilirubin

Impaired transport

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15
Q

What is hepatic jaundice?

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

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16
Q

What is post-hepatic jaundice?

A

Abdominal pain

Cholestasis

17
Q

What are the clinical signs of pre-hepatic jaundice?

A

Pallor

Splenomegaly

18
Q

What are the clinical signs of hepatic jaundice?

A

Stigmata of CLD
Ascites
Asterixis

19
Q

What are the clinical signs of post-hepatic jaundice?

A

Palpable gall bladder

20
Q

What are the investigations for jaundice?

A 
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
21
Q

What are the causes of cirrhosis?

A 
Alcohol
Autoimmune
Haemochromatosis
Chronic viral hep B and C
NAFLD
Drugs
CF, wilsons
Vascular problems
Cryptogenic
22
Q

What are the clinical features of ascites?

A 
Dullness in flanks and shifting dullness
confirmed by USS
palmar erythema
abdominal veins
umbilical nodule
JVP elevation
Flank haematoma
23
Q

What are the treatment options for ascites?

A 
Diuretics
Large volume paracentesis
TIPS
Aquaretics
Liver transplant
24
Q

How do varices occur?

A

Due to portal hypertension

Medical emergency

25
Q

How are varices managed?

A 
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
26
Q

What are the signs of hepatocellular carcinoma?

A 
Decompensation of liver disease
Abdominal mass
Abdominal pain
Weight loss
Bleeding from tumour
27
Q

How is hepatocellular carcinoma diagnosed?

A 
Tumour markers: AFP
USS
CT
MRI
Liver biopsy (rare)
28
Q

What is the treatment for hepatocellular carcinoma?

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

GI - Year 2 (39 decks)

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