Flashcards
Week 3 (pt 2)
Cards in this deck (20)
- 1What is bilirubin?-An orange-yellow pigment formed in the liver by the breakdown of haemoglobin and excreted in bile/urine
-It is made from RBCs, myoglobin, cytochromes and peroxidases - 2What substances can be measured to test liver function?-Bilirubin
-Liver enzymes (AST/ALT)
-Hepatobiliary enzymes (gGT, Alk Phos)
-Albumin
-Total protein - 3What would ... levels be if there is liver disease? AST/ALT AP/gGTBoth are increased
- 4What would you expect to happen to serum albumin levels when liver disease is present?They would decrease since they are made by hepatocytes
- 5Describe jaundice-Yellow discolouration of the skin, sclera and other tissues
-Due to build up of bilirubin
-Doesn't have to be a liver disease ie. in neonatal jaundice
-Can have pre-hepatic, intra-hepatic or extra-hepatic causes - 6Describe bilirubin metabolism-Haemo from RBCs is broken down into unconjugated bilirubin (UCB) and iron
-UCB is lipid soluble to albumin carries UCB to the liver via blood
-Kupffer cells in the liver also break down RBCs
-UCB undergoes conjugation to make it water-soluble (excreted in bile)
-The UCB in the bile is eventually excreted in faeces (gives the brown colour) - 7Describe the pre-hapatic causes of jaundice in relation to haemolysis Treatment?Haemolytic anaemia- RBC destruction
Paroxysmal nocturnal haemaglobulinurea- genetic, fragile RBCs
Sickle cell disease- genetic varient forms of haemoglobin present
Exchange RBC transfusion - 8Liver symptoms in anaemias-Gallstones
-Increased bilirubin
-Dark urine
-Hepatomegaly, splenomegaly
-AST/ALT elevated
-Thrombosis
-Iron overload
-Hepatic thrombosis
-Coagulation deficit
-Altered MRI signal - 9Describe the pre-hepatic condition of Gilbert's syndrome-Mutation in bilirubin UDP-glucuronyl transferase 1 gene
-Elevated UCB
-Only picked up when another problem arises
-Increased fasting bilirubin
-Need to exclude haemolysis and other liver diseases
-Benign- genetic condition - 10Describe neonatal jaundice-Common
-Caused by delays in clearance of bilirubin from RBC breakdown
-Treated with phototherapy
-Only a problem if it persists and is accompanied by pale stool/dark urine - 11Describe some causes of jaundice due to liver injury-Failure of cellular mechanisms to conjugate/excrete conjugated bilirubin
-Acute hepatitis
-Chronic hepatitis or cirrhosis - 12Describe viral hepatitis-Viruses selectively infect hepatocytes
-Strong immune response causes severe hepatitis
-Immune system kills the infected hepatocytes (liver damage) - 13Describe hepatitis A and BA:
-faecal, oral transmission
-hospitalisation rarely needed- flu-like symptoms, nausea, jaundice
B:
-bilirubin is conjugated but cells are dying so conjugated bilirubin is released into the bloodstream - 14What else can interrupt bile flow as a result of damage to the liver?-Cancer
-Destruction of bile ductules
-Cholestasis - 15Describe the post-hepatic causes of jaundice in relation to obstructed bile flowCan be due to:
-gallstones (can result in cholangitis-infection of bile duct)
-disease of the ducts ie. cancer/inflammation
-compression of the ducts by lymph nodes, pancreatic cancer - 16Describe pancreatic cancer-Growth obstructs bottom of the common bile duct
-Painless jaundice
-Weight loss
-Common in older patients
-Very poor outcome (presents late)
-Difficult to treat surgically - 17If someone has jaundice due to chronic alcoholic liver disease, what would you expect to see?-Increased conjugated and total bilirubin
-Dark urine
-Pale stools - 18Why would the presence of pale stools and dark urine be a concern in a baby with jaundice?Suggestive of liver disease due to a lack of conjugation of bilirubin
- 19If someone has jaundice as a result of gallstones what would you expect to see?-Pale stools
-Dark urine
-Normal levels of unconjugated bilirubin
-Increased conjugated bilirubin - 20True/false A patient with jaundice as a result of Gilberts' syndrome would have no conjugated bilirubin in their urineFalse