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Medicine Notes > Gastrointestinal Disease Notes
This is an extract of our Liver Disease document, which we sell as part of our Gastrointestinal Disease Notes collection written by the top tier of University Of Leicester students.
The following is a more accessble plain text extract of the PDF sample above, taken from our Gastrointestinal Disease Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
Liver Disease Jaundice (icterus)
Yellow pigmentation of skin, sclerae and mucosae due to increase plasma bilirubin (>35umol/L) Bilirubin metabolism Haemoglobin Globin Fe2+
Haem Unconjugated bilirubin
Bilirubin + glucuronic acid (glucuronyl transferase)
= Conjugated bilirubin (water soluble) Into gut via bile
Gut bacteria
Urobilinogen
Reabsorbed
Sterobilin Excreted in urine (brown wee)
= Brown poo Classification Pre-hepatic jaundice:
- Increased bilirubin production Increased unconjugated bilirubin
- Decreased liver uptake in blood (normal colour urine)
- Decreased conjugation
- Some causes are o Physiological neonatal jaundice o Haemolysis o Glucuronyl transferase deficiency Hepatocellular jaundice
- Result of hepatocyte damage
- Usually some cholestasis (therefore mixed picture of unconjugated and conjugated bilirubin but as disease progresses more cholestatic - obstructive jaundice occurs)
-
Two main causes are viral hepatitis and alcohol Other causes = drugs, cirrhosis, autoimmune hepatitis
Post-hepatic jaundice
- Obstruction (e.g common bile duct) causes increased conjugated bilirubin in blood
- Is water-soluble so urine = dark
- Less conjugated bilirubin enters the bowel - faeces = pale
- Causes =
o Gallstones o Pancreatic cancer o PSC (primary sclerosing choleangitis) o PBC (primary biliary cirrhosis)
Viral hepatitis Hepatitis ARNA virus Faecal-oral spread Mostly self-limiting acute hepatitis of childhood No chronic liver disease Immunisation available
Hepatitis BDNA virus Spread through blood products, IV durg abuse, sexual intercourse and direct contact + vertical transmission Causes acute hepatitis Increased risk of hepatocellular carcinoma Immunisation available
Hepatitis CRNA virus Spread through blood products, IV drug abuse + sexual intercourse Mild illness 85% progress to chronic liver disease
Hepatitis DIncomplete RNA virus Exists only with Hep. B Increased risk in IV drug abusers Increased risk of acute hepatic failure and cirrhosis
Hepatitis ERNA virus
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