Final Exam - Liver and Biliary Disorders

What causes jaundice in liver disease?

Accumulation of bilirubin due to impaired bile flow, liver dysfunction, or obstruction.

What bilirubin level typically produces visible jaundice?

Serum bilirubin 3–4× normal.

Difference between intrahepatic and post-hepatic jaundice?

Intrahepatic: liver cannot process bilirubin. Post-hepatic: obstruction prevents bilirubin excretion.

Why does liver disease cause pruritis?

Bile salts deposit in tissues and irritate the skin.

What causes dark urine in liver disease?

Excess conjugated bilirubin excreted through kidneys.

What causes light/gray stools?

Lack of bile entering intestines due to obstruction.

What is ascites?

Accumulation of fluid in the peritoneal cavity.

Main mechanisms leading to ascites?

Portal hypertension, low albumin, RAAS activation (aldosterone + ADH).

How does hypoalbuminemia cause ascites?

Decreased oncotic pressure → fluid shifts into abdomen.

How does RAAS activation worsen ascites?

Aldosterone increases Na⁺/water retention; ADH increases water reabsorption.

Cause of hepatic encephalopathy?

Ammonia accumulation crossing the blood–brain barrier.

Symptoms of hepatic encephalopathy?

Confusion, agitation, asterixis, fetor hepaticus, coma.

Which labs increase with hepatocellular injury?

AST and ALT.

Which lab elevation suggests bile duct obstruction?

Alkaline phosphatase.

Why does liver disease cause bleeding tendencies?

Decreased clotting factor synthesis + vitamin K malabsorption.

What causes esophageal varices?

Portal hypertension forcing blood through fragile esophageal veins.

Why are esophageal varices dangerous?

High risk of rupture → rapid, life-threatening bleeding.

What is cholelithiasis?

Formation of gallstones from cholesterol sludge, bile stasis, and calcium precipitation.

What promotes gallstone formation?

Bile stasis, cholesterol saturation, calcium precipitation.

Which ducts can gallstones obstruct?

Cystic duct, hepatic duct, common bile duct.

Classic symptom pattern of cholelithiasis?

RUQ pain after fatty meals, radiating to right shoulder/back.

Why does fatty food trigger gallstone pain?

Gallbladder contracts, pressing stones into ducts.

What typically causes cholecystitis?

A gallstone obstructing a duct → trapped bile → inflammation.

Complications of cholecystitis?

Ischemia, necrosis, perforation.

Symptoms of cholecystitis?

Constant severe RUQ pain, fever, N/V, leukocytosis.

What is Murphy’s sign?

Pain on inspiration during RUQ palpation; indicates cholecystitis.

Why can cholecystitis cause jaundice?

Inflammation or stones block bile flow.

Cholecystitis pain pattern

constant severe pain

Cholelithiasis pain pattern

intermittent colicky pain