07.2 Liver and Pancreatic Disease

Question 1

What plasma levels would be altered due to hepatocellular damage?

Answer 1

ALT
AST
Gamma-Glutamyl Transpeptidase

Question 2

What plasma levels would be altered due to cholestasis?

Answer 2

Bilirubin

Alkaline phsphatase

Question 3

What can be used to test the synthetic function of the liver?

Answer 3

Albumin levels

Prothrombin time

Question 4

Which is more specific to the liver, ALT or AST?

Answer 4

ALT is more specific to damage to the hepatocytes, AST is found in the liver but also found in cardiac and skeletal muscle.

Question 5

If the AST:ALT ratio is greater than 2 what can this be indicative of?

Answer 5

Alcoholic liver disease

Question 6

If the ALT:AST ratio is less than 1, what is this indicative of?

Answer 6

Viral hepatocyte damage.

Question 7

Where can alkaline phosphatase be found?

Answer 7

Bile cannuliculi - hence why it is released upon cholestasis

Bones - released upon Paget’s disease

Question 8

What can gamma glutamyl transpeptidase increase be indicative of?

Answer 8

Cholestasis - if seen with alkaline phosphatase increase.

If it’s a big increase it is indicative of chronic alcohol toxicity.

Question 9

What is specifically found in pre hepatic jaundice?

Answer 9

Unconjugated bilirubinaemia

Increased reticulocytes

Question 10

What can cause pre hepatic jaundice?

Answer 10

Excessive haemolysis

Question 11

What is specifically found in hepatic jaundice?

Answer 11

Unconjugated and conjugated bilirubinaemia
Increase ALT and AST
Abnormal clotting

Question 12

What can cause hepatic jaundice?

Answer 12

Damage to hepatocytes

Question 13

What is specifically found in post hepatic jaundice?

Answer 13

Conjugated bilirubinaemia
Bilirubin in urine
Increased ALP

Question 14

What can cause obstruction of the biliary system?

Answer 14

Hepatocyte swelling (intrahepatic)
Obstruction distal to cannuliculi - e.g. Tumour/stones (extrahepatic)

Question 15

What can cause cirrhosis of the liver?

Answer 15

Alcohol
Hep B + C
Autoimmune hepatitis
Haemachromotosis
Wilson's disease
Alpha 1 antitrypsin deficiency

Question 16

What is fulminant hepatic failure?

Answer 16

An acute/severe degeneration of hepatic function defined as “onset of hepatic encephalopathy within 2 months after diagnosis of liver disease.”

Question 17

Name some benign hepatic tumours

Answer 17

Haemangioma
Adenoma
Cysts
Focal modular hyperplasia

Question 18

Name a primary malignant liver cancer.

Answer 18

Hepatocellular carcinoma

Question 19

What are the main three types of gall stones?

Answer 19

Mixed
Pure cholesterol
Pigment - calcium bilirubinate

Question 20

What is pancreatitis?

Answer 20

Inflammatory process caused by effects of enzymes from the pancreatic acini.

Question 21

What can cause pancreatitis?

Answer 21

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
Iatrogenic
Drugs

Question 22

What is increased due to pancreatitis?

Answer 22

Blood Amylase

Blood Glucose

Question 23

What are functions of the liver?

Answer 23

Bile production
Carb, protein, lipid metabolism
Protein synthesis
Vitamin d hydroxylation
Detoxification
Vitamin and mineral storage
Phagocytosis