07.2 Liver and Pancreatic Disease Flashcards
What plasma levels would be altered due to hepatocellular damage?
ALT
AST
Gamma-Glutamyl Transpeptidase
What plasma levels would be altered due to cholestasis?
Bilirubin
Alkaline phsphatase
What can be used to test the synthetic function of the liver?
Albumin levels
Prothrombin time
Which is more specific to the liver, ALT or AST?
ALT is more specific to damage to the hepatocytes, AST is found in the liver but also found in cardiac and skeletal muscle.
If the AST:ALT ratio is greater than 2 what can this be indicative of?
Alcoholic liver disease
If the ALT:AST ratio is less than 1, what is this indicative of?
Viral hepatocyte damage.
Where can alkaline phosphatase be found?
Bile cannuliculi - hence why it is released upon cholestasis
Bones - released upon Paget’s disease
What can gamma glutamyl transpeptidase increase be indicative of?
Cholestasis - if seen with alkaline phosphatase increase.
If it’s a big increase it is indicative of chronic alcohol toxicity.
What is specifically found in pre hepatic jaundice?
Unconjugated bilirubinaemia
Increased reticulocytes
What can cause pre hepatic jaundice?
Excessive haemolysis
What is specifically found in hepatic jaundice?
Unconjugated and conjugated bilirubinaemia
Increase ALT and AST
Abnormal clotting
What can cause hepatic jaundice?
Damage to hepatocytes
What is specifically found in post hepatic jaundice?
Conjugated bilirubinaemia
Bilirubin in urine
Increased ALP
What can cause obstruction of the biliary system?
Hepatocyte swelling (intrahepatic) Obstruction distal to cannuliculi - e.g. Tumour/stones (extrahepatic)
What can cause cirrhosis of the liver?
Alcohol Hep B + C Autoimmune hepatitis Haemachromotosis Wilson's disease Alpha 1 antitrypsin deficiency
What is fulminant hepatic failure?
An acute/severe degeneration of hepatic function defined as “onset of hepatic encephalopathy within 2 months after diagnosis of liver disease.”
Name some benign hepatic tumours
Haemangioma
Adenoma
Cysts
Focal modular hyperplasia
Name a primary malignant liver cancer.
Hepatocellular carcinoma
What are the main three types of gall stones?
Mixed
Pure cholesterol
Pigment - calcium bilirubinate
What is pancreatitis?
Inflammatory process caused by effects of enzymes from the pancreatic acini.
What can cause pancreatitis?
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia Iatrogenic Drugs
What is increased due to pancreatitis?
Blood Amylase
Blood Glucose
What are functions of the liver?
Bile production Carb, protein, lipid metabolism Protein synthesis Vitamin d hydroxylation Detoxification Vitamin and mineral storage Phagocytosis
