12 Jaundice and LFTs Flashcards
What is jaundice?
Clinical manifestationof raised bilirubin
What is bilirubin and how is it excreted?
Breakdown product of haem
Excreted: urine and faeces
What are the 2 forms that bilirubin can be found in the body?
Unconjugated- bound to albumin not water soluble
Conjugated- in liver water soluble
The causes of jaundice can be divided into 3 broad categories. What are these categories?
Why are the levels of unconjugated bilirubin high in prehepatic jaundice?
Increased degradation of haemoglobin
- Bilirubin excretion fine*
- Hepatocyte function fine*
Give some causes of prehepatic jaundice.
Why is it so important to pick up jaundice in neonates?
High levels of bilirubin can damage neonate brain
Explain how hepatic jaundice is caused.
Reduced hepatocyte function
-reduced conjugating ability so mix of conjugated and unconjugated bilirubin
- Cirrhosis
- Acute liver damage
(see flashcards 11)
Why will raised bilirubin in post-hepatic jaundice be conjugated?
Why will stools be lighter and urine be darker in posthepatic jaundice?
Obstructive cause- bilirubin goes to kidney instead of GI tract
Give some causes of post hepatic jaundice. (3)
- Gallstones
- Biliary stricture
- Pathology of head of pancreas
Identify intrahepatic pathology that can cause compression of the intrahepatic bile ducts.
Which LFTs give information about the function of the liver and which give information about liver damage?
What does testing for albumin tell you about the function of the liver?
Liver’s synthetic function
- Low albumin contributes to ascites*
- Low albumin may also be linked to pathology in urinary system*
What happens to levels of ALT and AST if the hepatocytes are damaged?
Levels rise
Why is ALT more specific to the liver than AST?
AST found in cardiac/skeletal muscle and RBCs
If ALT levels are higher than AST levels, what does this indicate? What does it indicate is AST levels are higher than ALT levels?
What would cause ALP levels to rise? Why?
What is the Gamma GT test used for?
(Gamma-Glutamyl Transferase)
ALP increased in increased bone turnover (may be high in kids)
Gamma GT used to differentiate between source of high ALP
Gamma-Glutamyl Transferase- found in bile duct
If a patient is not jaundiced can LFTs still be abnormal?
Yes
What LFT results will we see with pre-hepatic, hepatic and post-hepatic jaundice?
For info about peptic ulcers: 4 Ps
From an embryological point of view, why is the pain of peptic ulceration felt in the epigastric area of the abdomen?
Stomach is foregut embryologically
All referred pain is sympathetic- can’t feel pain of viscera
Greater splanchnic sympathetic nerve innervates epigastric area of abdomen and foregut
Briefly describe fat absorption (duodenum to thoracic duct).
