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Gastrointestinal Week 7 2016/17 > 3: LFTs > Flashcards

3: LFTs Flashcards

1
Q

Which levels give an indication of the liver’s function?

A

Albumin

Prothrombin time

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2
Q

The albumin level gives an indication of the liver’s ability to synthesise ___.

A

protein

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3
Q

The INR gives an indication of the liver’s ability to produce ___ ___.

A

clotting factors

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4
Q

What are the enzymes included in a liver function (damage?) test?

A

ALP (alkaline phosphatase)

ALT/AST

GGT

Bilirubin (not an enzyme…)

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5
Q

What are key things to ask about in the history of someone with liver disease?

A

Alcohol?

Drugs?

Medication?

Travel history?

Sexual history?

Any tattoos? Blood transfusions?

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6
Q

Recent tattoos from a foreign country indicate what cause of liver disease?

A

Hepatitis C

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7
Q

Recent dodgy blood transfusion indicates what cause of liver disease?

A

Hepatitis C

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8
Q

Which medications can induce liver disease?

A

Antibiotics

NSAIDs

Methotrexate

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9
Q

Which particular antibiotics can trigger liver disease?

A

Flucloxacillin

Co-amoxiclav

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10
Q

Broadly, which viruses can cause liver disease?

A

Hepatitis viruses (A, B, C, D, E)

Cytomegalovirus (CMV)

Epstein-Barr virus (EBV)

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11
Q

The presence of particular antibodies can indicate the cause of liver disease. Which diseases are diagnosed based on the presence of…

Anti smooth muscle antibody (ASMA)

Anti mitochondrial antibody (AMA)

A

ASMA ⇒ autoimmune hepatitis, primary sclerosing cholangitis

AMA ⇒ primary biliary cholangitis

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12
Q

LFT derangements indicate three broad categories of disease. What are they?

A

Hepatitic disease

Cholestatic disease

Mixed disease

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13
Q

What is hepatitis?

What happens to hepatocytes?

A

Inflammation of the liver

Hepatocytes are damaged

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14
Q

Which liver enzymes are elevated in hepatitic disease?

A

ALT

AST

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15
Q

Which three diseases cause hepatitic LFT changes?

A

Non-alcoholic fatty liver disease

Viral hepatitis

Autoimmune hepatitis

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16
Q

How do bilirubin, ALP and GGT appear in hepatitic disease?

A

Normal

Because there’s no bile duct obstruction

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17
Q

Autoimmune hepatitis is common in (males / females) aged 20-40 and 55-65.

A

females

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18
Q

Autoimmune hepatitis comes in waves. What terms are used to describe this?

A

Relapsing and remitting

19
Q

Which:

liver enzyme

specific antibody

broad class of antibody

are raised in autoimmune hepatitis?

A

ALT

Anti smooth muscle antibody (ASMA)

IgG

20
Q

Which immune cells are found on biopsy of someone with autoimmune hepatitis?

A

Plasma cells

(produce antibodies)

21
Q

What are some symptoms of autoimmune hepatitis?

A

Fatigue

Weight loss

RUQ pain

22
Q

How is autoimmune hepatitis treated?

A

Prednisolone (steroid)

Azathioprine / Mercaptopurine (steroid-sparing immunosuppressants)

23
Q

Who is at risk of catching Hepatitis C?

A

PWID

People who get tattoos and blood transfusions

Pakistani / Indian people

24
Q

Which:

liver enzyme

antibody

is raised in Hepatitis C infection?

A

ALT

HCV antibody

25
Q

How is Hepatitis C treated?

A

Refer to a hepatologist

26
Q

What is the most common hepatitis seen in the West?

What is the cause?

A

Non-alcoholic fatty liver diseae (NAFLD)

Obesity

27
Q

NAFLD exists on a spectrum. What is:

simple steatosis

steatohepatitis

cirrhosis?

A

Simple steatosis - fat in the liver

Steatohepatitis - fat and inflammation in the liver

Cirrhosis - irreversible fibrosis of the liver due to chronic inflammation

28
Q

NAFLD is usually (symptomatic / asymptomatic).

A

asymptomatic

goes undetected for ages

29
Q

Which liver enzyme is raised in NAFLD?

A

ALT

modestly

30
Q

What is cholestatic disease?

A

Disease in which bile is stationary, so

obstruction / disease of the bile ducts

31
Q

Which components of an LFT are raised in cholestatic disease?

A

ALP

GGT

Bilirubin

ALT is mildly elevated too.

32
Q

When is ALP elevated?

A

Bile duct obstruction

Bone growth (normal and abnormal)

Breast disease

so you need to be careful diagnosing something based off ALP alone

33
Q

Which liver enzyme is used to confirm cholestatic disease indicated by an elevated ALP?

A

GGT

34
Q

Why may the bile ducts be obstructed?

A

Gallstones

Obstructing tumours (pancreatic tumours, cholangiocarcinomas)

Primary biliary cholangitis

Primary sclerosing cholangitis

35
Q

Primary biliary cholangitis is an autoimmune disease caused by the body’s production of which antibody?

A

Anti mitochondrial antibody (AMA)

36
Q

Who tends to develop primary biliary cholangitis?

A

Older women

37
Q

Which bile ducts are inflamed in primary biliary cholangitis?

A

Microscopic ones within the liver

38
Q

What are the symptoms of PBC?

A

Fatigue

Itch

Jaundice

Hyperlipidaemia

39
Q

What is the classic presentation of PBC?

A

Old lady who is itchy, jaundiced, tired and has high cholesterol on investigation

40
Q

Which components of an LFT are raised in PBC?

A

ALP

Bilirubin

ALT modestly raised too.

41
Q

Patients with primary biliary cholangitis will be positive for which antibody?

A

Anti mitochondrial antibody (AMA)

42
Q

How is primary biliary cholangitis treated?

A

Ursodeoxycholic acid (to help bile flow by making it less sticky)

Itching relief (baths, lotions etc.)

43
Q

What causes mixed cholestatic and hepatitic disease?

A

Alcohol

Obstructive tumours

Drugs

diagnosed by taking a good history.

Gastrointestinal Week 7 2016/17 (9 decks)

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