Abnormal LFTs Flashcards
what determines the size of the liver
metabolic requirements
what is ‘splanchinic steal’
when the body tries to increase blood supply to the liver which results in low BP in the rest of the body and eventually reduces blood supply everywhere else
which clotting factor is not made in the liver
factor 8
lack of what clotting factor causes haemophilia and how much needs to be lost to cause disease
factor 8
95%
can you have normal LFTs in liver cirrhosis
yes
what is found in liver sinusoids
mixed arterial and portal blood
what needs to and doesn’t need to be considered in liver transplants
needs to match blood group
don’t need to consider HLA antigens - hepatocytes don’t have any
why is some urobilinogen reabsorbed in the gut
due to microbes
what is Gilberts syndrome
an isolated rise in bilirubin with no adverse consequences
an isolated rise in bilirubin could be gilberts or
haemolysis
at what bilirubin level will you start to jaundice
> 50
at what bilirubin level will you have obvious jaundice
> 100
where does conjugated bilirubin become urobilinogen
in the intestine
is ALT and AST more liver specific
ALT
what are ALT and AST
enzymes
how do ALT and AST change in advanced NAFLD
AST increases relative to ALT
when do AST and ALT increase
when hepatocytes die and leak them into the blood
average ALT or AST in NAFLD
75-100
what would ALT or AST be if all hepatocytes die and give example of when this could occur
10,000
paracetamol overdose
what do increased alkaline phosphatase levels indicate
there’s something wrong with your bile ducts
what do you need to check in addition to alkaline phosphatase when you suspect a problem with the bile ducts
gamma GTP
is gamma GTP liver specific
no
does a sole rise in GGTP without other LFT abnormalities likely indicate early or late stage disease
late
what is the most abundant protein in the body
albumin
what type of substances does albumin carry and give an example
water soluble substances
including unconjugated bilirubin
what is albumin levels in dehydration
high
why might albumin levels be low
due to dilution (e.g. increased body volume in pregnancy or oedema)
due to reduced synthesis
what are albumin levels like in cirrhosis
often normal until liver is failing
what type of liver disease is prothrombin time good for
acute liver failure
why is prothrombin time rarely very abnormal in cirrhosis
because there is enough reserve in the liver
possible cause of increased prothrombin time
paracetamol poisoning
what is NASH
non alcoholic steroid hepatitis
caeruloplasmin tests for
wilsons disease
what investigations are usually triggered after abnormal LFTs
a ‘liver screen’
hepatitis viruses
autoantibodies (ANA, AMA and antiSMAb)
ferritin
caeruloplasmin
alpha-1-antitrypsin
immunoglobulins
ultrasound scan
referral
what is ferratin a marker for
haemachromotosis
