Biochemical investigation of liver disease Flashcards by paige bishop

what are the major functions of the liver?

carb metabolism
fat, protein,hormone metabolism
drugs and foreign compounds
storage
bilirubin

How well did you know this?

Not at all

Perfectly

What is damaged in hepatitis?

hepatocytes

How well did you know this?

Not at all

Perfectly

what is the characteristics of cirrhosis?

increased fibrosis
liver shrinkage
decreased hepatocellular function
obstruction of bile flow

How well did you know this?

Not at all

Perfectly

where is ALT present?

Hepatocytes

Mildly in skeletal muscle

How well did you know this?

Not at all

Perfectly

where is AST present?

Hepatocytes, cardiac/skeletal muscle and erythrocytes

How well did you know this?

Not at all

Perfectly

what is more liver specific out of ALT and AST?

ALT

How well did you know this?

Not at all

Perfectly

what can cause a rise in alkaline phosphatase?

Cholestasis, 3rd trimester of pregnancy,meals

How well did you know this?

Not at all

Perfectly

what is the albumin half life, why is this important?

20 days

in liver damage it won’t drop as quickly as you expect

How well did you know this?

Not at all

Perfectly

what is a useful marker for hepatocellular carcinoma?

alpha fetoprotein

How well did you know this?

Not at all

Perfectly

what is alpha fetoprotein useful for?

A marker of hepatocellular carcinoma

How well did you know this?

Not at all

Perfectly

what is low low levels of caeruloplasmin associated with?

Wilsons disease

How well did you know this?

Not at all

Perfectly

what is high levels of ferritin associated with?

iron overload

How well did you know this?

Not at all

Perfectly

where does bilirubin become conjugated?

in liver by joining with albumin

How well did you know this?

Not at all

Perfectly

what happens to conjugated bilirubin?

bilirubin –> urobilinogen –> excretion or enterohepatic circulation/ kidney

How well did you know this?

Not at all

Perfectly

what can physiological process can cause a change in alkaline phosphatase?

Growth

How well did you know this?

Not at all

Perfectly

what markers are important in inflammatory patterns?

ALT mainly

How well did you know this?

Not at all

Perfectly

what markers are important in cholestatic patterns?

ALP mainly

GGT and bilirubin also

How well did you know this?

Not at all

Perfectly

when do albumin concentrations tend to be decreased?

chronic liver disease

How well did you know this?

Not at all

Perfectly

what are the first things to exclude when there is a raised ALT?

Alcohol intake,diabetes, increased triglycerides

How well did you know this?

Not at all

Perfectly

If the ALT is raised but less than double the upper limit what is the recommendation?

repeat in 1-3 months unless they appear very ill

How well did you know this?

Not at all

Perfectly

what are the first line tests for a raised ALT?

AST to work out ratio
FBC
Auto antibodies
ferritin
hep B surface antigen
Hep C antibody
liver USS

How well did you know this?

Not at all

Perfectly

what are the second line tests for a raised ALT?

anti tissue transglutaminase antibodies
alpha 1 antitrypsin
caeruloplasmin

How well did you know this?

Not at all

Perfectly

A raised ALT with a raised GGT is suggestive of?

alcohol intake

How well did you know this?

Not at all

Perfectly

A raised ALT showing thrombocytopenia on blood test is suggestive of?

hypersplenism

portal hypertension

How well did you know this?

Not at all

Perfectly

A raised ALT investigated showing a raised AMA is suggestive of/

PBC (AMA m2 is specific)

A raised ALT investigated showing a raised ASM/ANA is suggestive of?

AIH

what is ALT with raised ferritin suggestive of?

Iron overload

what populations are more likely to have haemochromotosis?

Scottish men | Post menopausal women

Where in the cells is AST found?

20% cytosol | 80% mitochondria

what is half life of AST?

12-22 hours

what is a AST:ALT ratio <1 suggestive of?

Majority of liver diseases will have this finding

what is a AST:ALT ratio >2 suggestive of?

An extrahepatic source

A raised AST:ALT ratio above 2 is suggestive of an extrahepatic source what are examples of this?

``` Alcohol hepatitis ischaemia/ toxins acute wilsons lymphoma cirrhosis ```

what is a AST:ALT ratio >4 suggestive of?

fulminant wilsons disease

A raised ALT with raised anti tissue transglutaminase antibodies suggests?

Coeliacs

what is the most common finding on biopsy for non explained raised transaminases?

Non alcoholic steatohepatitis followed by non alcoholic fatty liver

what is more prevelant: non alcoholic fatty liver disease or alcoholic liver disease?

non alcoholic fatty liver disease

what is the most common cause of abnormal LFT's?

non alcoholic fatty liver disease

what are the stages of non alcohol fatty liver disease?

Healthy liver --> non alcohol fatty liver --> cirrhotic/ non alcohol steatohepatitis --> HCC

what is step 1 in the development of non alcoholic fatty liver disease?

Non alcoholic fatty liver --> cirrhotic liver/ non alcoholic steatohepatitis

what is step 2 in the development of non alcoholic fatty liver disease?

Cirrhotic liver/ non alcoholic steatohepatitis --> hepatocellular carcinoma

What are the major risk factors in non alcoholic fatty liver disease for fatty liver --> cirrhotic liver (step one)?

- obesity - arterial hypertension - diabetes - dyslipidaemia - PNPLA3/TM6SF2 - polymorphisms

What are the major risk factors in non alcoholic fatty liver disease for cirrhotic liver (step one) --> hepatocellular carcinoma (HCC)?

``` obesity diabetes advanced fibrosis PNPLAS3/TM6SF2 Age ```

how does body weight change in NAFLD and alcoholic liver disease?

NAFLD- increase | alcoholic- varies

how does fasting plasma glucose change in NAFLD and alcoholic liver disease?

NAFLD- increased | alcoholic- normal

what is the reported daily alcoholic intake in alcoholic liver disease?

>20g in women and over 30g in men

how does AST change in NAFLD compared with alcholic liver disease?

Normal in NAFLD | alcoholic liver disease- increase

what is the AST:ALT ratio in non alcoholic fatty liver disease?

<0.8 Unless advanced

what is the AST:ALT ratio in alcoholic liver disease?

>1.5

what is the management for NAFLD with an ALT <50?

Lifestyle advice to achieve weight loss Reduce alcohol Reassess

what is the management for NAFLD with an ALT of 50-150?

Lifestyle advice, weight loss, alcohol reduction, stop hepatotoxic drugs

what is gilberts disease?

A defect in the regulatory part of gene coding for bilirubin UPD-glucuronyl transferase leading to raised bilirubin

what is crigler najjar?

Ascence in bilirubin UDP glucuronyl transferase

what over the counter things can raise GGT?

Phenytoin | st johns wart.

If there is a raised ALP how can you check the origin of the problem?

check GGT levels if normal bone in origin | if not normal; vit d/ pregnanc

what can cause ALP levels to be high in the population?

- black women - old age - hyperthyroidism - pregnancy

what tests can be done to check for fibrosis?

P3NP | ELF

what tests can be done to check for alcohol?

CDT | Ethanol metabolites

what tests can be done for tumour markers?

- CA199 CEA AFPT CA125

What is P3NP often used for?

to monitor methotrexate treatment long term as it can cause liver fibrosis

what is the ELF test?

Meases three biomarkers 1. hyaluronic acid 2. P3NP 3. tissue inhibitor of metalloproteinase 1 uses this to calculate a fibrosis score

what is a non invasive assesment for pancreatic exocrine insufficiency?

faecal elastase

what causes a raised CEA?

colorectal cancer

what causes a raised AFPT?

Hepatocellular carcinoma

what causes a raised CA125?

ovarian cancer | - conditions that cause peritoneal inflammation

what is hepatic elastography used to assess?

chronic liver disease

what are some causes of iron overload?

haemochromotosis | alcohol