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Case 9: Liver > Biochemical Markers of Liver > Flashcards

Biochemical Markers of Liver Flashcards

1
Q

When is bile secretion normal

A

After a meal

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2
Q

What 3 pathologies are associated with abnormal bile acid levels in the blood

A
  1. Obstruction:obstruction at biliary tree w/ reflux into circulation leading to constantly high levels of
  2. Liver damage: impaired reabsorption of bile from portal circulation
  3. Ileal disease: bile is not reabsorbed and low bile acid levels
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3
Q

What 2 proteins are not synthesised by the liver

A

Immunoglobulin
Clotting factor VIII

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4
Q

What is the main protein in the blood

A

Albumin

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5
Q

What is the second biggest protein in the plasma

A

Immunoglobulin

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6
Q

What is the function of albumin

A

Oncotic pressure, buffering, general binding & transport protein

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7
Q

What is the function of CRP

A

Activates complement, binds to damaged tissues & pathogens, role in innate immunity

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8
Q

What is the function of coagulation factors & fibrinogen

A

Coagulation & clot formation

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9
Q

What is the function of transferring & ferritin

A

Iron transport & iron storage

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10
Q

What is the function of caeruloplasmin

A

Copper & iron metabolism

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11
Q

What is the function of Ig

A

Immune response

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12
Q

What 2 products does the liver detoxify

A

Ammonia
Xenobiotics

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13
Q

Where is ammonia from & how is it excreted

A

It comes from amino acid metabolism that ca be toxic to CNS & converted to urea in urea cycle & excreted

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14
Q

What is the 4 types of liver function tests that can be performed

A
  1. Excretory function
  2. Detoxification function
  3. Synthetic function
  4. Metabolic function
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15
Q

What is the 3 test done for excretory function & their meanings

A
  1. Bile salts:
  2. Bilirubin: total, conjugated or unconjugated (normally not present in urine but conjugated is present if there is an obstruction)
  3. Urobilinogen: dipstick urine test as water soluble & urobilin (yellow)
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16
Q

What is the test done for detoxification function & their meanings

A

Blood ammonia: normally very low but w/ severe damage it is high

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17
Q

What is the signs of hyperammonaemia

A

Irritability, coma, flapping trimmer, confusion & change in behaviour/personality

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18
Q

What is the 2 tests done for synthetic function & their meanings

A

Prothrombin time: measure coagulation cascade & use INR
Albumin & total protein: decrease in total protein/albumin is due to decrease synthesis or increased loss & increase total protein & decrease albumin increase immunoglobulin

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19
Q

What is the test done for metabolic function & their meanings

A

Blood glucose

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20
Q

What is the 4 tests performed to determine cause of liver dysfunction

A
  1. RC parameters
  2. Viral serology
  3. Specific proteins
  4. Auto-immune markers
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21
Q

What are the 5 liver enzymes

A
  1. ALT: alanine transaminase
  2. AST: aspartate transaminase
  3. LDH: lactate dehydrogenase
  4. ALP: alkaline phosphotase
  5. GTT: gamma-glutamyl transaminase
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22
Q

What does each of the liver enzymes indicate

A
  1. AST: widespread damage but indicates severity as enzyme inside mitochondria
  2. ALT: specific to the liver enzymes
  3. LDH/LD: not specific to the liver & specific iso-enzyme needs to be tested for & done in haemolysis- prehepatic
  4. ALP: not liver specific but released at cholestasis (obstructive enzyme)
  5. GGT: liver specific in cytoskeleton for transport of AA (obstructive enzyme) released at increased cholestasis, chronic alcohol or drug abuse
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23
Q

What biochemical markers are seen w/ hepatocellular damage referring to bilirubin, urobilinogen, ALT & AST

A

Total bilirubin increase (UB increased & not CB)
Urine bilirubin negative
Urine urobilinogen increase
ALT & AST elevated

24
Q

What biochemical markers are seen w/ obstruction referring to bilirubin, urobilinogen, ALP & GGT

A

Increased total bilirubin (CB increased)
Urine bilirubin positive
Urine urobilinogen decreased
ALP & GGT elevated
INR can be prolonged

25
Q

What 4 biochemical markers are seen w/ liver failure

A

Hypoalbuminaemia
Prolonged INR
Hyperammonaemia
Hypoglycaemia

26
Q

What is a normal AST:ALT ratio

A

Less than 1

27
Q

What does a AST:ALT ratio above 1 & 2 mean

A

> 1 is cirrhosis
2 alcoholic liver disease

28
Q

What is the 3 types of jaundice & their consequences

A

Pre-hepatic: excess bilirubin production beyond liver’s capability to conjugate & increased UB in blood
Intra-hepatic: decrease uptake, metabolism or excretion & increased UB or CB I blood
Extra-hepatic: obstruction of bile flow * increased in CB

29
Q

What is the 2 main causes of pre-hepatic jaundice

A

Haemolytic disorders:
Abnormal haemoglobins (e.g. sickle cell anaemia)
RBC membrane defects (e.g. hereditary spherocytosis)
RBC enzyme defects (e.g. G6PD deficiency)
Autoimmune haemolytic anaemias
Mechanical RBC damage (e.g. prosthetic heart valves)
Blood group incompatibility
Malaria
Ineffective erythropoiesis:
Megaloblastic anaemias

30
Q

What is the biochemical results of pre-hepatic jaundice (bilirubin, urobilinogen & liver enzymes)

A

Increased unconjugated bilirubin & normal conjugated (if no obstruction)
Urine bilirubin negative & urobilinogen increased
LDH enzyme elevated & rest of liver enzymes normal

31
Q

What haemolytic tests are performed w/ pre-hepatic jaundice

A

Hb, haemocrit & RC

32
Q

What is the 3 causes of post-hepatic jaundice

A

Lumen: worm or gallstone
Wall: carcinoma, stricture or atresia
Outside wall: Ca of pancreas & lymph nodes enlarged

33
Q

What is the clinical features of post-hepatic jaundice

A

Dark urine, pale stool & jaundice

34
Q

What is the biochemical results of post-hepatic jaundice (bilirubin, urobilinogen & liver enzymes)

A

Increased conjugated bilirubin in serum & urine
Decreased urobilinogen/urobilin in stool
Increased obstructive enzymes

35
Q

What is different w/ partial obstruction biochemical test

A

Bilirubin can be normal/slightly elevated
Obstructive enzymes are elevated

36
Q

What is the two categories under inherited diseases of Intra-hepatic jaundice

A
  1. Defect in bilirubin uptake/conjugation
  2. Defect in excretion of bilirubin into bile canaliculi
37
Q

What is the 2 conditions under defect in bilirubin uptake/conjugation

A
  1. Gilbert syndrome:
    Decreased expression of UDPGT1 & mildly increased UB
  2. Criggler-Najjar syndrome:
    Type 1: absent UDPGT1 & severely increased UB
    Type 2: reduced UDPGT1 & moderately increased UB
38
Q

What is 3 causes of toxic hepatitis

A

Hepatotoxic drugs
Idiosyncratic drugs
Reye’s syndrome

39
Q

What is 3 causes intrahepatic cholestasis

A

Drugs, pregnancy & viral infection

40
Q

What is the initial biochemical measures of acute hepatitis

A

Increased UB, increased urobillinogen & decreased albumin
Increased Ig, prolonged INR, & elevated ALT & AST

41
Q

What is the later biochemical measures of acute hepatitis

A

Increased UB, decreased urobilinogen & increased ALP & GGT

42
Q

What 3 things does alcoholic liver disease lead to

A

Fatty liver
Alcoholic hepatitis
Cirrhosis

43
Q

What is the biochemical markers of alcoholic liver disease

A

Elevated GGT, AST & ALT & ratio

44
Q

When can you consider non-alcoholic fatty liver disease

A

After excluding alcohol & other causes

45
Q

What are the 2 types of NAFLD

A

Non-alcoholic fatty liver (NAFL) hepatic steatosis is present w/o inflammation
Non-alcoholic steatohepatitis (NASH) hepatic steatosis & inflammation

46
Q

What are 4 main risk factors for NAFLD

A

Central obesity
Type 2 diabetes mellitus
Dyslipidemia
Metabolic syndrome

47
Q

What are the known pathogenesis of NAFLD

A

Insulin resistance & oxidative damage

48
Q

What is the biochemical features of NAFLD

A

Mild elevation of ALT, AST or GGT

49
Q

What is the diagnosis of NAFLD

A

Ultrasound

50
Q

What is the treatment for NAFLD

A

Lifestyle changes like diet, exercise & gradual weight loss

51
Q

What is the final pathway for many chronic liver disease

A

Cirrhosis

52
Q

What is 3 histological appearances of cirrhosis

A
  1. Fibrosis
  2. Regenerating nodules
  3. Derangement of microvasculature
53
Q

In cirrhosis what causes micronodular & macronodular nodules

A

Micronodular: alcohol, cholestatic & congestive
Macronodular: post-viral hepatitis cirrhosis

54
Q

What are the 4 most common causes of cirrhosis

A
  1. Chronic viral hepatitis
  2. Alcoholic liver disease
  3. Haemochromatosis
  4. NAFLD
55
Q

What are the lab results of liver failure (bilirubin, liver e, albumin, INR, creatinine, ammonia & glucose)

A

Elevated bilirubin
AST & ALT elevated (decrease w/ worsening of liver failure)
Albumin low
INR prolonged
Creatinine elevated
Ammonia elevated
Glucose low

56
Q

What are the lab results of cirrhosis (bilirubin, liver enzymes, albumin, INR, Na, creatinine)

A

Bilirubin normal
ALT & AST elevated w/ ratio >1
Albumin reduced & INR prolonged = severity
Hyponatraemia
Increased creatinine (hepatorenal syndrome develop)

Case 9: Liver (8 decks)

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