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Leila's Yr 5 Pathology > Chem path 11 - LFTs > Flashcards

Chem path 11 - LFTs Flashcards

1
Q

What are some consequences of liver failure?

A

Hypoglycaemia
Lactic acidosis
Hyperammonaemia

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2
Q

Outline the process of xenobiotic metabolism

A
  1. Chemical modification: P450 enzyme system, acetylation/de-acetylation, oxidation/reduction
  2. Conjugation: glucuronation/sulphation
  3. Excretion
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3
Q

Outline the process of bilirubin metabolism and transporit

A

RBCs are broken down in to heme, iron and globin
The heme then goes on to form bilirubin –> bound to albumin in the plasma
The uBr goes to the liver to be glucuronidated i.e. conjugated
The cBr is released in to the bile

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4
Q

What are the two reticulo-endothelial functions of the liver?

A 
Kuppfer cells (clearance of infection and LPS, antigen presentation, immune modulation) 
Erythropoietin
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5
Q

What are the markers of liver cell damage?

A

ALT
AST
ALP
GGT

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6
Q

What are the synthetic markers of liver function?

A

Albumin and PT

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7
Q

What does the portal triad consist of?

A

Portal vein
Portal artery
Bile duct

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8
Q

Where are zones 1 and 3 of the liver?

A

Zone 1 = periportal

Zone 3 = centrilobular

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9
Q

What does an AST:ALT >2 indicate?

A

Alcoholic liver disease

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10
Q

In the absence of alcohol, what does an AST:ALT >0.8 suggest?

A

Advanced fibrosis or cirrhosis

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11
Q

Where is GGT found in the liver?

A

in the hepatocytes and in the epithelial cells lining the bile duct

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12
Q

When does GGT rise?

A

Chronic alcohol use, Bile duct obstruction and hepatic metastases

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13
Q

Where is ALP found?

A 
Bone
Liver
Intestine
Placenta 
BLIP
High in bone disease and pregnancy
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14
Q

What is the major protein synthesised by the liver?

A

Albumin

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15
Q

What is the half life of albumin and why is this significant?

A

long half-life of 20 days therefore it only really goes down in chronic liver disease

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16
Q

What are some causes of low albumin?

A

Low production states (chronic liver disease, malnutrition)
Losses(nephrotic syndrome, gutlosing enteropathy)
Sepsis - 3rd spacing (commonest cause in hospitals)

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17
Q

What are PT and INR markers of?

A

aCUTE liver function as their half lives are a matter of hours

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18
Q

Is aPTT or PT extrinsic or intrinsic pathway?

A

aPTT - Intrinsic

PT - extrinsic

19
Q

What is the serum marker for HCC?

A

AFP (also rasied in testicular cancer, pregnancy)

20
Q

Where is AFP produced in the foetus?

A

Yolk sac, GI epithelium, liver

21
Q

If a patient has jaundice and a raised bilirubin, a cholestatic picutre (i.e. raised ALP), what would the differentials be if there were dilated or undilated bile ducts

A

Dilated: gallstones, cancer
Undilated: PBC/PSC, pregnancy

22
Q

On urine dipstick, should there ever be any bilirubin?

A

No

23
Q

Can uBr or cBr be found in the urine?

A

Only conjugated –> dark urine

24
Q

What is urobilinogen?

A

A breakdown product of bilirubin in the intestines by bacteria. It is soluble so some of it will enter enterohepatic circulation and be found in small amounts in urine.

25
Q

When might increased levels of urobilinogen be found in the urine?

A

Haemolysis, sepsis, hepatitis

It is NOT found in obstructive jaundice… urobilinogen is normally found in the urine

26
Q

Why are stools pale in obstructive jaundice?

A

No stercobilinogen

27
Q

What does hepatitis serology consist of?

A

Hep B surface antigen

HCV antibody

28
Q

An isolated raised ALT is a very common abnormality. WHat is it a feature of?

A

Fatty liver disease

29
Q

Name 3 tests used to measure liver function

A

Dye tests, breath tests and serum bile acids

30
Q

What do dye tests show?

A

The excretory capacity of the liver and hepatic blood flow

31
Q

What do breath tests (Carbon 14) show?

A

residual functioning liver cell mass, distinguish cirrhosis without biopsy (70-80% accuracy)

32
Q

What do serum bile acids show?

A

Elevated in cholestasis
10-100x in choelstasis of pregnancy
25% in PBC/PSC

33
Q

what is the gold standard investigation in measuring liver function?

A

biopsy

34
Q

What is a fibroscan used for?

A

Measures elasticity of the liver and pressure is the marker of liver stiffness. Can tell whetehr a liver is likely to be cirrhotic or not.

35
Q

name 3 markers of liver fibrosis

A

TIMP-1
PIIIINP
HA

If number v low then rules out fibrosis, if number v high then most definitely fibrosis

36
Q

How can bilirubin sometimes be normal in acute liver failure?

A

Br has a long half life

37
Q

What is the most common drug that causes drug induced cholestasis?

A

AUGMENTIN (CO-AMOXICLAV)

38
Q

What is courvoisier’s sign?

A

In the presence of a painless, palpable gall bladder, jaundice is unlikely to be caused by gall stones

39
Q

What are 3 things that will make ALT > 1,000?

A

Paracetamol, viruses (hepatitis), ischaemia e.g. post resuscitation

40
Q

What is the follow-up for patients with hepC and cirrhosis?

A

6-mo follow up to screen for HCC

41
Q

Which blood tests best indicate acute liver dysfunction?

A

iNR + PT

42
Q

What are some features of PSC and PBC?

A

PSC - UC, strictures of bile duct, cholangiocarcinoma

PBC - AMA, older ladies, diffuse picture

43
Q

What histology stain is used in Wilson’s disease?

A

Rhodanin

44
Q

What histology stain is used in haemochromatosis?

A

Prussian blue (Perl’s stain)

Leila's Yr 5 Pathology (100 decks)

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