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Year 5 path SW > Chempath 25: LFTs And Cases > Flashcards

Chempath 25: LFTs And Cases Flashcards

1
Q

Which 2 vessels supply the liver ?

A

Hepatic artery

Portal vein

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2
Q

List 3 metabolic effects of Liver failure ?

A
  • low plasma glucose (less glycogen stores)
  • High ammonia (less metabolism of amino acids)
  • Lactic acidosis (lactic acid not metabolised)
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3
Q

What is the tumour marker for hepatocellular carcinoma of the liver ?

A

AFP

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4
Q

Which disease is suggested by a AST:ALT ratio > 2 ?

A

Alcoholic liver disease

AST rises more than ALT in alcoholic liver disease

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5
Q

What does a raised GGT level tell you ?

A

Chronic alcohol use

Or bile duct disease (if ALP and GGT is raised it means its likely not bone disease and more likely disease of the biliary tract)

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6
Q

What is the best acute marker of liver function ?

A

PT

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7
Q

Apart from hepatocellular carcinoma which other cancer can cause a raised AFP

A

testicular cancer

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8
Q

What does an isolated raised ALT suggest ?

A

Fatty liver disease

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9
Q

What does a raised bilirubin and raised ALP suggest?

A

Cholestatic liver diseases: Gall stones, PBC, PSC, Cancer

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10
Q

What does a raised bilirubin and raised ALT/AST suggest ?

A

Hepatocellular disease: Acute hepatitis, chronic liver failure

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11
Q

What causes an isolated raised unconjugated bilirubin ?

A

Gilbert’s syndrome

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12
Q

Which drug most commonly causes drug-induced cholestasis ?

A

Augmentin (co-amoxiclav)

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13
Q

What is Courvoisier’s law ?

A

In the presence of a palpable gall bladder which is non-tender and accompanied by mild painless jaundice the cause is unlikely to be gall stones

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14
Q

What are the 3 stages of xenobiotic modification

A

chemical modification (p450/ acetylation/deacetylation/ ox/red
conjugation - glucoronate/sulphate
excretion

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15
Q

3 types of hormone metabolism (liver)

A

vitamin D hydroxylation
steroid hormone conjugation and excretion
peptide hormone catabolism

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16
Q

what makes up bile

A 
water
bile salts/acids
bilirubin
phospholipids
cholesterol 
proteins
drugs and metabolites
17
Q

bile function

A

excretion
micelle formation
digestion

18
Q

stages in bile synthesis

A 
red cells broken down 
heme forms bilirubin
bilirubin binds to albumin in the plasma
unconjugated bilirubin - liver - glucoronidated
conjugated bilirubin released as bile
19
Q

what is the role of kuppfer cells

A

clearance of infection and LPS
antigen presentation
immune modulation - cytokines etc

20
Q

two main tests for liver synthetic function

A

albumin

PT

21
Q

what does a raised AST suggest

A

alcohol and cirrhosis

22
Q

what does a raised GGT suggest

A

chronic alcoholism, bile duct disease, hepatic mets

23
Q

what does a raised ALP suggest

A

obstructive jaundice, bile duct damage

24
Q

what are other causes of raised ALP

A

bone disease, pregnancy

25
Q

3 main causes of low albumin

A

low production states: CLD, malnutrition
increased loss: gut, kidney
sepsis: endothelium becomes leaky so albumin leaks out into tissues

26
Q

Is PT/INR an acute or chronic marker of liver function

A

acute - half life of most clotting factors is a matter of horus

27
Q

causes of a raised AFP

A

hepatocellular carcinoma
hepatic damage/regeneration
pregnancy
testicular cancer

28
Q

causes of jaundice

A

ALP - cholestatic - dilated ducts = obstruction/gallstones/cancer
- undilated ducts = drugs/PBC-PSC/pregnancy

ALT/AST - hepatocellular - acute/chronic

Normal enzymes - Gilberts

29
Q

when is urobilinogen absent

A

obstructive jaundice

pale stools/dark urine

30
Q

when is urobilinogen increased

A

haemolysis/hepatitis/sepsis

31
Q

how can liver function be measured

A
  • dye tests : indocyanine green/ bromsulphalein
  • breath tests : aminopyrine/galactose
  • serum bile tests : elevates esp. in cholestasis
32
Q

what 3 things cause an ALP over 1000

A

toxins (paracetamol)
viruses (hepatic viruses)
ischaemia (post-rescuscitation)

33
Q

how is paracetamol OD treated

A

N-acetylcysteine

In severe cases : liver transplant

Year 5 path SW (106 decks)

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