Clinical Aspects of Liver Aspects Flashcards
What is included in the standard LFTs?
Bilirubin Aspartate aminotransferase Alanine aminotransferase Gamma glutamylytransferase Alkaline phosphatase Albumin
Why might LFTs be normal in advanced cirrhosis?
The liver is so damaged that it cannot produce AST/ALT/GGT/ALP and so the levels of these enzymes will not be elevated
In what other tissue (besides liver) can AST and ALT be found?
Muscle
In what other tissue (besides liver) can ALP be found?
Bone
When does get raise acutely?
Alcohol and drug metabolism
Albumin is a marker of hepatocyte synthesis function but is also low in…?
Infection
Inflammation
Renal loss
Which tests can indicate the functional capacity of the liver?
albumin
Bilirubin
Prothrombin time
How should acute. liver injury be investigated?
Ultrasound looking for cancer, bile ducts and blood vessels
Serology for viral hepatitis
Paracetamol levels
ANA/SMA/LKM immunoglobulins
Which immunoglobulin is autoimmune hepatitis associated with?
LKM
Which immunoglobulin is primary biliary cholestasis associated with?
AMA
Caeruloplasmin is increased in which depository disease?
Wilson’s
What is a fibroscan?
A non-invasive test of liver fibrosis which uses the shear wave velocity to indicate liver stiffness
What scores are used to assess liver fibrosis?
APRI or FIB4
What conditions is non-alcoholic fatty liver disease associated with?
Obesity
T2DM
Hyperlipidaemia
How can non-alcoholic fatty liver disease be differentiated from alcoholic liver disease?
Weight always elevated in NAFLD and fasting glucose usually is elevated
there is usually less of a history of alcohol intake with. elevated or normal ALT but normal AST so the AST/ALT ratio is <0.8
What are the symptoms of alcoholic liver disease?
Malaise, itch, nausea, hepatomegaly, fever, jaundice, sepsis, encephalopathy, ascites, renal failure, death
What are the characteristics of alcoholic liver disease?
Hepatomegaly
Fever
Leucocytosis
Hepatic bruit
What is the biggest factor in reducing long term mortality from alcoholic liver disease?
Abstinence from alcohol
What scoring system is used to assess alcoholic liver disease?
Glasgow alcoholic hepatitis score
What factors are used in the GAHS scoring system for alcoholic liver disease?
Age WCC Urea PT/INR Bilirubin
What factors are related to the rate of the progression go hepatitis C to cirrhosis?
Male sex
age >40 years
alcohol >50g/week
What signs will be seen in decompensated cirrhosis?
Jaundice Ascites Encephalopathy Bleeding varices Hepatocellular cancer
What is the major complication which can occur with ascites?
Spontaneous bacterial peritonitis
What are the signs of chronic liver disease?
Spider nevi Palmar erythema Loss of male hair pattern Gynaecomastia Foetor Sarcopenia Bruising Scratching
