Clinical Aspects of Liver Disease Flashcards
List the 6 standard LFTs.
Bilirubin Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Gamma glutamylytransferase (GGT) Alkaline phosphatase (ALP) Albumin
What 3 blood tests would you do to measure actual liver function?
Albumin levels
Bilirubin levels
Prothrombin time
What further tests would you do in a patient with abnormal LFTs? (4)
Ultrasound
Viral hepatitis serology
Autoimmune liver disease serology
Metabolic liver disease markers
Which antibodies do you look for to test for autoimmune liver disease? (5)
Anti-nuclear antibody (ANA) Anti-smooth muscle antibody (ASMA) Liver kidney microsomal antibody (LKM) Anti-mitochondrial antibody (AMA) Immunoglobulins (Ig)
In chronic liver disease, what does raised IgG indicate?
What does raised IgM indicate?
IgG - autoimmune hepatitis
IgM - primary biliary cirrhosis/cholangitis
Which 3 metabolic markers do you look for in chronic liver disease?
What are each of these associated with?
Ferritin (haemochromatosis)
Caeruloplasmin (Wilson’s disease)
Alpha 1 anti-trypsin (liver cirrhosis)
Describe the LFT results suggesting alcoholic liver disease. (4)
High ALT (but usually <300)
High AST (but usually <500)
AST:ALT ratio 1.5+ (often 2.0+)
Very high GGT
Describe the features of alcoholic hepatitis. (5)
What are some other characteristic signs? (4)
ESSENTIAL FEATURES: Recent excess alcohol Bilirubin 80+ μmol/L AST <500 AST:ALT ratio 1.5+ Exclusion of other liver disease
CHARACTERISTIC FEATURES: Hepatomegaly Fever Leukocytosis Hepatic bruit
What is liver kidney microsomal antibody (LKM) associated with?
Autoimmune hepatitis
Which autoimmune liver disease serology markers indicate primary biliary cirrhosis/cholangitis? (2)
Anti-mitochondrial antibody (AMA)
IgM immunoglobulin
What are the 2 main types of autoimmune liver disease?
Primary biliary cirrhosis/cholangitis
Autoimmune hepatitis
What is the pathophysiology of alcoholic liver disease? (3)
What is the pathophysiology of non-alcoholic fatty liver disease? (3)
ALCOHOLIC LIVER DISEASE:
- Alcoholic steatosis
- Alcoholic hepatitis
- Alcoholic cirrhosis
NAFLD:
- Steatosis
- Non-alcoholic steatohepatitis
- NAFLD cirrhosis
List the 4 main consequences of liver cirrhosis.
Ascites
Encephalopathy
Variceal bleeding
Hepatocellular carcinoma
How do you measure the severity of alcoholic hepatitis?
What is the clinical significance of this score?
Glasgow alcoholic hepatitis score (GAHS)
Maximum score: 12
Very severe disease: 9+
Which features are used to define the Glasgow alcoholic hepatitis score (GAHS)?
Age WCC Urea PT ratio (INR) Bilirubin
Describe the LFT results suggesting non-alcoholic fatty liver disease. (4)
High ALT
Normal AST
AST:ALT ratio: <0.8
Normal/high GGT
Describe the signs of chronic liver disease.
What are the stigmata of CLD? (3)
What are the signs of synthetic dysfunction? (2)
What are the signs of portal hypertension? (4)
Stigmata:
- Spider naevi
- Foetor
- Encephalopathy
Synthetic dysfunction:
- Prolonged prothrombin time (PT)
- Hypoalbuminaemia
Portal hypertension:
- Caput medusa
- Hypersplenism
- Thrombocytopenia
- Pancytopenia
List 3 methods of measuring severity of chronic liver disease.
Childs-Turcotte-Pugh score
Conn score for hepatic encephalopathy
Model for end-stage liver disease (MELD)
Which 5 features are used to measure the Childs-Turcotte-Pugh score?
What is this used for?
Encephalopathy Ascites Bilirubin Albumin PT prolongation
Used for: chronic liver disease
What is the clinical significance of the Childs-Turcotte-Pugh score?
HINT: there are 3 grades of severity.
Grade A (mild): 5-6
Grade B (moderate): 7-9
Grade C (severe): 10-15
What is the clinical signficance of the MELD score?
What is this used for?
Mild: <10
Moderate: 10-15
Severe: 15+
Used for: chronic liver disease
How do you measure Conn score for encephalopathy?
What is this used for?
See table (Grades 1-4)
Used for: severity of chronic liver disease
What are the 2 types of hepatorenal syndrome (HRS)?
Type 1 - rapidly declining
Type 2 - moderately stable decline
What investigation would you do for ascites?
After this, which 2 tests would you do?
Ascites fluid sample
Fluid analysis:
- Cell count (detects spontaneous bacterial pertonitis, SBP)
- Serum ascites albumin gradient
