Clinical liver

Question 1

3 major problems with liver tests

Answer 1

1. poor population standards
2. abnormal tests don’t always have clinical significance
3. can have normal tests and still have problems (cirrosis)

Question 2

what do abnormal enzymes mean

Answer 2

Transaminitis or

Hepatocellular Injury

Question 3

what are 2 main liver enzymes measured

Answer 3

1. Alanine Aminotransferase (ALT) - specific for liver diease
2. Aspartate Aminotransferase (AST) also found in heart, skeltal muscle, blood

Question 4

what is correlation with degree of enzyme abromality and clincal

Answer 4

none

Question 5

5 main classes of liver disease

Answer 5

1. Fatty liver (non-alcoholic)
2. Hep A,B,C,E
3. autoimmune (enzymes)
4. drugs/toxins
5. wilsons (copper) or hemochromatiosis (iron)

Question 6

what is seen in Cholestatic Liver Disease (4)

Answer 6

1. high ALP
2. high GGT - inducible membrane from cells
3. high 5’NT - only in biliary epithelium
4. high bilirubin

Question 7

3 main causes of Cholestatic Liver Disease

Answer 7

1. drugs/toxins
2. infiltrative disease
3. Primary biliary cirrhosis
   Primary sclerosing cholangitis

Question 8

what are 3 abnormal liver biochem patterns and what do they look like

Answer 8

1. hepatocellular - high ALP and AST
2. cholestatic -↑ ALP, GGT, Bili, 5-NT
3. mixed - Bili, INR, Albumin

Question 9

what are 3 things tested in liver function test

Answer 9

1. bili - conj or not?
2. albumin
3. INR - measure of clotting time, since liver make clotting factors (except 8)

Question 10

3 consequences of liver dysfunciton

Answer 10

1. poor bilirubin excretion
2. poor drug metabolism - toxicity
3. impaired E metabolism

Question 11

consequences of protein dysfunction (3)

Answer 11

1. ↑ INR (ecchymosis, deficiency in clotting factors: first to appear)
2. Low albumin (edema, ascites – also due to portal HTN)
3. Hepatic encephalopathy (ammonia, confusion ‐> coma)

Question 12

consequences of fat.carb dysfunction

Answer 12

hypoglycemia

Question 13

3 consequcnes of portal hypertension

Answer 13

1. ascites
2. varices
3. splenomegaly > thrombocytopenia

Question 14

what is Hepatic Venous Pressure Gradient (HVPG)

Answer 14

= (Wedged – Free) Hepatic Vein Pressure

Question 15

what is Hepatic Venous Pressure Gradient (HVPG) levels

Answer 15

>5 = resistance
>13 = risk of rupture

Question 16

what are 2 paths from cirrosis to ascites

Answer 16

1. increased pressure

2. arteriole resitiance > drop BP > RAAS activation > Na and water retention

Question 17

what is decompensated cirrosis

Answer 17

cirrosis with clincial signs

Question 18

what are 3 parameters for Model of End Stage Liver Disease (MELD) score

Answer 18

1. Creatinine
2. INR
3. Bilirubin