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GI 15 Flashcards

1
Q

What is the function of our Liver?

A 
Protein synthesis and metabolism
Production of bile
Carbohydrate metabolism
Toxin elimination and breakdown
Biotransformation of xenobiotics
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2
Q

What is the test available to check liver function (LFT)?

A

Albumin
Prothrombin
Protein

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3
Q

What are the tests available to check hepatocyte integrity?

A

AST =Aspartate transaminase

ALT= Alanine transaminase

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4
Q

What are the tests available for biliary excretory function?

A

GGT
ALK phosphate
Bilirubin

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5
Q

What is LFT?

A

Its mean Liver function test. Is actually intercellular enzyme that spell out into the plasma when they damaged to the cell.

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6
Q

Does the LFT has single biomarker to test its function?

A

There is no single biomarker for estimating hepatic function.

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7
Q

What is AST & ALP abbreviate?

A 
AST= Aspartate transaminase 
ALP= Alkaline phosphatase
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8
Q

What are the Tests we use for hepatocyte integrity tests?

A

ALT & AST test.
• Intracellular enzymes involved in the production of amino acids
• Ubiquitous throughout the body but vary in different tissues
• Leakage or injury to enzyme rich tissue and spelling to the plasma

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9
Q

Where is the concentration of Alanine Transaminase ALT is very high?

A

In the liver. In comparison of whole body. so, if we see higher concentration of this enzyme then we can surely guess that something wrong in the liver.

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10
Q

Where is the concentration of Aspartate Transaminase AST is very high?

A

High concentration in several organs. This test not specific for Liver injury
Like cardiac muscle> skeletal muscle> Kidney> lungs> RBC. Elevation of this enzymes may suggest Cardiac injury or skeletal muscle injury or haemolysis or hepatocyte injury. So, this test is not for only liver test.

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11
Q

SO, AST & ALT elevation how to prioritise?

A

Mild to Moderate elevation is 2-20 x higher than normal level
Chronic viral hepatitis. Various drug toxicity hepatitis

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12
Q

Marked elevations means of ALT & AST?

A

20-1000x higher than normal level. Which suggest serious injury in liver or other toxicity.

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13
Q

How AST/ALT ratio elevation occur?

A

Non-specific if it is greater than 2 than the patient is alcoholic hepatitis and alcoholics patients become malnourished and lacking in vitamin B6,

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14
Q

Aspartate transaminase (AST) is a Not a specific marker of hepatocellular damage?

A

True

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15
Q

ALT is the Specific marker for hepatocellular damage?

A

True. (Remember L for Liver & T for toxicity)

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16
Q

What are the tests for biliary excretory Functions?

A

1.(ALP)Alkaline phosphate: This is a test enzyme cleaves phosphate from protein and other molecules. It is high concentration in canalicular (on the surface of the bile ducts) surface of hepatocytes, bone, kidney and placenta.
Its increased concentration when damage occur to biliary tract. (But not a specific marker). This test used to detect of Cholestatic disease.

2.GGT (Gamma Glutamyl Transpeptidase)
Increased in concentration in canalicular surface of hepatocytes kidney pancreas and gut. But not specific marker for Liver disease.
-However, if we see increase GGT and ALP then we may think of cholestasis but not 100 % sure.
-Increase in GGT may occur in alcohol abuse.

3.(Bilirubin test): which is the metabolic product of Heme (red blood cells)

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17
Q

What is cholestatic disease?

A

Stasis of the bile duct. Bile duct cannot secret bile when needed.

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18
Q

Hyperbilirubinemia may be due to?

A

So, we elevated concentrations in the plasma of bilirubin or hyper bilirubinaemia which can be Excessive breakdown of RBC (haemolysis) and the production of heme increased.

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19
Q

Hyper bilirubinaemia involves blockage of the biliary tree due to?

A

Obstruction and inflammation

20
Q

Elevated ALP means?

A

MILD elevated means:
Hepatic disease
During pregnancy
Or bone growth in children

Marked elevation mean however, though this test is not specific for following disease.
Cholestatic disease
Bone disease
Cancer.

21
Q

What is the Difference between conjugated vs unconjugated?

A

This is the process of bilirubin of transportation or disposition into the body:
Unconjugated bilirubin: RBC die or get break down the haemoglobin into unconjugated bilirubin. It is unconjugated because it’s not attached to anything. Very Insoluble, so it is transported to the liver by albumin. It is absorbed by the hepatocyte and it is conjugated exactly the same way is phase 2 drug metabolisms. Glucuronidated to make more water soluble. Once Is water soluble it can be excreted into the bile. Once it is into the bile it ends up to GI tract and can be excreted.

22
Q

Conjugated vs unconjugated bilirubin?

A

By measuring conjugated and unconjugated bilirubin we can determine what is going on
If there is huge elevation of Unconjugated bilirubin in our blood plasma than you will think the red blood cells dyeing all over your body. So, you have haemolytic anaemia.

When we will get a large proportion of conjugated bilirubin accumulate in the plasma then we will determine patient has Obstructive jaundice yellow discolouration in skin body. Because bile duct blocked and can’t excrete bile.

23
Q

What is the test for liver function (hepatocyte damage or injury)?

A

ALT is the specific marker for liver test.

24
Q

Why we think in context of drug metabolism ?

A

If the liver unable to synthesise protein or if it declined working, then we also can say that it will not be able to make drug metabolising enzymes and unable to metabolise drugs as well. So, by testing PT or INR we can realise that as they are not making enough “clotting factor” so they might be also not making other CYP enzymes and other enzymes as well.

25
Q

Albumin concentration reduced by?

A

Liver disease
Inflammation
Malnutrition
Protein loss

26
Q

How to measure Clotting time tests?

A

By measuring PT & INR

27
Q

What is clotting factor is?

A

Clotting factors are made by the liver and which can help stop bleeding.

28
Q

What happen if albumin concentration Alter or reduced?

A

It alters vascular oncotic pressure

Cause oedema, Ascites (abdominal oedema)

29
Q

How to measure PT test?

A

PT= Prothrombin time test (usually done by adding reagents in blood and waiting 15 sec & we will see the result)
What is INR mean?
International Normalised Ratio.

30
Q

Elevated INR (means a longer clotting time) occurs because of?

A

Longer clotting time happens because of Decrease synthesis of clotting factors. why they decrease?
Because of Liver disease, Inherited deficiency, Anticoagulants.
Ex: Warfarin inhibit the synthesis of clotting factor as anticoagulant.

31
Q

How Dabigatran can block the activity of Coagulant factors?

A

Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly. Dabigatran works by stopping a clotting factor called thrombin from working. This thins your blood, so it takes longer to clot.

32
Q

Why clotting time tests can (i.e. PT & INR) be used?

A

To understand liver function and liver injury.

The “prothrombin time” (PT) is one way of measuring how long it takes blood to form a clot, and it is measured in seconds

When the PT is high, it takes longer for the blood to clot (17 seconds, for example). This usually happens because the liver is not making the right amount of blood clotting proteins, so the clotting process takes longer. A high PT usually means that there is serious liver damage or cirrhosis.

33
Q

Could you use INR as a liver function test?

A

Yes

34
Q

Name one drug which is Thrombin inhibitor?

A

Dabigatran.

35
Q

Quiz: following all are correct.

A
  1. Hyperbilirubinemia may be caused by decreased biliary excretion of conjugated bilirubin.
  2. In severe liver disease, clotting time tests like (prothrombin time) PT and INR may be elevated.
  3. The clinical value of alkaline phosphatase (ALP) and GGT measurements is the detection of cholestatic disease.
36
Q

What is LFTs?

A

Liver Function Tests (LFTs) are a group of tests that are looked at to see how healthy the liver.

37
Q

Altered ALP, GGT & bilirubin concentrations may indicate?

A

Impaired biliary excretory function.

38
Q

Elevated PT and reduced Albumin indicate?

A

Reduced hepatic synthetic capacity

39
Q

Elevate LFTs concentration may indicate?

A

Hepatocyte damage but do not necessarily indicate liver dysfunction.

40
Q

What is Child- Pugh score?

A

It is one of the composite scores of many factors.
Dr use for prognosis of Drug clearance for patient.
Factors included in the score is albumin, bilirubin, INR, Ascites, Encephalopathy.

41
Q

Some enzyme inducing drug can be Mild elevate LFT what are they?

A

Phenytoin
Carbamazepine
Rifampicin
Paracetamol

42
Q

Quiz:

Mildly elevated by enzyme inducing drugs e.g. phenytoin?

A

Mildly Elevation of ALT AST ALP GGT but not Bilirubin will elevate.

43
Q

Marked elevation 2-3 days after a paracetamol overdose?

A

ALT AST ALP GGT & bilirubin all of them will elevated.

44
Q

What elevation would suggest Cholestatic disease?

A

ALP, GGT, Bilirubin.

45
Q

What is the specific marker for hepatocyte damage?

A

ALT

46
Q

Paracetamol Injury how does it happen?

A

More than 12 g or 150mg/kg carries a significant risk of liver injury
Over 20-30g carry a very high risk of severe hepatotoxicity.

GI (16 decks)

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