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3006 Clin. Biochem > Hepatobiliary disease > Flashcards

Hepatobiliary disease Flashcards

1
Q

Liver synthesise

A
  • Albumin
  • prothrombin
  • AST & ALT & gamma GT
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2
Q

Function of liver

A
  • Performs 500+ chemical processes
  • Synthesise: fat, CHO, protein, clotting factors
  • Stores: gly., Vit, minerals, nutrients
  • Excrete: bile & bilirubin
  • detoxify: toxins & drugs
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3
Q

Describe the blood flow in & out of the liver via hepatic vein, Hepatic artery, portal vein

A
  • HV: deox. blood & nutrients out of liver to <3
  • HA: ox. blood from <3
  • PV: deox. blood, nutrients & toxins from most organs to liver
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4
Q

List the liver function tests

A
  • Enzymes: ALP, ALT, AST, gamma GT

- Proteins: Alb, PT

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5
Q

markers for hepatocellular damage (liver damage)

A

ALT, AST, ALP, gammaGT

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6
Q

markers for determining liver excretory function

A

Bilirubin

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7
Q

markers for determining liver synthesis function

A

Albumin, PTT, 5’ nucleotidase (instead of GGT), ammonia, LDH, glucose

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8
Q

Ehrlich rxn measures _ by

A

D. bilirubin by reacting w/ Diazo agent => red/blue

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9
Q

How are In.d bilirubin detected in the lab?

A

Ind. bilirubin + Diazo agent + ACCELERATOR => red/blue

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10
Q

Types of hyperbilirubinemia (3)

A
  1. Pre/intrahepatic: inc. breakdown of Hb = inc Ind. bilirubin
  2. Extra/Hepatic: obstruction = partial cholestasis = damage to hepatocytes = inc. Ind + D. bilirubin
  3. Complete obstructive jaundice / Posthepatic: Complete biliary obstruction = inc D. bilirubin
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11
Q

bilirubin metabolism from formation of bilirubin (haemolytic jaundice)

A
  1. excess haemolysis of RBC => heme => excess unconj./indirect bilirubin
  2. Ind. bilirubin in blood -> liver via Alb
  3. liver converts Ind. bilirubin to D w/ UDP-glucuronosyl-transferase
  4. Hi [ ] of direct bilirubin -> intestine & converted by a bacteria => stercobilinogen
  5. excess stercobilinogen
    => dark poo bc stercocilin
    => dark urine bc stercobilinogen
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12
Q

Expected lab results of Hemolytic jaundice*

A
  • AST, ALT, ALP, PT & Alb normal
  • Hb dec
  • inc Ind. bilirubin
  • Dark colour poo & pee
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13
Q

What happens when you have cholestasis (obstructive bilirubin)

A
  1. excess haemolysis of RBC => heme => excess unconj./indirect bilirubin
  2. Ind. bilirubin in blood -> liver via Alb
  3. liver converts Ind. bilirubin to D w/ UDP-glucuronosyl-transferase
  4. obstruction/cholestasis ≠> intestine = low stercobilinogen formed = pale poo
  5. direct bilirubin reabsorbed back in blood excreted via urine (water-soluble) = v. yellow urine
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14
Q

Expected lab results of intrahemolytic/hepatocellular jaundice (diagnosis)*

A
  • inc AST & AST
  • inc D. & Ind. bilirubin in blood
  • pale poo
  • urine dark brown (bc only exit for bilirubin)
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15
Q

posthepatic/ obstructive jaundice*

A
  • inc D. bilirubin
  • ALP >3
  • ALT & AST not inc. ~normal
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16
Q

diagnose a patient w/ High GGT & High ALP

A

cholestasis

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17
Q

ALP 3x higher than the upper limit =

A

(complete) obstructive jaundice

18
Q

diagnose a patient w/ High GGT (& normal ALP, AST, ALT)

A

Alcoholism & drugs

19
Q

diagnose a patient w/ High GGT, Hi ALT & Hi AST (& normal ALP)

A

Hepatocellular disease

20
Q

diagnose a patient w/ High ALP (& normal GGT)

A

Skeletal bone disease (occur in pregnant females)

21
Q

State where in&direct biliruben can appear whther in plasma or urine

A

In: plasma (bc insoluble in water)
Direct: plasma & urine (bc water soluble)

22
Q

Where can you find ALT, AST, ALP & GGT

A
  • ALT: hepatocyte
  • AST: hepatocyte, RBC, skeletal muscles
  • ALP: bone, liver, placenta, kidney, intestines
  • GGT: liver
23
Q

Define cholestasis. & marker for cholestasis

A

decrease in bile duct/f;low due to obstruction

marker inc. GGT, ALP (normal AST & ALT)

24
Q

Total Bilrubin (TBIL) RRange

A

0.2–1.2 mg/dL

25
Q

Direct Bilirubin (Conj. Bilirubin): RRange

A

0–0.4 mg/dL

26
Q

—–jaundice is very common in babies and neonates and may cause —– damage (Kernicterus).
If conc. ~200 µmol/L, then use —-
If conc. ~300 µmol/L, then use ——-

A

a. haemolytic
b. brain
c. PHOTOTHERAPY to breakdown the molecules in the skin.
d. blood exchange TRANSFUSION

27
Q

The marker that can differentiate b/w acute & chronic liver disease

A
  • Alb
  • Acute: normal Alb lvls
  • Chronic: dec. Alb lvls
28
Q

Alpha Fetoprotein (AFP) is a tumor marker, which is synthesized by __ liver. However, it can be increased in —— giving false positive.

A

embryonic liver

pregnant women

29
Q

An increased —— is more sensitive and earlier indicator of reduced hepatic synthesis than __ (in hepatocellular disease).

A

PT than Alb

30
Q

—–is a more specific indicator of liverinflammationthan —-, and, —-often follows —-.

A

ALT more specific than AST

AST follows ALT

31
Q

a) An AST:ALT result of >2:1 or >3:1 means

b) an AST:ALT result of > 1 or >2

A

a) alcoholic liver disease

b) acute hepatocellular disorders (viral hepatitis)

32
Q

Acute liver disease occurs due to one of the following

A
  • Poisoning (e.g. w/ paracetamol)
  • Infection (e.g. Hepatitis A, B & C)
  • Inadequate perfusion / shock
33
Q

The stages of Hepatitis and liver damage are:

A

Fat accumulation – Fibrosis – Cirrhosis (chronic liver failure)

34
Q

Among the rare causes of cirrhosis are:
Jaundice in (a)
Wilson disease in (b)
Hemochromatosis in (c)

A

a) Neonates
b) Children
c) Adults

35
Q

Clinical features of cirrhosis (chronic liver failure)

A
  • Developing jaundice.
  • Encepholopathy (high ammonia are not removed from the plasma).
  • Ascites (low albumin).
  • Bleeding tendencies (low coagulation factors, PT).
36
Q

Patient with cirrhosis may suffer from a bad itch due to accumulation of ———-.

A

bile acids

37
Q

liver diagnosis usally done w/

A

liver biopsy

38
Q

If AST & ALT are —-, liver damage is more likely to be due to hepatocellular injury.

A

> 1000 U/L (*Note: 300 U/L non-specific)

and the AST:ALT ratio is >1 bu not >2

39
Q

—— enzyme is 10x-100x normal in acute hepatitis and it is ˂10x normal in obstructive jaundice .

A

ALT

40
Q

In case of obstructive jaundice, ALP is usually very high due to injury in the ———attached to the liver.

A

Bile canaliculi

3006 Clin. Biochem (13 decks)

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