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Year 3 - Met3a > Investigation in Liver disease > Flashcards

Investigation in Liver disease Flashcards

1
Q

What blood tests do you use in liver disease

A
  • Liver function tests
  • liver screen
  • haemolysis screen if indciated
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2
Q

What imaging do you do in a liver disease

A
  • Ultrasound
  • CT
  • MRI/MRCP
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3
Q

What other investigations do you do in liver disease investigations

A
  • Blood tests
  • imaging
  • liver biopsy
  • endoscopy
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4
Q

What type of endoscopy do you use in liver disease investigations

A
  • Upper GI endoscopy: diagnostic and therapy

- ERCP

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5
Q

what liver enzyme are specific to the liver

A
  • Alanine aminotransferase (ALT)
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6
Q

Where is the AST present in

A
  • mitochondrial enzyme
  • liver/heart/muscle/kidney
  • released into the blood stream after hepatocellular injury
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7
Q

what causes AST to raise

A

Hepatits

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8
Q

Where is alkaline phosphatase (ALP) secreted in

A
  • Bile cannlicular and sinusoidal

- bone and placenta

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9
Q

what causes ALP to rise

A
  • cholestasis - intra/extrahepatic
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10
Q

Where is gamma glutamyl transpeptidase (GGT) produced

A

= hepatocytes

- is also expressed in pancreas, renal tubules and intestine so not very specific

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11
Q

What causes gamma glutamyl transpeptidase (GGT) to rise

A
  • cholestasis
  • alcohol
  • hepatitis
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12
Q

what tests measure liver function

A
  • prothrombin time (clotting factors)
  • albumin
  • bilirubin
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13
Q

what does a liver screen include

A
  • Viral screen
  • immunoglobulins
  • auto antibodies
  • metabolic
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14
Q

What antibodies does a viral screen include

A
  • HBsag - hepatitis B
  • HCV ab - hepatitis C
  • IgM HAV - hepatitis A
  • IgM HEV- hepatitis E
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15
Q

What does the immunoglobulins screen include

A
  • IgA: Alcoholic liver disease
  • IgM - PBC - primary biliary cirrhosis
  • IgG - AIH - autoimmune hepatitis
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16
Q

What auto antibodies are associated with

  • primary biliary cirrhosis
  • autoimmune hepatitis
  • primary sclerosing cholagnitis
A
  • primary biliary cirrhosis = AMA, M2 antibody
  • autoimmune hepatitis = ANA, SMA, SLA
  • primary sclerosing cholagnitis = ANCA
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17
Q

What are the metabolic diseases and there screens

A
  • NAFLD: Lipids, fasting sugar
  • Haemochromatosis: Ferritin, HFE genotype
  • Wilsons disease - caeruloplasin is increased in those aged over 40 years of age
  • A1AT - this is usually a co-factor in adults
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18
Q

what do the markers look like in a cholestatic problem

A
  • an elevated alkaline phosphatase

- with or without an elevated bilirubin, if the bilirubin is elevated than that suggests a more severe cholestatsis

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19
Q

What do the markers look like in a hepatic pattern

A
  • elevated enzymes

- elevated bilirubin

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20
Q

What do the markers look like in a synthetic pattern

A
  • decrease in albumin
  • increase in prothrombin time
  • low platelets
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21
Q

what does a mixed pattern look like

A
  • elevation of enzymes and alkaline phosphatase

- this is seen in ALD, Drugs, NAFLD

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22
Q

What are the signs of cirrhosis in liver disease

A
  • Nodular liver
  • ascites
  • enlarged spleen, dilated portal veins
  • portal vein flow
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23
Q

What is a dilated biliary tree caused by

A
  • CBD
  • pancreatic tract stones
  • pancreatic cancer
24
Q

if there are spaces occupying lesions in the liver what does it mean

A
  • Primary HCC

- metastases

25
Q

Name the two types of liver biopsy

A
  • Percutaneous liver biopsy

- Transjugular liver biopsy

26
Q

describe a percutaneous liver biopsy

A
  • diagnostic and staging
  • risk bleeding
  • mortality 0.02%
27
Q

Describe a transjugular liver biopsy

A
  • reduced risk
  • less pain
  • smaller size of specimen
  • hepatic vein pressure readings
28
Q

what does Firboscan measure

A

measure liver stiffness

  • gives a number and an elevated score is suggestive of scarring
  • this reduces the number of liver biopsys that we carry out
29
Q

What is endoscopy useful for

A
  • screening varices
  • treatment of varices
  • surveillance of varices
30
Q

How do you use endoscopy for screening varices

A
  • Risk of bleeding propotional to size
  • grade 1 to 4
  • stigmata of high risk bleed/recent bleed
31
Q

How do you treat varices using endoscopy

A
  • esophageal varices - ligation or banding

- gastric varices - injection of cyanoacrylate glue

32
Q

what does ERCP stand for

A

Endoscopic retrograde cholangio pancreaticography

33
Q

What is ERCP used for

A
  • Diagnosis to see for blockage

- treatment - to remove and crush a stone, to widen a blockage by using a stent or balloon

34
Q

What does TIPSS stand for

A

transjugular intrahepatic protosystemic shunt

35
Q

What does TIPSS do

A
  • reduces portal pressure
  • embolise varices in recurrent variceal bleed
  • ascites refractory to medical therapy
36
Q

what blood tests are used to assess hepatocellular function

A
  • albumin
  • bilirubin
  • PT/INR
37
Q

How can you use ALP and Gamma GT to work out if it is a liver problem

A
  • Gamma GT is not expressed in bone, so if raised ALP is from the bone if gamma GT has not changed and from the liver if gamma GT rises with it
38
Q

What are the infective markers of the liver

A
  • HAV
  • HBV
  • HCV
  • HDV
  • HEV
  • EBV
  • CMV
  • leptospirosis
  • malaria
  • Q fever
  • syphilis
  • yellow fever
39
Q

what is present in the FBC if the patient drinks alcohol excessively

A
  • macrocytosis in alcohol excess
40
Q

What biochemical tests can you do in the liver

A
  • Alpha - antitrypsin enzyme
  • alpha - fetoprotein (AFP)
  • serum copper and caeruloplasmin
41
Q

what can a deficiency in alpha-antitrypsin enzyme indicate

A
  • deficiency can cause cirrhosis
42
Q

What can alpha-fetoprotein (AFP) indicate

A
  • presence in adults indicates hepatocellular carcinoma
43
Q

what can a low serum copper and caeruloplasmin indicate

A
  • low in Wilson’s disease (urinary copper will be high)
44
Q

What serum immunoglobulins can be used to find out what is wrong with the liver

A
  • IgG – autoimmune hepatitis
  • IgG4 – autoimmune pancreatitis/cholangitis
  • IgM – PBC
45
Q

What serum autoantibodies can be used to find out what is wrong with the liver

A
  • Anti-mitochondrial antibody (AMA) – PBC
  • Anti-nuclear cytoplasmic antibodies (ANCA) – PSC
  • Anti-nucleic antibody (ANA) – autoimmune hepatitis
  • Anti-smooth muscle antibody (ASMA) – autoimmune hepatitis
  • Anti-liver/kidney microsomal type 1 antibodies (LKM1) – autoimmune hepatitis
46
Q

What gene shows you have hereditary haemochromatosis

A

HFE gene

47
Q

What urinary tests can you use to test liver function

A
  • urinary bilirubin

- urinary urobilinogen

48
Q

What does urinary bilirubin tell you

A

Bilirubinuria due to presence of conjugated hyperbilirubinaemia

Absent in unconjugated hyperbilirubinaemia

49
Q

What does urinary urobilinogen tell you

A
  • Suggests haemolysis or hepatic dysfunction
50
Q

What does alcoholic liver disease look like in liver function tests

A
  • ↑AST (more than ALT ∴ AST/ALT ratio >2:1)

- When Hx is not reliable: normal ALP, ↑γGT, ↑MCV

51
Q

what does acute viral hepatitis look like

A
  • ↑ALT (usually more than AST ∴ AST/ALT ratio <1:1)

- Bilirubin may be normal

52
Q

What does chronic viral hepatitis look like

A
  • raised ALT

- HBV and HCV present

53
Q

Who does autoimmune hepatitis mainly occur in

A
  • young and middle aged females
54
Q

What does non-alcoholic fatty liver disease look like

A
  • probably the cause of mildly elevated LFTs in general population
  • can be seen on an ultrasound
55
Q

What does ischemic hepatitis look like

A
  • raised ALT

- raised LDH

56
Q

What can cause ischaemic hepatitis

A
  • in condition where circulatory volume is low e.g. MI, hypotension or haemorrhage
57
Q

What does a cholestasis predominant liver injury look like

A
  • raised ALP
  • raised gamma GT
  • mildly raised AST and ALT

Year 3 - Met3a (43 decks)

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