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Clinical Pathology > Investigation of the Liver > Flashcards

Investigation of the Liver Flashcards

1
Q

Hepatocytes constitude what percentage of liver mass?

A

60%

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2
Q

Each hepatocyte is in contact with what other cells?

A

Sinusoid
Bile canaliculus
Neighbouring hepatocyte

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3
Q

Role of SER

A

Bilirubin conjugation

Drug detoxification

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4
Q

Carbohydrate metabolism of the liver

A

Glycogen storage and synthesis

Glycolysis and gluconeogenesis

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5
Q

Protein functions of the liver

A

Syynthesis and catabolism
Clotting factors
Amino acid metabolism
Urea synthesis

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6
Q

Lipid functions of the liver

A

Lipoprotein and cholesterol synthesis
Fatty acid metabolism
Bile acid synthesis

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7
Q

What is excreted by the liver

A

Bile acid and bilirubin

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8
Q

What does the liver do to drugs?

A

Detoxification and excretion

Inactivates steroids and excretes iron

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9
Q

What vitamins are stored in the liver

A

Vit A,D,E and B12

Iron

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10
Q

6 LFTs in routine liver panel

A 
Alkaline phosphatase 
ALT (alanine aminotransferase)
Bilirubin
Albumin
Total protein
GGT (gamma glutamyl transferase)
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11
Q

What would you test to determine the functional production of metabolites?

A

Urea, plasma proteins

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12
Q

What would you test to measure the clearance of endogenous substances?

A

Bilirubin
Ammonia
Hormones

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13
Q

What would you test to measure the clearance of exogenous substances?

A

Drugs, toxins

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14
Q

Measure of the integrity of the hepatocytes- released during damage

A

Aminotransferases

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15
Q

2 types of aminotransferases

A

Alamine/ALT

Asparate/AST

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16
Q

Which aminotransferase is more specific for the liver?

A

ALT

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17
Q

Where else, other than the liver, is AST found?

A

In the muscle and RBCs

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18
Q

Tumour markers for primary hepatocellular carcinoma (high levels found in children)

A

alpha fetoprotein

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19
Q

What are the 2 main results of biliary tract damage

A

Impaired excretory function (increased conjugated bilirubin)

Increased synthesis of enzymes by cells lining the bile canaliculi (ALP and yGT)

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20
Q

When do you get elevevated ALP (alkaline phosphatase)

A

Due to increased production by cells lining the bile canaliculi and overflow into blood

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21
Q

4 causes of elevated alkaline phosphatase

A

Cholestasis
Infiltrative diseases
Space-occupying lesions (tumours)
Cirrhosis

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22
Q

Sites of production of ALP

A

Liver, bone, intestine, placenta

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23
Q

How do you distinguish between ALP isoenzymes

A

Liver and bone ALP isoenzymes separated by electrophoresis

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24
Q

Enzyme that is elevated due to structural damage, and can support a liver source of raised ALF

A

Gamma glutamyltransferase (yGT)

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25
Q

When can gamma glutamyltransferase levels be induced?

A

Alcohol
Enzyme inducing agents e.g. anti-epileptics
Fatty liver e.g. alcohol, diabetes, obesity
Heart failure
Prostatic disease
Pancreatic disease
Kidney damagw

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26
Q

Novel biochemical markers of fibrosis

A

ELF score (PIIINP, TIMP-1, Hyaluronic acid)

27
Q

Bilirubin is a measure of what?

A

Excretory capacity of the liver and free flow of bile

28
Q

What 3 measurements of bilirubin can be taken?

A

Total
Unconjugated
Conjugated

29
Q

What levels of bilirun defines jaundice

A

> 40micromol/l

30
Q

slide 21

A

ok

31
Q

2 examples of pre-hepatic hyperbilirubinaemia

A

Haemolysis e.g. rhesus incompatibility

Ineffective erythropoiesis e.g. spherocytosis

32
Q

4 post hepatic (obstructive) causes of jaundice

A

Gallstones
Bilicary stricutre
Cancer e.g. cholangiocarcinoma
Cholangitis

33
Q

2 examples of inborn errors of bilirubin metabolism

A

Decreased activity of UDP glucoronyl transferase

Reduced ability to excrete bilirubin glucuronide

34
Q

2 inborn errors related to decreased activity of UDP glucuronyl transferase

A

Gilbert’s

Crigler Najjar

35
Q

2 inborn errors related to reduced ability to excrete bilirubin glucuronide

A

Dubin-Johnson

ROTOR

36
Q

AST/ALT elevated and normal ALP

A

90% hepatitis

37
Q

AST/ALT normal and elevated ALP

A

90% obstructive jaundice

38
Q

urine results in prehepatic jaundice

A

No urinary bilirubin

39
Q

Urine results in post-hepatic obstruction

A

Dark urine and pale stools

40
Q

Tests for viral hepititis

A

Serology (hep A-E, EBV, CMV, HIV)

41
Q

Tests for chronic active and autoimmune hepatitis

A

Anti smooth msucle, anti liver/kidney, anti microsomal and anti nuclear antibodies

42
Q

Test for primary biliary cirrhosis

A

Anti mitochondrial antibodies

43
Q

Tests for hereditary haemachromatosis

A

ferritin, transferrin saturation, liver biopsy, genetic testing

44
Q

Test for wilson’s disease

A

Caeruloplasmin, urine copper, plasma copper, liver biopsy

45
Q

Test for alpha antitrypsin deficiency

A

Alpha antitrypsin, genetic testing

46
Q

Test for hepatocellular cancer

A

AFP

47
Q

4 effects of oestrogen not being broken down in liver disease

A

Gynaecomastia
Spider naevi
Liver palms
Testicular atrophy

48
Q

What percentage of subjects with abnormal LFTs have liver disease?

A

1%

49
Q

5 signs/symptoms of liver disease

A 
Pain
Itching
Jaundice
TATT
Bruising
50
Q

Exocrine secretions come from which cells?

A

Ductal and acinar cells

51
Q

What 2 exocrine secretions are secreted from the pancreas?

A

Bicarbonate

Digestive enzymes

52
Q

Describe the pathology of acute pancreatitis

A

Acute necrotising liquefaction

Inflammatory

53
Q

Causes of acute pancreatitis

A 
Gallstones
Alcohol
Drugs
Hypertriglyceridaemia- increased demand on pancreas for digestive enzymes
Trauma,infections
Rare tumours, autoimmune
54
Q

Symptoms of acute pancreatitis

A

Severe epigastric pain
Sudden onset
Radiating to the back

55
Q

Potential biochemical features of acute pancreatitis

A 
Uraemia
Hypoalbuminaemia
Hypocalcaemia
Hyperglycaemia
Metabolic acidosis
Abnormal LFTs
56
Q

Diagnosis for acute pancreatitis

A

Amylast or lipase
Imaging
Clinical history

57
Q

Pathology of chronic pancreatitis

A

Progressive loss of both islet cells and acinar tissues

58
Q

Presentation of chronic pancreatitis

A

Abdominal pain
Malabsorption
Impaired glucose tolerance
Alcohol often an important factor

59
Q

Do amylase/lipase values play a role in the diagnosis of chronic pancreatitis/

A

No

60
Q

Diagnosis of chronic pancreatitis

A

Imaging
Pancreatic function tests for investigating insufficiency
Misc. Vit D, calcium, FBC, LFTs, glucose, lipids

61
Q

2 types of pancreatic function tests

A

Direct (invasive) test

Indirect (non-invasive) test

62
Q

Intubation to collect aspirates in the duodenum.

Secretin, CCK, Lundh Tests

A

Direct (invasive) tests

63
Q

Pancreatic enzyme analysis in stools (Elastase)
Trypsinogen (IRT) measured in blood in CF screening
Pancreolauryl & NBT-PABA tests

A

Indirect (non invasive tests)

Clinical Pathology (53 decks)

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