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MET3a > Investigations in Liver Disease > Flashcards

Investigations in Liver Disease Flashcards

1
Q

What blood tests are done in liver disease?

A

LFTs
Liver Screen
Haemolysis Screen if indicated

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2
Q

What imaging is done?

A

US/Fibroscan
CT
MRI/MRCP

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3
Q

Apart from bloods and imaging what other Ix are done?

A

Liver biopsy

Endoscopy - diagnostic, ERCP

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4
Q

ALT

A

Alanine Aminotransferase

Liver specific

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5
Q

What does AST stand for?

A

Aspartate Aminotransferase

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6
Q

What does ALP stand for?

A

Alkaline Phosphatase

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7
Q

What does GGT stand for?

A

Gamma glutamyl transpeptidase

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8
Q

What is AST?

A

Mitochondrial
Heart/muscle/kidney
Raised in hepatitis

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9
Q

What is ALP?

A

Bone/placenta
Bine canalicular and sinusoidal membranes
Cholestasis = intra/extrahepatic

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10
Q

What is GGT?

A

Hepatocellular conditions
cholestasis
Alcohol excess

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11
Q

What other things are done in LFTs apart from enzymes

A

Bilirubin
PT - prothrombin time
Albumin

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12
Q

When are liver enzymes raised?

A

Inflammation

Hepatitis

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13
Q

When are other liver function measures raised?

A

Chronic liver disease - synthetic problem

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14
Q

What viral screens are done?

A

HbsAg
HCV Ab
IgM HAV
IgM HEV

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15
Q

What immunoglobulins are looked for?

A 
IgA = alcoholic liver disease
IgM = PBC
IgG = autoimmune hepatitis

(cirrhosis may have elevated all 3)

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16
Q

Auto-antibodies

A 
PBC = AMA subtype M2
AIH = ANA, SMA, SLA
PSC = ANCA
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17
Q

Metabolic liver disease blood tests

A 
NAFLD = high lipids, high fasting sugar
Haemochromatosis = high ferritin, HFE genotype
Wilsons = caeruloplasmin in <40 yrs
A1AT = co-factor in adults
18
Q

What is the blood test pattern of a cholestatic condition?

A

High ALP

With or without high bilirubin (high if more severe)

19
Q

What is the blood test pattern of a hepatic condition?

A

High enzymes

High bilirubin if more serious

20
Q

What is the blood test pattern of a synthetic condition?

A

Low albumin
Long PT
Low platelets

21
Q

What is the blood test pattern of a mixed condition?

A

High bilirubin
High enzymes
High ALP

22
Q

Causes of a synthetic condition

A

Cirrhosis

23
Q

Causes of a hepatic condition

A 
NAFLD
Alcohol liver disease
Drugs
Autoimmune hepatitis
Viral
24
Q

Causes of a cholestatic condition

A

Common bile duct Stones
Drugs - microscopic biliary tree damage
PBC/PSC

25
Q

Causes of mixed conditions

A

Alcoholic liver disease
Drugs
NAFLD

26
Q

What is the first imaging step?

A

Always ultrasound

27
Q

Signs of cirrhosis on US

A 
Nodular 
Ascites
Enlarged spleen
Dilated portal vein
Reverse portal vein flow
28
Q

Signs of biliary/duct dilatation on US

A

Pancreatic tract stones or cancer

Common bile duct stones

29
Q

Space occupying lesions in liver US use

A

Primary HCC or metastases

30
Q

What further imaging would you do after US?

A

CT triple phase - nature of lesion

MRI/MRCP

31
Q

What is MRCP good for?

A

To look at biliary tree better

32
Q

Percutaneous liver biopsy

A

Diagnostic + staging

Bleeding risk

33
Q

Transjugular liver biopsy

A

Reduced risk of bleeding
Less pain
Smaller size of specimen
Hepatic vein pressure readings

34
Q

When is a biopsy required?

A

Confirm scarring

Detect cancer

35
Q

When can transjugular liver biopsy be better?

A

Cirrhosis - impaired clotting not good with risk of bleeding & ascites

36
Q

Fibroscan

A
  • measures liver stiffness
  • elevated score = scarring
  • non invasive so less need for biopsies
  • diagnosis and monitoring
37
Q

Use of endoscopy

A 
Varices screening
- detect bleeding risk
- grade 1-4
Treatment of varices
- oesophageal ligation or banding
-injection of glue for gastric varices
Surveillance of varies
38
Q

ERCP

A

Endoscopic Retrograde Cholangio Pancreaticography

  • fluoroscopic guidance
  • diagnostic and therapy
  • visualise pancreatic and biliary tree
  • strictures/blocks detect
  • crush stones
  • stents to restore bile flow
39
Q

Transjugular Intrahepatic Portosystemic Shunt

A

Small shunt between portal vein and hepatic vein via catheter through jugular vein
Reduced portal pressure
To embolise varices in recurrent variceal bleed
For ascites refractory to medical therapy

40
Q

Downside of transjugular intrahepatic portosystemic shunt

A

Forces portal into systemic circulation via manmade shunt so increases risk of hepatic encephalopathy

MET3a (38 decks)

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