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IOD > Ix of liver disease > Flashcards

Ix of liver disease Flashcards

1
Q

Give 5 major functions of the liver

A 
Carbohydrate metabolism
Fat metabolism
Protein metabolism
Hormone metabolism
Drugs and foreign compounds
Storage
Metabolism and excretion of bilirubin
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2
Q

3 main categories of liver disease

A

hepatitis
cirrhosis
tumours

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3
Q

hepatitis disease process

A

Damage to hepatocytes

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4
Q

disease process of cirrhosis

A

Increased fibrosis
Liver shrinkage
Decreased hepatocellular function
Obstruction of bile flow

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5
Q

are biochemical tests for the liver sensitive for hepatic function?

A

No

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6
Q

what can biochemical assessment of liver function tell us?

A
  • Can be highly sensitive indicators of liver damage
  • Looking at patterns of results: Inflammatory / hepatitic OR Cholestatic
  • Monitoring
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7
Q

3 main liver enzymes

A
  • transaminases- ALT, AST
  • alkaline phosphatase
  • Gamma glutamyl transferase
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8
Q

where is ALT found

A

hepatocytes and skeletal muscle

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9
Q

where is AST found?

A

hepatocytes, cardiac/skeletal muscle and erythrocytes

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10
Q

where is alkaline phosphatase found

A

biliary system, bone, placenta, intestines

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11
Q

where is GGT found

A

hepatocytes- induced by drugs, alcohol

biliary system

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12
Q

6 proteins associated with LFTs

A 
albumin
clotting factors
a1 antitrypsin
a-fetoprotein
caeruloplasmin
ferritin
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13
Q

what is a-fetoprotein useful for?

A

marker of hepatocellular carcinoma

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14
Q

what are low levels of caeruloplasmin associated with?

A

Wilson’s disease

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15
Q

basic metabolism of bilirubin

A

SPLEEN: Hb–> globin and haem. Haem–> iron and bilirubin

LIVER: unconjugated bilirubin (bilirubin-albumin) is conjugated in the liver to bilirubin diglucuronide and albumin is recycled.

INTESTINES: bilirubin–> urobilinogen. Urobilinogen is either excreted from the large intestines or travels in the portal vein back to the liver, or to the kidney for excretion.

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16
Q

when is GGT used?

A

laboratory when required to assist in interpretation of a raised ALP

17
Q

Pattern of LFTs in inflammatory pattern (hepatocellular damage)

A 
N to raised bilirubin
v high ALT
n to raised ALP
N albumin
N to raised GGT
18
Q

Pattern of LFTs in cholestatic pattern

A 
raised to v raised bilirubin
N to raised ALT
raised to v raised ALP
N albumin
raised to v raised GGT
19
Q

Most common causes for raised transaminases

A

non-alcoholic steatohepatitis (fatty change plus inflammatory change)

non-alcoholic fatty liver

drug related liver damage

normal liver

alcohol related liver damage

AI hepatitis

20
Q

characteristics of non-alcoholic fatty liver disease

A 
Increased body weight
increased HBA1c or fasting glucose
increased/normal ALT
normal AST 
AST:ALT ratio <0.8
Increased/normal GGT
Increased triglycerides
Low HDL cholesterol
N mean corpuscular volume
21
Q

characteristics of alcoholic fatty liver disease

A 
variable weight
normal HBA1c/ fasting glucose
increased/N ALT
increased AST
AST:ALT >1.5
increased GGT
variable TG
Increased HDL cholesterol 
Increased mean corpuscular volume
22
Q

characteristics of alcoholic fatty liver disease

A 
variable weight
normal HBA1c/ fasting glucose
increased/N ALT
increased AST
AST:ALT >1.5
increased GGT
variable TG
Increased HDL cholesterol 
Increased mean corpuscular volume
23
Q

are conventional liver function tests helpful in assessing fibrosis

A

No

24
Q

what is the FIB4 test?

A

used in fibrosis

age [yr]x AST [U/L]) / ((PLT [109/L]) x (√ALT [U/L])

25
Q

what is P3NP used in?

A

long term methotrexate treatment to monitor for the development of liver fibrosis

26
Q

what are the components of an enhanced liver fibrosis test?

A

Hyaluronic acid (HA)
Procollagen III amino terminal peptide (PIIINP)
Tissue inhibitor of metalloproteinase 1 (TIMP-1)

27
Q

what is carbohydrate deficient transferrin test used for?

A

alcohol misuse

CDT < or = 1.5% : No excess alcohol intake
CDT 1.6-1.9% : Intake may be high but not necessarily in the range of dependence
CDT > or = 2.0% : Excess alcohol intake

28
Q

what is faecal calprotectin

A

Stable zinc and calcium binding protein belonging to the S100 family that is derived mostly from neutrophils and monocytes
Released into the faeces when neutrophils gather at the site of any gastro-intestinal tract inflammation.

29
Q

what is faecal calprotectin used for?

A

differentiating IBS and IBD

30
Q

what is faecal elastase used for?

A

Non invasive assessment of pancreatic exocrine insufficiency.

Often used in assessment of CF patients

31
Q

give 4 tumour markers

A

CA199- pancreatic cancer
CEA- CRC
AFPT- hepatocellular carcinoma
CA125- ovarian cancer

IOD (54 decks)

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