Jaundice and Chronic Liver Disease Flashcards
What is a doctor who deals with the liver called?
Hepatologist
What are the different categories of liver functions?
Synthetic function
Detoxification function
Immune function
Storage function
What are synthetic functions of the liver?
Clotting factors
Bile acids
Carbohydrates
Proteins
Lipids
Hormones
What functions related to carbohydrates is the liver responsible for?
Gluconeogenesis
Glycogenolysis
Glycogenesis
What is glycogenolysis?
Breakdown of glycogen to glucose
What is glycogenesis?
The formation of glycogen from glucose
What is gluconeogenesis?
Generation of glucose from non-carbohydrate substances
What protein is the liver responsible for making?
Albumin
What lipids is the liver responsible for making?
Cholesterol
Lipoprotein and triacylglyerol
What hormones is the liver responsible for making?
Angiotensinogen
Insulin like growth factor
What are detoxification functions of the liver?
Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones
What are immune functions of the liver?
Combating infections
Clearing the blood of particles and infections, including bacteria
Neutralising and destroying all drugs and toxins
What are storage functions of the liver?
Stores glycogen
Stores vitamin A, D, B12 and K
Stores copper and iron
What things do liver function tests measure?
Bilirubin
Aminotransferases
Alkaline phophotase
Gamma GT
Albumin
Prothrombin time
Creatinine
Platelet count
What is bilirubin a by product of?
Haem metabolism
What is bilirubin generated by?
Senescent RBCs in the spleen
What is bilirubin bound to when it is unconjugated?
Albumin
What does conjugating bilirubin do?
Solubilises it
What is bilirubin elevated as a result of?
Haemolysis (pre-hepatic)
Parenchymal damage (hepatic)
Obstruction (post hepatic)
What are aminotransferases?
Enzymes present in hepatocytes
What are examples of aminotransferases?
AST
ALT
What can the AST/ALT ratio point towards?
Alcoholic liver disease
What is alkaline phosphotase?
Enzyme present in bile ducts
What causes alkaline phosphatase to be elevated?
Obstruction or liver infiltration
Other than the bile duct, where is alkaline phosphatase present?
Bone
Placenta
Intestines
What is Gamma GT?
Non-specific liver enzyme
What causes Gamma GT to be elevated?
Alcohol use
What drugs can raise Gamma GT levels?
NSAIDs
What do low levels of albumin suggest?
Chronic liver disease
Other than liver diseases, what else can cause low albumin levels?
Kidney disorders and malnutrition
What does prothrombin time tell?
Degree of liver dysfunction
What is prothrombin time used to calculate?
Scores to decide stage of liver disease, who needs a liver transplant and who gets a liver transplant
How does cirrhosis of the liver affect the spleen?
Causes splenomegaly
What is platelet count being low an indirect marker of?
Portal hypertension
What is the clinical presentation of the liver not working?
Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy
What is jaundice?
Yellowing of the skin, sclerae and other tissues caused by excess circulating bilirubin
When is jaundice detectable?
When total plasma bilirubin levels exceed 34umol/L
What are the different classifications of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
What can cause pre-hepatic jaundice?
Increased quantity of bilirubin (haemolysis)
Impaired transport
What can cause hepatic jaundice?
Defective uptake of bilirubin
Defective conjugation
Defective excretion
What can cause post-hepatic jaundice?
Defective transport of bilirubin by the biliary ducts
When is bilirubin unconjugated?
Before it arrives in the liver
What are clues from the history for pre-hepatic jaundice?
History of anaemic (fatigue, dyspnoea, chest pain)
Acholuric jaundice
What are clues from the history for hepatic jaundice?
Risk factors for liver disease (such as IVDU, drug intake)
Decompensation (ascites, variceal bleed, encephalopathy)