Jaundice and Chronic Liver Disease Flashcards
what does the liver synthesise?
> clotting factors >bile acids > carbohydrates > proteins > lipids > hormones
in what way is liver involved in detoxification?
> produces urea from ammonia
detoxifies drugs
metabolises bilirubin
breaks down insulin and hormones
what does the liver store?
> glycogen
vitamin A, D, B12 AND k
copper
iron
what is bilirubin generated by
> senescent RBC’s in spleen
why may bilirubin levels be elevated?
> haemolysis
parenchymal damage
obstruction
what is bilirubin initially bound to?
albumin
what are amino transferases?
enzymes present in hepatocytes
where is alkaline phosphatase present?
> bile ducts
bone
placenta
intestines
with what is alkaline phosphatase elevated?
obstruction or liver infiltration
what can elevate gamma GT levels?
> alcohol use
> NSAID’s
what does albumin test for?
synthetic function of the liver
what do low albumin levels suggest?
> chronic liver disease
kidney disorders
malnutrition
what does prothrombin time test tell you?
the degree of liver dysfunction
what tests are carried out to assess transplant need?
> prothrombin time
creatinine
what is platelet count an indirect marker for?
portal hypertension
why would platelet count by low in cirrhotic patients?
cirrhosis results in splenomegaly and platelet counts are low due to hypersplenism
what are general symptoms of liver failure?
> jaundice
ascites
variceal bleeding
hepatic encephalopathy
define jaundice
yellowing of the skin, sclerae and other tissues due to excess circulating bilirubin
at what total plasma bilirubin level is jaundice detectable?
levels exceeding 34 umol/L
what is the differential diagnosis for jaundice?
carotenemia
what could cause pre-hepatic jaundice?
> Increased quantity of bilirubin (Haemolysis)
> Impaired transport
what are the reasons for hepatic jaundice?
> Defective uptake of bilirubin
Defective conjugation
Defective excretion
what classification of jaundice is caused by defective transport of bilirubin by the biliary ducts?
post hepatic jaundice
what would be the history of prehepatic jaundice?
> anaemia (fatigue, dyspnoea, chest pain)
> acholuric jaundice