Jaundice and LFTs Flashcards
things that the liver makes
clotting factors bile acids glucose albumin cholesterol TAG angiotensin IGF
the liver neutralizes and destroys all ___
drugs and toxins
things stored in liver
glycogen, vits A, B12, D and K, copper and iron
8 LFTs
bilirubin aminotransferases alkaline phosphatase gamma GT albumin prothrombin time creatinine platelet count
relevance of bilirubin levels to liver function
bile pigment formed by liver from breakdown products of Hb. Elevated in liver damage
what is haemolysis
breakdown of RBCs
where is bilirubin made
the spleen
how is the liver involved in bilirubin production
it conjugates it (solubises it)
what condition is caused by raised bilirubin
jaundice
how does liver damage cause elevated bilirubin
liver isn’t clearing bilirubin from blood effectively to excrete it
how does haemolysis cause raised bilirubin
excess breakdown of Hb means more bilirubin made
what state is bilirubin in before it reaches the liver
unconjugated - bound to albumin
what is an aminotransferase
enzyme in hepatocytes: important for formation of amino acids from keto-acids
what conditions are aminotransferases raised in
hepatocellular disease and viral hepatits
alkaline phosphatase test
enzyme in bile ducts that is raised in obstruction of liver infiltratino
gamma GT
enzyme often tested along with alkaline phosphatase to confirm the liver is the source
why do gamma GT along with alkaline phosphatase
because alkaline phosphatase is present outside liver so doing gamma GT confirms the liver as the source
what kind of people is alkaline phosphatase often raised in
pregnant women
lifestyle causes of raised gamma GT
alcohol abuse and NSAIDs
what result of albumin would be most concerning
low - indicates chronic liver disease
what non liver condition can albumin be low in
kidney disease
relevance of prothrombin time in liver
liver produces coagulation factors so the time it takes to make prothrombin into thrombin tells the degree of liver dysfunction
when is prothrombin time used
to determine the stage of liver disease
what vitamin is important for clotting and is stored by the liver
vitamin K
what hepatovascular disease is platelet count an indirect marker of
portal hypertension
what is jaundice
yellow skin and sclera caused by excess circulating bilirubin
how can jaundice be distinguished from carotenemia
carotenemia has no yellowing of the sclera
3 classifications of jaundice
pre-hepatic
hepatic
post-hepatic
pre-hepatic jaundice has elevated conjugated/unconjugated bilirubin
unconjugated bilirubin
organ of issue in haemolysis
spleen
ways in which liver can raise bilirubin
defective uptake, conjugation and excretion
3 hepatic causes of jaundice
intra-hepatic bile duct obstruction
cholestasis
hepatitis
3 post-hepatic cause of jaundice
cholelithiasis
gall bladder disease
extra-hepatic duct obstruction
stool findings of post-hepatic jaundice
pale, fatty stool from lack of bile (bilirubin) leaving liver
urine in post-hepatic jaundice
dark coloured - excess bilirubin excretion
why do you get gynaecomastia and spider naevi in liver disease
failure of the liver to break down oestrogen
which type of jaundice cause would you find spider naevi and gynaecomastia in
hepatic
in which type of jaundice is the urine pale ad what is this known as
pre-hepatic - acholuric jaundice
pathology of pre-hepatic jaundice
excess breakdown of Hb
why is urine pale in pre-hepatic jaundice
the excess bilirubin is unconjugated and water insoluble. It therefore is not excreted into urine
if haemolysis jaundice is the excess breakdown of RBCs and Hb what other condition might it result in
anaemia
what is asterixis
flapping tremor
investigations in jaundice
LFTs
ultrasound
hep B and C serology
what LFT is raised in viral hepatitis
aminotransferases
what LFT is raised in alcohol abuse or cholestasis
gamma GT
what is ERCP
endoscopic retrograde cholangioprancreatomoy
when is ERCP commonly used therapeutically
to open up sphincter of Oddi, to remove stones or tumour
imaging of biliary tree
percutaneous transhepatic cholangiogram (PTC)
endoscopic ultrasound
