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gi - pathology > Jaundice and LFTs > Flashcards

Jaundice and LFTs Flashcards

1
Q

things that the liver makes

A 
clotting factors
bile acids
glucose
albumin
cholesterol
TAG
angiotensin
IGF
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2
Q

the liver neutralizes and destroys all ___

A

drugs and toxins

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3
Q

things stored in liver

A

glycogen, vits A, B12, D and K, copper and iron

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4
Q

8 LFTs

A 
bilirubin
aminotransferases
alkaline phosphatase
gamma GT
albumin
prothrombin time
creatinine
platelet count
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5
Q

relevance of bilirubin levels to liver function

A

bile pigment formed by liver from breakdown products of Hb. Elevated in liver damage

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6
Q

what is haemolysis

A

breakdown of RBCs

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7
Q

where is bilirubin made

A

the spleen

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8
Q

how is the liver involved in bilirubin production

A

it conjugates it (solubises it)

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9
Q

what condition is caused by raised bilirubin

A

jaundice

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10
Q

how does liver damage cause elevated bilirubin

A

liver isn’t clearing bilirubin from blood effectively to excrete it

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11
Q

how does haemolysis cause raised bilirubin

A

excess breakdown of Hb means more bilirubin made

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12
Q

what state is bilirubin in before it reaches the liver

A

unconjugated - bound to albumin

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13
Q

what is an aminotransferase

A

enzyme in hepatocytes: important for formation of amino acids from keto-acids

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14
Q

what conditions are aminotransferases raised in

A

hepatocellular disease and viral hepatits

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15
Q

alkaline phosphatase test

A

enzyme in bile ducts that is raised in obstruction of liver infiltratino

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16
Q

gamma GT

A

enzyme often tested along with alkaline phosphatase to confirm the liver is the source

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17
Q

why do gamma GT along with alkaline phosphatase

A

because alkaline phosphatase is present outside liver so doing gamma GT confirms the liver as the source

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18
Q

what kind of people is alkaline phosphatase often raised in

A

pregnant women

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19
Q

lifestyle causes of raised gamma GT

A

alcohol abuse and NSAIDs

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20
Q

what result of albumin would be most concerning

A

low - indicates chronic liver disease

21
Q

what non liver condition can albumin be low in

A

kidney disease

22
Q

relevance of prothrombin time in liver

A

liver produces coagulation factors so the time it takes to make prothrombin into thrombin tells the degree of liver dysfunction

23
Q

when is prothrombin time used

A

to determine the stage of liver disease

24
Q

what vitamin is important for clotting and is stored by the liver

A

vitamin K

25
Q

what hepatovascular disease is platelet count an indirect marker of

A

portal hypertension

26
Q

what is jaundice

A

yellow skin and sclera caused by excess circulating bilirubin

27
Q

how can jaundice be distinguished from carotenemia

A

carotenemia has no yellowing of the sclera

28
Q

3 classifications of jaundice

A

pre-hepatic
hepatic
post-hepatic

29
Q

pre-hepatic jaundice has elevated conjugated/unconjugated bilirubin

A

unconjugated bilirubin

30
Q

organ of issue in haemolysis

A

spleen

31
Q

ways in which liver can raise bilirubin

A

defective uptake, conjugation and excretion

32
Q

3 hepatic causes of jaundice

A

intra-hepatic bile duct obstruction
cholestasis
hepatitis

33
Q

3 post-hepatic cause of jaundice

A

cholelithiasis
gall bladder disease
extra-hepatic duct obstruction

34
Q

stool findings of post-hepatic jaundice

A

pale, fatty stool from lack of bile (bilirubin) leaving liver

35
Q

urine in post-hepatic jaundice

A

dark coloured - excess bilirubin excretion

36
Q

why do you get gynaecomastia and spider naevi in liver disease

A

failure of the liver to break down oestrogen

37
Q

which type of jaundice cause would you find spider naevi and gynaecomastia in

A

hepatic

38
Q

in which type of jaundice is the urine pale ad what is this known as

A

pre-hepatic - acholuric jaundice

39
Q

pathology of pre-hepatic jaundice

A

excess breakdown of Hb

40
Q

why is urine pale in pre-hepatic jaundice

A

the excess bilirubin is unconjugated and water insoluble. It therefore is not excreted into urine

41
Q

if haemolysis jaundice is the excess breakdown of RBCs and Hb what other condition might it result in

A

anaemia

42
Q

what is asterixis

A

flapping tremor

43
Q

investigations in jaundice

A

LFTs
ultrasound
hep B and C serology

44
Q

what LFT is raised in viral hepatitis

A

aminotransferases

45
Q

what LFT is raised in alcohol abuse or cholestasis

A

gamma GT

46
Q

what is ERCP

A

endoscopic retrograde cholangioprancreatomoy

47
Q

when is ERCP commonly used therapeutically

A

to open up sphincter of Oddi, to remove stones or tumour

48
Q

imaging of biliary tree

A

percutaneous transhepatic cholangiogram (PTC)

endoscopic ultrasound

gi - pathology (23 decks)

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