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Year 4: General Surgery + GI > Jaundice + LFTs > Flashcards

Jaundice + LFTs Flashcards

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1
Q

what blood tests are taken to measure liver function

A 
Bilirubin 
Albumin 
Prothrombin Time (PT)
ALP (alkaline phosphatase) 
AST + ALT
GGT
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2
Q

which LFTs measure the livers synthetic function

A

Bilirubin, Albumin, PT

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3
Q

which LFTs demonstrate hepatocellular damage

A

AST + ALT

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4
Q

which LFT is significantly raised in cholestasis

A

ALP

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5
Q

what is bilirubin

A

a normal breakdown product of Haem metabolism

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6
Q

where is bilirubin conjugated

A

the liver

- then excreted via bile into GI tract

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7
Q

what happens to bilirubin that is excreted into GI tract

A

majority egested in faeces as urobilinogen + stercobilin (colours faeces)
roughly 10% is reaborbed into bloodstream + excreted by kidneys

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8
Q

what is jaundice

A

the yellow discolouration of the sclera / skin as a result of hyperbilirubinaemia

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9
Q

what are the three types of jaundice

A

pre-hepatic
hepatic
post-hepatic

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10
Q

what is the mechanism of pre-hepatic jaundice

A

excessive red blood cell breakdown

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11
Q

LFT results pre-hepatic jaundice

A

isolated rise in bilirubin

  • bilirubin is unconjugated as has not undergone conjugation in liver
  • normal AST, ALT, ALP
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12
Q

causes of pre-hepatic jaundice

A

Gilberts syndrome

Haemolytic anaemia

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13
Q

what is Gilberts syndrome

A

autosomal recessive condition causing defective bilirubin conjugation

  • deficiency of UDP glucuronosyltransferase
  • jaundice during illness, fasting, exercise
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14
Q

LFTs in Gilberts syndrome

A

isolated rise unconjugated bilirubin

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15
Q

what is the mechanism of hepatic jaundice

A

dysfunction of hepatic cells

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16
Q

causes of hepatic jaundice

A 
alcoholic liver disease
viral hepatitis
autoimmune hepatitis 
medications
haemochromatosis 
hepatocellular carcinoma 
primary sclerosis cholangitis
primary biliary cirrhosis
17
Q

LFT results in hepatic jaundice

A 
raised bilirubin (unconjugated + conjugated)
a greater raised ALT/AST than ALP
18
Q

what is the mechanism of post-hepatic jaundice

A

obstruction of biliary drainage – cholestasis

19
Q

causes of post-hepatic jaundice

A

intraluminal - gallstones

mural - cholangiocarcinoma, strictures

extra-mural- pancreatic cancer, lymphoma

20
Q

LFT results in post-hepatic jaundice

A 
raised bilirubin (conjugated)
a greater rise in ALP than ALT/AST
21
Q

normal colour of urine + stools suggests which type of jaundice

A

pre-hepatic

22
Q

dark urine + normal colour stools suggests which type of jaundice

A

hepatic

23
Q

dark urine + pale stools suggests which type of jaundice

A

post-hepatic

24
Q

what can cause an isolated GGT rise

A

alcohol
phenytoin

(raised GGT + markedly raised ALP = cholestasis)

25
Q

what can cause an isolated rise in ALP

A

anything that leads to increased bone breakdown:

  • bony mets / primary bone tumour
  • vit D deficiency
  • recent bone fractures
  • renal osteodystrophy
26
Q

what are the main synthetic functions of the liver

A

conjugation + elimination of bilirubin
synthesis of albumin
synthesis of clotting factors
Gluconeogenesis

27
Q

how can the synthetic function of the liver be assessed

A

by measuring:

  • serum bilirubin
  • serum albumin
  • PT time
  • blood glucose
28
Q

what is the function of albumin

A

helps to bind water, cations, fatty acids and bilirubin

29
Q

what can cause low albumin

A

liver disease, e.g. cirrhosis, causing low levels to be produced
nephrotic syndrome
acute inflammation that causes suppression of livers production

30
Q

what can cause a high albumin

A

dehydration

31
Q

how does liver dysfunction affect PT time

A

causes increased PT time due to impaired synthesis of clotting factors

32
Q

common causes of acute hepatocellular injury

A

poisoning – paracetamol overdose
infection – hepatitis A + B
liver ischaemia

33
Q

what is cholestatic pruritis

A

generalised itch that occurs with post hepatic jaundice

  • accumulation of bile salts below skin causes inflammatory response
  • often worse at night + exacerbated by heat
  • no sin lesions
34
Q

tx of cholestatic pruritis

A

mild - topical menthol cream

mod/severe - cholestyramine

Year 4: General Surgery + GI (13 decks)

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