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Clinical Chemistry > L.8 Liver Disease > Flashcards

L.8 Liver Disease Flashcards

1
Q

What is jaundice?

A

Yellow discoloration of the skin and the sclera of the eyes due to hyperbilirubinemia

Jaundice occurs when there is an excess of bilirubin in the blood.

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2
Q

At what plasma bilirubin level is jaundice detectable?

A

Plasma bilirubin >50μmol/L

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3
Q

What are the three types of jaundice based on its determination?

A
  • Pre-hepatic
  • Hepatic
  • Post-hepatic
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4
Q

What causes pre-hepatic jaundice?

A
  • Increased bilirubin production (unconjugated)
  • Increased haemolysis
  • Decreased albumin
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5
Q

What are some causes of hepatic jaundice?

A
  • Failure of bilirubin conjugation e.g. Gilbert’s syndrome
  • Hepatitis
  • Malignancy
  • Cirrhosis
  • Drug interaction
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6
Q

What causes post-hepatic jaundice?

A
  • Gallstones
  • Malignancy
  • Pancreatitis
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7
Q

True or False: Hepatic jaundice is caused by increased bilirubin production.

A

False

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8
Q

Fill in the blank: Pre-hepatic jaundice is characterized by increased bilirubin production, which is __________.

A

unconjugated

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9
Q

Fill in the blank: Hepatic jaundice results from __________ of bilirubin conjugation.

A

failure

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10
Q

Fill in the blank: Post-hepatic jaundice is associated with decreased bilirubin __________.

A

excretion

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11
Q

What is Kernicterus?

A

Neonatal unconjugated hyperbilirubinemia brain damage

Kernicterus results from high levels of unconjugated bilirubin in neonates.

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12
Q

What is the primary cause of Kernicterus?

A

Immature liver function in neonates results in inefficient conversion of unconjugated bilirubin to conjugated form.

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13
Q

What happens if unconjugated bilirubin exceeds the binding capacity of albumin?

A

Free bilirubin circulates.

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14
Q

Can free bilirubin cross the blood-brain barrier?

A

Yes.

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15
Q

What effect does neurotoxic bilirubin have on neurons?

A

It causes neuronal cell death.

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16
Q

What bilirubin level indicates the need for phototherapy?

A

Bilirubin levels >200μmol/L.

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17
Q

What is the role of blue light in treating hyperbilirubinemia?

A

Blue light converts bilirubin to a water-soluble form.

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18
Q

What bilirubin level may require exchange transfusion?

A

Bilirubin >300μmol/L.

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19
Q

What is cholestasis?

A

A condition where bile cannot flow from the liver to the duodenum.

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20
Q

What are the two types of cholestasis?

A
  • Hepatocyte damage (intra-hepatic)
  • Obstruction of bile ducts (extra-hepatic)
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21
Q

What can cause intra-hepatic cholestasis?

A
  • Viral hepatitis
  • Autoimmune cholestasis
  • Intrahepatic cholestasis of pregnancy
  • Sepsis-associated liver injury
  • Drug-induced
  • Familial Intrahepatic cholestasis
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22
Q

What can cause extra-hepatic cholestasis?

A
  • Benign biliary tract pathology
  • Malignancies (biliary or pancreatic origin)
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23
Q

What are common symptoms of cholestasis?

A
  • Fatigue
  • Pruritus
  • Dark urine
  • Malabsorption of fat-soluble vitamins
  • Osteoporosis
  • Jaundice
24
Q

What causes pruritus in cholestasis?

A

Bile salts in the blood irritate PNS nerves.

25
How does cholestasis affect fat-soluble vitamins?
It causes malabsorption of fat-soluble vitamins.
26
What vitamin deficiency can lead to osteoporosis in cholestasis?
Vitamin D.
27
What stage of cholestasis is jaundice associated with?
Late stage.
28
What is the primary cause of gallstones?
Deposition of cholesterol or bilirubin in the gallbladder
29
What is a common cause of post-hepatic cholestasis?
Gallstones
30
Which type of gallstones is more common?
Cholesterol stones
31
What percentage of adults have gallstones?
1 in 10 adults
32
What proportion of those with gallstones develop symptoms?
Minority develop symptoms
33
About what fraction of individuals with gallstones will develop epigastric pain?
About 1/3
34
What are two treatment options for gallstones?
* Endoscopic removal of stones * Cholecystectomy (remove gallbladder)
35
What is a consequence of cholecystectomy?
Cannot concentrate bile
36
How does cholecystectomy affect fat absorption?
Affects fat absorption
37
What gastrointestinal issue can result from cholecystectomy?
Diarrhoea
38
What does total bilirubin confirm in jaundice?
Hyperbilirubinemia
39
What do unconjugated bilirubin fractions indicate?
Pre-hepatic or hepatic
40
What do conjugated bilirubin fractions indicate?
Hepatic or post-hepatic
41
What do elevated AST/ALT levels suggest?
Hepatocellular damage – hepatic
42
What do ALP/GGT levels indicate?
Cholestasis (hepatic or post-hepatic)
43
What may low albumin levels suggest?
Compromised synthesis (chronic damage)
44
What does prolonged PT indicate?
Compromised synthesis (acute damage)
45
What is acute hepatitis?
Acute inflammation of the liver ## Footnote Caused by viral hepatitis, non-viral infections, metabolic conditions, and toxicity.
46
What are the main causes of acute hepatitis?
* Viral hepatitis (A, B, C, D, E) * Non-Viral infections (e.g. brucella) * Metabolic conditions (e.g. Wilson’s disease, Alpha-1-antitrypsin deficiency) * Toxicity (e.g. drug-induced, environmental) ## Footnote Approximately 80% of cases are undiagnosed infections.
47
What are common symptoms of acute hepatitis?
Flu-like symptoms ## Footnote Symptoms may include fatigue, fever, and malaise.
48
What characterizes acute liver failure?
Severe liver dysfunction with encephalopathy and coagulopathy ## Footnote It occurs when the rate of hepatocyte death exceeds the regenerative capacity of the liver.
49
What are the signs of acute liver failure?
* INR >1.5 * Neurological dysfunction with any degree of hepatic encephalopathy * No prior evidence of liver disease * Disease course of <26 weeks ## Footnote These signs indicate critical liver dysfunction and the need for urgent medical attention.
50
What is the significance of total bilirubin in acute hepatitis?
May be elevated ## Footnote Elevated total bilirubin levels can indicate liver dysfunction.
51
What are the expected laboratory findings (LFTs) in acute hepatitis regarding AST/ALT?
Marked elevation in both ## Footnote AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are liver enzymes that indicate liver cell injury.
52
What is the expected level of albumin in acute hepatitis?
Within range ## Footnote Albumin levels may remain normal in the early stages of acute hepatitis.
53
What does a prolonged PT indicate in acute hepatitis?
May be a poor prognostic sign ## Footnote Prolonged prothrombin time (PT) indicates impaired liver function and can predict outcomes.
54
Fill in the blank: Acute liver disease can progress to acute liver failure when the rate of ______ exceeds the regenerative capacity of the liver.
hepatocyte death
55
True or False: Acute hepatitis is always caused by viral infections.
False ## Footnote Acute hepatitis can also result from non-viral infections, metabolic conditions, and toxicity.
56
What are the bilirubin fractions in acute hepatitis?
No clinical value ## Footnote The bilirubin fractions do not provide useful information in the context of acute hepatitis.
57
What is the typical duration of the disease course for acute liver failure?
<26 weeks ## Footnote This timeframe helps differentiate acute liver failure from chronic liver disease.

Clinical Chemistry (25 decks)

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