Learning Objectives (Non-CLIC) Flashcards
What are the synthetic Functions of Healthy Liver?
▪ Conjugation + elimination of bilirubin ▪ Synthesis of albumin ▪ Synthesis of clotting factors ▪ Gluconeogenesis ▪ Glycogen storage ▪ Production of bile - needed to digest fat, and absorb vitamin A, D, E and K.
What are LFT’s used for?
- Confirm clinical suspicion
* Differentiate between hepatocellular and cholestasis/post-hepatic/obstructive
Which of the LFT’s are used to differentiate between Hepatocellular and cholestasis?
- ALT (High concentrations in Hepatocytes)
- AST
- ALP (High concentrations in liver, bile duct, and bone tissues - produced as a response to cholestasis - indirect marker)
- GGT
Which of the LFT’s are used to assess liver synthetic function?
• Albumin
• Bilirubin
• Prothrombin Time
(Also check serum glucose as one function of gluconeogenesis - the production of glucose from non-carbohydrates)
What proportion of ALT to ALP indicates likelihood of hepatocellular injury?
• Greater than 10 fold increase in ALT with Lower than 3 fold increase in ALP
What proportion of ALT to ALP indicates likelihood of cholestasis?
• Lower than 10 fold increase in ALT with Higher than 3 fold increase in ALP
List reasons to why GGT might be raised in a patient.
▪ Biliary obstruction/epithelial damage
▪ Alcohol
▪ Drugs (phenytoin)
Raised ALP with raised GGT is highly suggestive of obstruction. What can raised ALP alone be indicative of?
▪ Bony metastases / primary bone tumours
▪ Vitamin D deficiency
▪ Recent bone fracture
▪ Renal Osteodystrophy
What would an ALT>AST ratio indicate in relation to liver disease?
▪ Chronic Liver Disease
What ratio of ALT to AST would cirrhosis or acute alcoholic hepatitis show?
▪ AST>ALT
List three reasons why there might be a drop in Albumin levels?
▪ Decreased production due to liver disease
▪ Inflammation triggering acute phase response
▪ Loss (e.g nephrotic syndrome)
What other screening would you do for liver?
▪ Ferritin (haemochromatosis)
▪ Anti0mitochondrial Antibody (AMA) - primary biliary cirrhosis (cholangitis)
▪ Viruses in the blood (hepatitis etc…)
What is the definition of an addiction?
addictions are chronic conditions ‘resulting in a powerful motivation to engage in a given behaviour with a significant potential for harm’
What is the most prevalent addiction in the world?
Alcohol
A) Name a psychological model that is used to understand addiction
B) Describe this model
A) The PRIME model
B)
- there is an internal and external influences/elements. Dysfunction in any of these elements can contribute to the addiction.
▪ The Internal Environment has 5 element (PRIME): ○ Plans (Malfunction = the person cannot create effective plan to quit the addiction, or they cannot retrieve the plan from their memory etc.. So less likely to quit) ○ Evaluations (Malfunction = the person views the information or memory of doing the drug in a biased manner - so they will have this unrealistic belief that when they drank their problems got solved) ○ Motives (Malfunction = powerful urges to take part due to previous experiences - motivations are affected by the good times when they were on it, and the bad feelings when they didn’t have it) ○ Impulses (Malfunction = there is a strong association between certain cues and taking part in the addictive behaviour - for example they are used to smoking after they have their dinner, so every time they have their dinner there is a strong urge to smoke which may make them relapse) ○ Response
PRIME is now the chosen theory and model through which addiction is considered. Name other models that are used understand addiction.
▪ Temperance - drug is dangerous and causes the problem. Moderation is not the answer, the answer is total prohibition. Once you start using you cannot stop.
▪ Moral - this model states that it is the person who decides whether to use or not. Biology doesn’t matter. If they use it’s a reflection of their weak character. And its their social and religious norms that dictate all this. This model is now rejected.
▪ Disease - this one states that certain people have physiological process where if they use it leads to loss of control. So here its completely based on the biological factor, it’s a disease!
▪ Medical - this is similar to disease model. There is a number of physiological factors which put a certain individual at risk of addiction. Again very biology based.
▪ Psychodynamic - misuse is primarily related to psychodynamic facotrs such as early childhood experiences of trauma. They need psychotherapy
▪ Socio-cultural - Its not biology, or individual experiences, but there is sociocultural factors which increase likelihood of addiction. If you address these you can solve the problem.
▪ Systems and families - the use of alcohol and other drugs should be considered in the light of the relationships that the individual has with their family, and other social circle elements. So in order to change the behaviour, those relationships have to be healthy… so its not about the person, but about the relationships that person has with everyone around them.
▪ Learning theory - using and drinking are learnt behaviours… if you can learn something you can unlearn it.
List the DSM-5 criteria scores for the following Substance Use Disorders Categories:
1) Mild
2) Moderate
3) Severe
1) 2-3
2) 4-5
3) >6
Define Dependence.
Altered physiological state induced by long-term drug exposure that leads to a withdrawal syndrome on cessation of drug administration
Define Tolerance.
A state of reduced responsiveness to the effects of a drug caused by previous administration of the drug. The repeated administration means that more is required for the same effects.
Define Withdrawal.
▪ Physical withdrawals - can be fatal particularly in alcohol, seizures, death
▪ Psychological withdrawal state of anhedonia, characterised by dysphoria, irritability, emotional distress
List the viruses that are associated with hepatitis.
▪ Hepatitis viruses (Hepatitis A, B, C, D, E, G)
▪ Cytomegalovirus
▪ Epstein-Barr Virus
▪ Herpesviruses (mostly in immunosuppressed)
▪ Other: yellow fever virus, dengue virus
• Discuss the global disease burden of Viral Hepatitis
▪ 1.34 million deaths globally in 2015
▪ Hep B and C prevalent all over the world but mainly in Africa and Asia
▪ Hep C most prevalent in Europe
▪ Hep E rare in Europe and more prevalent in Africa and Asia
Explain the epidemiology of Hepatitis A?
▪ High risk in developing countries where there is poor sanitation, hence faeces, contaminated foods, and water are sources of infection
A) Name 5 of the constitutional symptoms that may precede symptoms and signs of liver dysfunction in a patient with hepatitis.
B) Name symptoms of liver dysfunction in hepatitis.
A) ▪ Anorexia ▪ Flu-like symptoms ▪ Fatigue ▪ Malaise ▪ Headache
B) ▪ Jaundice ▪ Dark Urine ▪ Abdominal Pain ▪ Enlarged/tender Liver
What can LFT’s show in regards of hepatitis.
▪ Whether it is chronic or acute
State the incubation periods for Hep A, B, C, E.
▪ Hep A: 28 days (15-50d)
▪ Hep B: 3 months (can be up to 6 months in some patients - becomes chronic in 5%)
▪ Hep C: 45 days (up to 6 months possible - 70% chronic)
▪ Hep E: 40 days
A) What are some of the most common routes of transmission of Hepatitis B.
B) Risk Factors.
A)
▪ Heterosexual transmission
▪ Nosocomial (infection originating in a hospital)
▪ Mother-to-child transmission
B)
▪ IV Drug Use/shared needles
▪ Unprotected sex (especially multiple sexual partners, sex with someone from a high risk area, men who have sex with men)
▪ Infant born to an infected mother
