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MD4003 > LFT's > Flashcards

LFT's Flashcards

1
Q

What are Kupffer cells?

A

Phagocytic macrophages

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2
Q

What are the 4 metabolic functions of the liver?

A
  1. Carbohydrates
  2. Hormones
  3. Lipids
  4. Drugs
  5. Proteins
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3
Q

What 3 things does the liver store?

A
  1. Glycogen
  2. Vitamins
  3. Iron
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4
Q

What are the 2 protective functions of the liver?

A
  1. Detoxification and elimination of toxic compounds

2. Kupffer cells ingest bacteria & other foreign material from blood

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5
Q

List the 7 classifications of liver disease?

A
  1. Infection- Viral (Hepatitis A-E, CMV), bacterial, parasitic
  2. Toxic/Drug induced
  3. Autoimmune
  4. Biliary tract obstruction-Tumours, gallstones
  5. Vascular
  6. Metabolic- haemochromatosis, Wilson’s, hereditory hyperbilirubinaemias
  7. Neoplastic
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6
Q

What is Cholestasis?

A

Failure to produce or excrete bile

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7
Q

What is Intrahepatic cholestasis?

A

Problems in secretion of bile by hepatocytes due to damage

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8
Q

What is Extrahepatic cholestasis?

A

Problems with flow of bile out of the liver due to obstruction

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9
Q

What does cholestasis result in?

A
  • Accumulation of (conjugated) bilirubin in the blood leading to Jaundice
  • Urine darkens and stool lightens
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10
Q

What can Jaundice also be due to?

A

Excessive haemolysis- bilirubin is unconjugated and does not appear in the urine

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11
Q

What is acute hepatic failure?

A

Development of severe hepatic dysfunction within 24 wks of onset of disease

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12
Q

Give 3 examples of acute hepatitis causes?

A
  1. Poisoning (paracetamol)
  2. Infection (Hepatitis A-C)
  3. Inadequate perfusion
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13
Q

What are the 3 common causes of chronic liver disease?

A
  1. Alcoholic fatty liver
  2. Chronic active hepatitis
  3. Primary biliary cirrhosis
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14
Q

What are the 3 unusual causes of chronic liver disease?

A
  1. Alpha-1 AT deficiency
  2. Wilson’s disease
  3. Haemochromatosis
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15
Q

What are the 4 possible consequences of chronic liver disease?

A
  1. Cirrhosis
  2. Portal hypertension
  3. Ascites
  4. Renal failure
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16
Q

What can portal hypertension lead to?

A
  • Haemorrhage of oesophageal / gastric varices
  • Hepatic encephalopathy (detoxifying function bypassed)
  • Hypersplenism
  • Decreased resistance to infections
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17
Q

What are ascites?

A

Accumulation of fluid in the peritoneal cavity

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18
Q

What 4 things does liver failure result in?

A
  1. Inadequate synthesis of albumin
  2. Inadequate synthesis of clotting factors
  3. Inability to eliminate bilirubin
  4. Inability to eliminate nitrogenous waste
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19
Q

What is hepatic encephalopathy?

A

Poorly defined neuro-psychiatric disorder that occurs when products normally metabolised by the liver accumulate in the systemic circulation

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20
Q

How can ammonia accumulate in the systemic circulation?

A

Decreased liver capacity to synthesize urea and glutamine in liver failure means the ammonia is no longer adequately metabolised and accumulates in the systemic circulation

21
Q

List the 5 liver function tests?

A
  1. Aminotranferases (ALT & AST)
  2. Bilirubin
  3. ALP
  4. Gamma-GT
  5. Albumin
22
Q

What does Albumin show?

A

Liver synthetic function

23
Q

Under what 5 circumstances can albumin levels be low?

A
  1. Post-Surgical/ITU patients due to redistribution
  2. Significant malnutrition
  3. Nephrotic syndrome
  4. Burns
  5. Liver disease
24
Q

What is bilirubin?

A

Breakdown product of haemoglobin

25
Q

Describe the development and destruction of bilirubin?

A
  • Unconjugated & taken up by liver and conjugated
  • Conjugated bilirubin excreted in bile
  • Attacked by bacteria in colon and excreted in faeces
  • Small amounts reabsorbed & excreted in urine as urobilinogen
26
Q

What is AST & ALT enzymes a marker of?

A

Sensitive, non specific markers of acute damage to hepatocytes

27
Q

What is ALP enzyme a marker of?

A

Increased in liver disease due to increased synthesis in response to cholestasis

28
Q

What is gamma-GT enzyme a marker of?

A

Raised in cholestasis, also affected by ingestion of alcohol and drugs such as phenytoin

29
Q

Where else, other than the liver, is ALT found?

A
  • Cardiac muscle

- Erythrocytes

30
Q

Where else, other than the liver, is ALP found?

A
  • Bone
  • Gut
  • Placenta
31
Q

Where else, other than the liver, is gamma-GT found?

A
  • Bone
  • Biliary tract
  • Pancreas
  • Kidney
32
Q

When can bilirubin be increased in the asymptomatic patient?

A
  • Haemolysis

- Gilberts syndrome

33
Q

When can ALP be increased in the asymptomatic patient?

A
  • Pregnancy

- Adolescence

34
Q

When can AST be increased in the asymptomatic patient?

A
  • Skeletal muscle disorders

- MI

35
Q

When can gamma-GT be increased in the asymptomatic patient?

A
  • Alcohol

- Drugs

36
Q

Describe LFT’s in acute hepatocellular damage?

A
  • Bilirubin= RAISED
  • ALT= RAISED
  • ALP= NORMAL/ RAISED
  • Gamma-GT= NORMAL/ RAISED
37
Q

Describe LFT’s in chronic hepatocellular damage?

A
  • Bilirubin= NORMAL/ RAISED
  • ALT= NORMAL/ RAISED
  • ALP= NORMAL/ RAISED
  • Gamma-GT= NORMAL/ RAISED
38
Q

Describe LFT’S in cholestasis?

A
  • Bilirubin= RAISED
  • ALT= RAISED
  • ALP= RAISED
  • Gamma-GT= RAISED
39
Q

What is the most common LFT result from acute cholecystitis?

A

Increased ALP

40
Q

What are the clinical signs of post-hepatic jaundice?

A

Dark urine & foul smelling pale stools which float

41
Q

What are the clinical signs of pre-hepatic jaundice?

A

Normal urine and stools

42
Q

What is the most important LFT change in hepatocellular jaundice?

A

Increased ALT

43
Q

What is the most important LFT change in cholestatic (obstructive) jaundice?

A

Increased ALP

44
Q

What are 4 possible causes of pre-hepatic jaundice?

A
  1. Haemolysis
  2. Haemolytic anaemia
  3. Rhabdomylosis
  4. Unconjugated bilirubinaemia
45
Q

What are 3 possible causes of intrahepatic cholestasis?

A
  1. Tumours
  2. Drugs
  3. Virus giving acute hepatocellular damage
46
Q

What are 3 possible causes of extra hepatic cholestasis?

A
  1. Gallstones
  2. Cancer of the head of pancreas
  3. Cancer of biliary tree
47
Q

If ALT>AST what does this indicate?

A

Chronic liver disease

48
Q

If AST>ALT what does this indicate?

A

Cirrhosis and acute alcoholic hepatitis

MD4003 (22 decks)

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