LFT teach Flashcards
ways you can classify liver disease
whether its acute or chronic
where the pathology is - hepatocellular level ( viral hepatitis are the hepatocytes being damaged) or biliary tree( are the bile ducts being blocked)
example of acute liver disease
infection hep-a
drugs and toxins –> paracetamol overdose, NSAIDs, tetracycline , sodium valproate, carbamazepine and phenytoin
vascular - obestuciton
metabolic - Wilsons disease
example of chronic liver disease
infection - hep B and C
Drugs and toxins alcoholic liver disease , methotrexate and amiodarone
biliary cirhosis
haemochomatoisis
alpha 1 antitrpsin deficiency
autoimmune hepatiits
biliary tree - what can block it
obstruction of bile ducts causing back flow of bile into the liver jaundice is then prominent feature. most commonly gallstones also scarred cirrhotic liver, tumours and cysts and injury
ALT - alanine aminotransfrase - when is it raised
liver cell injury
this enzyme produced exclsuisvley in the liver and released into blood when hepatocytes die
AST when is it raised
liver cell injury and renal and cardiac disease
produced in kidney and cardiac and skeletal muscle
ALP
liver enzyme also found in bone and placenta when is it raised
biliary blockage
preg
pages disease - old man
GT - gamma glytamyltransferase raised when
biliary blockage
high in drug and alcohol toxicity
not as useful
bilirubin is a product of hb breakdown processed in the liver when is it raised
biliary blockage
or liver function processing bilirubin is shit
albumin is a plasma protein synthesis in the liver A measure of synthetic liver function
when is it low
also in liver disease clotting factors may be low
advanced disease such as cirrhosis
dont forget about clotting factors as they are synthesised in the liver so if you have liver disease you may not produced then and you may bleed so what do you need to measure
prothrombin time
hepatocellular injury what could you see
raised ALT and AST - lots of hepatocytes dying at once
hepatocellular injury what could you see
3 things
raised above than other
high
raised ALT and AST - lots of hepatocytes dying at once
AST rise is greater than ALT - alcoholic liver disease - high gamma GT reflects this
rise in ALT greater than AST - non-alcoholic fatty liver disease
Biliary obstruction what markers are raised and what the most
all raised
ALP
gamma GT
bilirubin
these 3 highest
chemical engineer, malaise, anorexia and fever. normally fit and well but ill after retuning from India. Gp noticed he is jaundiced
really high AST and ALT
ALP and bilirubin raised
what condition as well
acute hepatocelleular injury
hepatitis
what hepatitis
acute illness, resolves after few weeks , fever and sick, jaundice transmitted faecal oral route
hepatitis A
the one that develops congenital infections and transmitted by sex what heapptis
B
acute raised more than chronic which is midl raised
raised AST and ALT very raised and ALP, GGT and bilirubin high albumin low
what are my thoughts
case is miranda brought into ED she has been vomiting and complaining of epigastric pain. jaundice and tender palpation of abdomen. broke up with boyfriend so depressed and withdrawn.
what is the condition
thinking hepatoceelualr injury
acute
paracetamol overdose
paracetamol overdose commonest cause of acute liver failure in the UK - what is the treatment
N-acetyl cysteine
however if presenting within hour of taking paracetoam give them activated charcoal which prevents paracetamol being arrived from the GI tract
if patient presents iwithin 4 hours of overdose treatment delayed because serum levels might not represent peak then treat with N-aceytl cysteine
bloke drinks too much after losing his job no what bilateral dupuytrens contracture and liver palpable 3cm below costal margin
AST raised more than ALT and GGT raised
ALP bilirubin and albumin normal
alohcolic liver disease diagnose obvs
what is the spectrum of this
steatosis - fatty liver - symptomatic - heavy drinkers
alcoholic hepatitis - inflammation of hepatocytes ,, jaundice and heaptocmegaly - prolonged pt and encephalopathy ( ammonia build up causing cerebral oedema)
alcoholic cirrhosis - scar tissue replaces healthy liver tissue and prevents the liver from working normally
cirrhosis investigations
LFTs , UandE, clotting screen, viral serology, ferritin and iron studs (haemochromatosis), autoantibodies and Igs, alpha fetoprotein ( marker for hepatoelluarl carcinoma ) , alpha 1 trypsin
markers of downs
The blood markers are pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin (free beta-hCG). The ultrasound marker is nuchal translucency (NT) thickness. In pregnancies with Down syndrome, PAPP-A tends to be low, and NT and hCG tend to be raised.
raised ALT more than AST
presents more hepatoceelualr injury as ALP and GGT are normal ( therefore not gonna be obstructive)
looking at chronic too as not that high
cse is bloke with type 2 diabetes with elevated cholesterol, measure baseline Lfts , onE normal
what is going on
non-alcoholic fatty liver disease - - fibrosis and hepatic steatosis, steatohepatitis, and most people with type 2 diabetes.
risk factors are obesity and T2DM
may be completely asymptomatic depending on the disease stage therefore diagnosis may be made form incidental findings
case 5
GGT and ALP high so looking at some sort of obstructive cause
case is woman with progressive history of tiredness and pruritus. vitiligo and RA in remission. Has bilateral zanthelsma and palmar erythema . enlarged liver
antimicrobial antibody comes back positive what are we looking at here
primary biliary cirrhosis
destruction of small interlobular bile ducts by chronic grnulomatoru inflammation. bile ducts destroyed by autoimmune becomes scarred and cirrhosed.
signs include mention as well as RUQ pain and osteoposiris
AMA antibodies
liver transplant is the management of this
primary biliary choalngitis
what condition is it associated with
what does it look like
and autoantibodies
associated with ulcerative colitis
stricter bile ducts - beaded appearance
antibodies are ANA, SMA and ANCA need live rtrnapolant tooo
autoimmune hepatitis affects hepatocytes and presents with other autoimmune disorders what antibodies
management of this
ANA , ASA,
immunosuppreison needed
raised GGT and ALP so thinking obstruction
raised bilirubin
artist presenting with RUQ and jaundice and stools are light and urine darker than usual. high temp and pain, raised BP and mild tenderness. Murphys sign is positive too
what is the diangosis
main cause
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
Charcots triad
ascending cholangitis - inflammation of the biliary tree caused by bacteria ascending from the duodenum through a partially obstructed bile duct lead to gram negative sepsis.
E.coli
charcots triad - RUQ , fever and jaundice
Reynolds pentad with low Bp and confusion
stools light/pale stools ( no bile pigments) and urine darker colour
MRCP used
need ERCP
obstruction normally in cystic duct
biliary colic
stones in gallbladder move into the neck or cystic duct - when gallbladder contracts that will cause inflammation/obstruction - after rfatty meals
acute cholecystitis
obstruction of cystic duct leading to inflammation of gallbladder and you can have Murphy signs and raised CRP and increased white cell count , LFTs not usually deranged.
cholescystosotmy
budd-chiari syndrome
hepatic venous outflow obstruction causing ischaemia.
triad of symptoms - abdomen pain, ascites and hepatomegaly
haemochormatosis - excessive absorption of iron from digestive tract.
symptoms
treated with blood letting
high ferritin, bronze discolouration of the skin and hair loss and joint pain and progressive liver disease
treated with blood letting
Wilsons disease
sumtpoms
treatment
copper accumulation - Parkinsonism , Kaiser fischler rings ( iris) and arrhymias - treated with copper shelters such as pencillamien
