LFT teach

Question 1

ways you can classify liver disease

Answer 1

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)

Question 2

example of acute liver disease

Answer 2

infection hep-a

drugs and toxins –> paracetamol overdose, NSAIDs, tetracycline , sodium valproate, carbamazepine and phenytoin

vascular - obestuciton
metabolic - Wilsons disease

Question 3

example of chronic liver disease

Answer 3

infection - hep B and C
Drugs and toxins alcoholic liver disease , methotrexate and amiodarone

biliary cirhosis

haemochomatoisis
alpha 1 antitrpsin deficiency
autoimmune hepatiits

Question 4

biliary tree - what can block it

Answer 4

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

Question 5

ALT - alanine aminotransfrase - when is it raised

Answer 5

liver cell injury

this enzyme produced exclsuisvley in the liver and released into blood when hepatocytes die

Question 6

AST when is it raised

Answer 6

liver cell injury and renal and cardiac disease

produced in kidney and cardiac and skeletal muscle

Question 7

ALP

liver enzyme also found in bone and placenta when is it raised

Answer 7

biliary blockage

preg
pages disease - old man

Question 8

GT - gamma glytamyltransferase raised when

Answer 8

biliary blockage

high in drug and alcohol toxicity

not as useful

Question 9

bilirubin is a product of hb breakdown processed in the liver when is it raised

Answer 9

biliary blockage

or liver function processing bilirubin is shit

Question 10

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

Answer 10

advanced disease such as cirrhosis

Question 11

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

Answer 11

prothrombin time

Question 12

hepatocellular injury what could you see

Answer 12

raised ALT and AST - lots of hepatocytes dying at once

Question 13

hepatocellular injury what could you see

3 things

raised above than other

high

Answer 13

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

Question 14

Biliary obstruction what markers are raised and what the most

Answer 14

all raised

ALP
gamma GT
bilirubin

these 3 highest

Question 15

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

Answer 15

acute hepatocelleular injury

hepatitis

Question 16

what hepatitis

acute illness, resolves after few weeks , fever and sick, jaundice transmitted faecal oral route

Answer 16

hepatitis A

Question 17

the one that develops congenital infections and transmitted by sex what heapptis

Answer 17

B

Question 18

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

Answer 18

thinking hepatoceelualr injury
acute

paracetamol overdose

Question 19

paracetamol overdose commonest cause of acute liver failure in the UK - what is the treatment

Answer 19

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

Question 20

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

Answer 20

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

Question 21

cirrhosis investigations

Answer 21

LFTs , UandE, clotting screen, viral serology, ferritin and iron studs (haemochromatosis), autoantibodies and Igs, alpha fetoprotein ( marker for hepatoelluarl carcinoma ) , alpha 1 trypsin

Question 22

markers of downs

Answer 22

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.

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

primary biliary choalngitis

what condition is it associated with
what does it look like

and autoantibodies

Answer 25

associated with ulcerative colitis

stricter bile ducts - beaded appearance

antibodies are ANA, SMA and ANCA need live rtrnapolant tooo

Question 26

autoimmune hepatitis affects hepatocytes and presents with other autoimmune disorders what antibodies

management of this

Answer 26

ANA , ASA,

immunosuppreison needed

Question 27

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

Answer 27

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

Question 28

biliary colic

Answer 28

stones in gallbladder move into the neck or cystic duct - when gallbladder contracts that will cause inflammation/obstruction - after rfatty meals

Question 29

acute cholecystitis

Answer 29

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

Question 30

budd-chiari syndrome

Answer 30

hepatic venous outflow obstruction causing ischaemia.

triad of symptoms - abdomen pain, ascites and hepatomegaly

Question 31

haemochormatosis - excessive absorption of iron from digestive tract.

symptoms

treated with blood letting

Answer 31

high ferritin, bronze discolouration of the skin and hair loss and joint pain and progressive liver disease

treated with blood letting

Question 32

Wilsons disease

sumtpoms

treatment

Answer 32

copper accumulation - Parkinsonism , Kaiser fischler rings ( iris) and arrhymias - treated with copper shelters such as pencillamien