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Residency Exam > LFT Tutorial June 28th 2023 > Flashcards

LFT Tutorial June 28th 2023 Flashcards

1
Q

What is a major limitation of albumin as a marker of liver function?

A

It is usually more related to the protein content in the patient’s diet than their liver’s functional capacity

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2
Q

What is a major limitation of clotting tests as a marker of liver function?

A

They are very difficult to interpret if a patient is on an anticoagulant

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3
Q

What are the two main markers of synthesis by the liver?

A
  1. Albumin
  2. INR
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4
Q

Describe the interpretation of LFTs in the presence of synthetic dysfunction

A

Once there is synthetic dysfunction of the liver, liver enzymes are of little use as the function has lost many of the enzymes

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5
Q

What is the Childs-Pugh score indicative of most severe damage?

A

C15

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6
Q

What are the 5 determinants of a Childs-Pugh score?

A

ABCDE
1. Albumin
2. Bilirubin
3. Coagulation Tests (prothrombin time/INR)
4. Distention (ascites)
5. Encephalopathy

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7
Q

What is Wilson’s disease?

A

An accumulation of copper occuring in the liver and the brain as a result of impaired excretion in the bile

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8
Q

What are 4 symptoms of Wilson’s disease?

A
  1. Jaundice-like symptoms
  2. CNS symptoms
  3. Liver cirrhosis
  4. Death
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9
Q

What are 4 symptoms of Wilson’s disease?

A
  1. Jaundice-like symptoms
  2. CNS symptoms
  3. Liver cirrhosis
  4. Death
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10
Q

What are two functions of copper?

A

It is an important factor in iron metabolism and the formation of connective tissue

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11
Q

What are 4 symptoms of Wilson’s disease?

A
  1. Jaundice-like symptoms
  2. CNS symptoms
  3. Liver cirrhosis
  4. Death
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12
Q

Where is two-thirds of the body’s copper supply found?

A

In the skeleton and muscles

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13
Q

What are two functions of copper?

A

It is an important factor in iron metabolism and the formation of connective tissue

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14
Q

What form does copper primarily take in the blood?

A

About 95% of copper in the blood is bound to ceruloplasmin

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15
Q

Where is two-thirds of the body’s copper supply found?

A

In the skeleton and muscles

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16
Q

What form does copper primarily take in the blood?

A

About 95% of copper in the blood is bound to ceruloplasmin

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17
Q

How is most copper excreted?

A

In the bile

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18
Q

What is Menke’s Disease?

A

Copper deficiency

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19
Q

What are the main complications of Menke’s Disease?

A

Impaired development of the brain, skin/hair, and bones

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20
Q

What is alpha 1-antitrypsin?

A

A protein produced in the liver, released into the blood to inhibit several enzymes (but especially elastin and elastase in the lung)

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21
Q

What is alpha 1-antitrypsin?

A

A protein produced in the liver, released into the blood to inhibit several enzymes (but especially elastin and elastase in the lung)

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22
Q

What is the usual function of alpha-fetoprotein (AFP) in the foetus?

A

It functions as a transport protein and helps to regulate oncotic pressure

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23
Q

What is the usual function of alpha-fetoprotein (AFP) in the foetus?

A

It functions as a transport protein and helps to regulate oncotic pressure

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24
Q

What is alpha 1-antitrypsin?

A

A protein produced in the liver, released into the blood to inhibit several enzymes (but especially elastin and elastase in the lung)

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25
Q

What is alpha-fetoprotein (AFP)?

A

A protein synthesised by the fetal liver, which re-expresses in certain types of tumours

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26
Q

What is the usual magnitude of GGT elevation due to induction from chronic ethanol intake?

A

200 to 400 U/L

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27
Q

What is a common cause of hepatocellular damage in young, otherwise healthy patients?

A

Viral hepatitis

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28
Q

What are two common complications of alpha 1-antitrypsin deficiency?

A

Chronic lung diseases and liver damage

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29
Q

What is alpha-fetoprotein (AFP)?

A

A protein synthesised by the fetal liver, which re-expresses in certain types of tumours

30
Q

What is alpha-fetoprotein (AFP)?

A

A protein synthesised by the fetal liver, which re-expresses in certain types of tumours

31
Q

Where is LDH found?

A

In the blood, heart, kidneys, brain and lungs

32
Q

What is the usual function of alpha-fetoprotein (AFP) in the foetus?

A

It functions as a transport protein and helps to regulate oncotic pressure

33
Q

Where is LDH found?

A

In the blood, heart, kidneys, brain and lungs

34
Q

How are alpha-fetoprotein (AFP) levels used in practice?

A

They are used to diagnose hepatocellular carcinoma and germ cell tumors (testes, ovaries)

35
Q

Where is ALT predominantly found?

A

In the liver

36
Q

Where is AST found?

A

In the heart, liver, kidneys and muscles

37
Q

What is the general threshold for paracetamol poisoning?

A

A single dose of 100 milligrams per kilogram

38
Q

What are 3 symptoms of hypercalcaemia?

A

Abdominal pain, thirst and polyuria

39
Q

Where is LDH found?

A

In the blood, heart, kidneys, brain and lungs

40
Q

What are 3 symptoms of hypercalcaemia?

A

Abdominal pain, thirst and polyuria

41
Q

What should you assume if you see AST and LDH elevated, but other LFTs normal?

A

Myocardial infarction

42
Q

What is a common cause of hepatocellular damage in young, otherwise healthy patients?

A

Viral hepatitis

43
Q

How do you know when ethanol has caused hepatocellular damage?

A

ALT begins to rise as well as the GGT (usually after the GGT has reached 250-400 U/L)

44
Q

What is the usual magnitude of GGT elevation due to induction from chronic ethanol intake?

A

200 to 400 U/L

45
Q

How do you know when ethanol has caused hepatocellular damage?

A

ALT begins to rise as well as the GGT (usually after the GGT has reached 250-400 U/L)

46
Q

Is isolated elevation of GGT secondary to induction grounds to hold or cease a drug?

A

No

47
Q

Describe the typical pattern of liver injury caused by flucloxacilin

A

It typically causes a cholestatic pattern, particularly in older patients and with extended therapy (i.e. over 2 weeks)

48
Q

If ALP is elevated in isolation, what is this typically indicative of?

A

Bone damage

49
Q

What does icteric mean?

A

Itchy

50
Q

What is the most common cause of cholestasis?

A

Gallstones

51
Q

What is the typical pattern of liver damage seen in paracetamol poisoning?

A

Extensive hepatocellular damage, which eventually causes secondary cholestasis

52
Q

What is the typical pattern of liver damage seen in paracetamol poisoning?

A

Extensive hepatocellular damage, which eventually causes secondary cholestasis

53
Q

What is the general threshold for paracetamol poisoning?

A

A single dose of 100 milligrams per kilogram

54
Q

What are 3 symptoms of hypercalcaemia?

A

Abdominal pain, thirst and polyuria

55
Q

What are the 2 main causes of hypercalcaemia?

A

Malignancy and primary hyperparathyroidism

56
Q

Where is most calcium in the body?

A

Within bones

57
Q

How do bones behave in maintaining calcium homeostasis?

A

The bones could be totally osteoporitic, but would still continue to dissolve to increase the calcium concentration in the blood

58
Q

What is a common cause of hyponatraemia in patients with liver disease?

A

Dilutional hyponatraemia secondary to ascites

59
Q

How does hyperparathyroidism affect calcium?

A

It increases serum calcium

60
Q

What is a common cause of drug-induced haemolysis?

A

Methyldopa

61
Q

What is a normal AST:ALT ratio?

A

< 1

62
Q

What is an increase in unconjugated bilirubin typically indicative of?

A

Haemolysis

63
Q

Why is haemolysis commonly implicated in causing an elevation in unconjugated bilirubin?

A

Unconjugated bilirubin is a product of blood breakdown

64
Q

Which LFT (besides unconjugated bilirubin) will become elevated in haemolysis?

A

LDH

65
Q

Why does LDH become elevated in haemolysis?

A

LDH is found in the membranes of red blood cells, so it is released into the blood in haemolysis

66
Q

What is a normal AST:ALT ratio?

A

< 1

67
Q

What is the main cause of an elevated AST:ALT ratio?

A

Alcoholic liver disease

68
Q

What are two electrolyte abnormalities commonly seen in alcoholic liver disease?

A

Hyponatraemia and hypomagnesaemia

69
Q

What are two electrolyte abnormalities commonly seen in alcoholic liver disease?

A

Hyponatraemia and hypomagnesaemia

70
Q

What are two electrolyte abnormalities commonly seen in alcoholic liver disease?

A

Hyponatraemia and hypomagnesaemia

71
Q

What is a common cause of hyponatraemia in patients with liver disease?

A

Dilutional hyponatraemia secondary to ascites

Residency Exam (22 decks)

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