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PATHOLOGY > LFTs > Flashcards

LFTs Flashcards

1
Q

what are the normal functions of the liver

A

Intermediary Metabolism
Protein Synthesis
Xenobiotic Metabolism
Hormone Metabolism
Bile Synthesis
Reticulo-endothelial

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2
Q

basic macroanatomy of liver

A

Dual circ
- Portal vein from gut
- Artery from heart

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3
Q

what is involved in intermediary metabolism in the liver

A

Glycolysis
Glycogen storage
Glucose synthesis
Amino-acid synthesis
Fatty acid synthesis
Lipoprotein metabolism

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4
Q

what is intermediary metabolism

A

Enzyme-catalysed processes within cells that extract energy from nutrient molecules and use that energy to construct cellular components

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5
Q

intermediary metabolism pathways and effects if stop working

A

Ammonia - encephalopathic

Hypoglycaemic - cant store glycogen

Acidotic - cant process lactic acid

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6
Q

summarise xenobiotic metabolism in the liver

A

Chemical Modification
* P450 Enzyme System
* Acetylation / de-acetylation
* Oxidation / Reduction

->

conjugation
* glucuronate
* sulphate

->

excretion

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7
Q

summarise hormone metabolism of the liver

A

vit D hydroxylation

steroid hormone - conjugation adn excretion

peptide hormone - catabolism

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8
Q

constituents of bile

A

Water

Bile salts/acids

Bilirubin

Phospholipids

Cholesterol

Proteins

Drugs and Metabolites

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9
Q

function of bile

A

excretion

micelle formation

digestion

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10
Q

summarise bilirubin metabolism and transport

A
  1. red cells are broken down
  2. globin is recirc in live r
  3. iron taken from haem
  4. haem becomes BR
  5. BR binds albumin
  6. conjugated in liver -> soluble
  7. comes out in bile
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11
Q

summarise the reticuloendotheial function of the liver

A

immune function

kupffer cells:
* clearance of infection and LPS
* Ag presentation
* immune modulation - cytokines etc

erythropoesis

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12
Q

what are the LFTs

A

Alanine Transaminase ALT
Aspartate Transaminase AST
Alkaline Phosphatase ALP
Albumin
Bilirubin
Gamma glutamyl transferase yGT / GGT

Clotting factors
Pro-thrombin time (PT)

Alpha fetoprotein

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13
Q

what are the markers of liver cell damage

A

ALT
AST
ALP
GGT

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14
Q

what are the markers of synthetic function of the liver

A

albumin
PT

BR

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15
Q

what is the liver tumour marker

A

AFP

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16
Q

what are ALT and AST

A

enzymes contained within cytoplasm of hepatocytes

present in other organs but in low amounts
* muscle, kidney, brain, pancreas

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17
Q

how do ALT and AST change with liver damage

A

ALT rise more than AST

AST more in alcohol and cirrhosis

  • AST:ALT >2 in alcohol = advanced disease
  • if no alcohol AST:ALT >1 = advanced fibrosis or cirrhosis
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18
Q

where is gamma-glutaryl transpeptidase (GGT) found

A

liver, - hepatocytes and epithelium of small bile ducts

kidney,
pancreas,
spleen,
heart,
brain,
seminal vesicles

19
Q

when is gamma-glutaryl transpeptidise raised

A

chronic alcohol abuse

bile duct disease

hepatic mets

20
Q

where is alkaline phosphtase located

A

liver isoenzyme located in sinusoidal and canalicular membranes

bone
SI
kidney
WBC
placenta

21
Q

when is alkaline phosphtase raised

A

obstructive jaundice

bile duct damage

less in viral hepatitis or alcohol disease - ie less in hepatocyte damage

bone disease - mets

pregnancy

22
Q

summarise albumin

A

the major protein synthesised by the liver
(8-14g/day)

molecular mass 65,000

half life 20 days

contributes to oncotic pressure

binds steroids /drugs/bilirubin/calcium

23
Q

when is albumin low

A

low production (chronic liver disease, malnutrition)

loss (eg gut, kidney - nephrotic syndrome)

sepsis (“3rd spacing”)

24
Q

what is the acute marker of liver function and why

A

clotting - PT

1/2 life - hours

very acute liver failure look at INR PT every 4hrs - starts climbing - when gets to 2.5 need transplant

25
summarise AFP and its role
glycoprotein MW 69 000 /albumin superfamily Fetal transport-immune regulation/tolerance in fetal life made by yolk sac, GI epithelium and liver in adult - low conc, no known function
26
clinical use of alpha-feto protein
diagnosis of **hepatocellular carcinoma** (but may rise too late or not at all) * **Used as screening in cirrhosis because risk of hepatocellular cancer - USS and AFP every 6 mo** raised in * hepatic damage/regeneration * preg * testicular cancer
27
which causes of jaundice (generally) give conjugated and unconjugated BR
28
differentials for jaundice
to diff - use LFTs and USS
29
how can USS help dx the cause of jaundice
30
interpret a urine dipstick in jaundice
BR * **should be -ve** * large amounts can be detected by naked eye * only conjugated urobilinogen * **normally in small amounts** - in gut, reabsorbed in enterohepatic circ - is soluble so get in urine * **absent in obstructive jaundice** * **increased in haemolysis, hepatitis, sepsis** pale stool and dark urine * obstructive jaundice * pale because doesnt enter GI * but conjugated - so get cBR in urine
31
what investigations are included in the liver panel
Fasting lipids, fasting glucose - fatty liver Coeliac serology Hepatitis serology (HBV surface antigen, HCV antibody) Alpha-1-antitrypsin Caeruloplasmin (if less than 50yo) - wilson's disease - worried about a low caeruloplasmin Liver AAbs (LKM, aSMA, AMA) Immunoglobulins Ferritin ANCA screen
32
next level tests for liver
Tumour markers Fibroscan Liver biopsy Iron studies and HH genetics - *in men with high ferritin* Viral DNA/RNA 24hr urinary copper Alpha-1-antitypsin phenotype CT MRCP - *bile ducts* MRI / MRI iron load in haemochromotosis EUS
33
how does the fibroscan work and what is it used for
USS Sound wave propagated in liver Velocity proportional to elasticity Can gauge how cirrhotic or fibrotic
34
what is the approach to a raised ALT
35
what tests are used to measure liver function
Dye tests - Indocyanine green / Bromsulphalein * Measure excretory capacity of liver * Meaure hepatic blood flow Breath tests - Aminopyrine / Galactose (carbon 14) * measure residual functioning liver cell mass * ? predict survival in alcoholic hepatitis * ? distinguish cirrhosis without biopsy (70-80%sensitivity) Serum bile acids - Elevated esp. in cholestasis * 10-100x in cholestasis of pregnancy * 25X in PBC/PSC
36
Non-invasive tests as an alternative to biopsy
Biopsy gold standard - BUT invasive/sample error Fibroscan Serum markers for liver fibrosis
37
what is the enhanced liver fibrosis score
Gauge whether likely to be cirrhotic *Important because do endoscopy for varies Screen for cancer* 3 markers associated with fibrosis * Tissue inhibitor of metalloproteinases 1 (TIMP-1) * Amino-terminal propeptide of type III procollagen (PIIINP) * Hyaluronic acid (HA) algorithm makes number
38
process of liver fibrosis
39
features of gilbert
Elevation in fasting BR - conjugated = gilberts Harmless
40
what hepatobiliary condition does augmentin cause
cholestasis
41
causes of ALT >1000
Toxins Virus Ischemia - cardiac arrest
42
features of Hep A
- Diarrhoeal illness - Faecal oral - Can be sx or asx - can get fulminant hep failure and die
43
what is suggested by course liver on USS and large spleen
cirrhosis

PATHOLOGY (94 decks)

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