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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
Q

summarise AFP and its role

A

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
Q

clinical use of alpha-feto protein

A

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
Q

which causes of jaundice (generally) give conjugated and unconjugated BR

A
28
Q

differentials for jaundice

A

to diff - use LFTs and USS

29
Q

how can USS help dx the cause of jaundice

A
30
Q

interpret a urine dipstick in jaundice

A

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
Q

what investigations are included in the liver panel

A

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
Q

next level tests for liver

A

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
Q

how does the fibroscan work and what is it used for

A

USS

Sound wave propagated in liver
Velocity proportional to elasticity

Can gauge how cirrhotic or fibrotic

34
Q

what is the approach to a raised ALT

A
35
Q

what tests are used to measure liver function

A

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
Q

Non-invasive tests as an alternative to biopsy

A

Biopsy gold standard - BUT invasive/sample error

Fibroscan

Serum markers for liver fibrosis

37
Q

what is the enhanced liver fibrosis score

A

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
Q

process of liver fibrosis

A
39
Q

features of gilbert

A

Elevation in fasting BR - conjugated

= gilberts

Harmless

40
Q

what hepatobiliary condition does augmentin cause

A

cholestasis

41
Q

causes of ALT >1000

A

Toxins
Virus
Ischemia - cardiac arrest

42
Q

features of Hep A

A
  • Diarrhoeal illness
    • Faecal oral
    • Can be sx or asx - can get fulminant hep failure and die
43
Q

what is suggested by course liver on USS and large spleen

A

cirrhosis

PATHOLOGY (94 decks)

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