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GI > LFTs > Flashcards

LFTs Flashcards

1
Q

What is ALT?

A

Alanine aminotransferase

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2
Q

What is AST?

A

Aspartate aminotransferase

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3
Q

What is ALP?

A

Alkaline phosphate

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4
Q

What is GGT or Gamma GT?

A

Gamma glutamyl transferase

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5
Q

Which liver function markers indicate inflammation and why?

A

ALT and AST (aminotransferases)
Liver enzymes in hepatocytes which leak into the blood stream when liver cells are damaged.
High in hepatitis

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6
Q

Which amino transferase is more specific to the liver?

A

ALT as AST can be raised in muscle damage

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7
Q

Where is ALP found?

A

Enzyme mainly in the bile ducts of the liver

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8
Q

What does and increase in ALP suggest regarding the liver?

A

Obstructive or cholestatic disease

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9
Q

ALP can also be raised in bone disease. What additional enzyme can be tested along with ALP to check the problem is liver related?

A

GGT will also be raised with ALP if its a liver problem.

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10
Q

What can cause a low albumin?

A

Chronic liver disease- especially if it is getting worse.

Proetin deficiency

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11
Q

Which clotting factors are produced in the liver?

A

Fibrinogen, Factor 2 (prothrombin), 7, 9 and 10.

ANd protein C, S and antithrombin which aid fibrinolysis

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12
Q

What causes pre-hepatic jaundice?

A

Excessive RBC breakdown which overwhelms the livers ability to conjugate bilirubin => Unconjegated hyperbilirubinaemia.
Haemolytic anaemia, Gilbert’s syndrome

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13
Q

What causes hepatocellular jaundice?

A

Liver dysfunction.
Liver loses ability to conjugate bilirubin. Cirrhosis can compress the intrahepatic portions of the biliary tree causing obstruction => Mixed (conjugated and unconjugated bilirubin in the blood.
Alcoholic liver disease, Viral hepatitis, Medication, autoimmune hepatitis, HCC, Primary sclerosing cholangitis

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14
Q

What causes post hepatic jaundice?

A 
Obstruction of biliary drainage.
Bilirubin is conjugated in the liver but cannot get into gut and spills into blood => conjugated hyperbilirubinaemia.
Gall stones (intraluminal)
Wall causes (cholangiocarcinoma, strictures)
Outside of the wall compression (pancreatic cancer or abdo mass)
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15
Q

What colour is conjugated bilirubin (soluble) in the urine?

A

Brown- so an excess of conjugated billirubin (post hepatic or hepatocellular) makes the urine very dark brown (coca cola)

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16
Q

What is albumin?

A

A marker of liver synthesising function

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17
Q

What is the half life of ALP?

A

A week. May lag behind disease and continue after treatment.

18
Q

What is the classic faeces/rine picture for cholestatic disease?

A

Pale faeces and dark urine.

19
Q

How is bilirubin transported in the blood?

A

Bound to albumin

20
Q

Which clotting factors does the liver synthesise?

A

Fibrinogen (factor 1)
Prothrombin (factor 2)
Factor 5, 7, 9, 10, 12 and 13.

21
Q

What does PT time measure?

A

Time it takes for prothrombin to be converted to thrombin.

22
Q

What does an elevated PT suggest?

A

Reduced synthetic function of the liver. Not necessarily pro haemorrage as the liver also synthesis protein C, S and antithrombin and these will also be reduced in poor liver function.

23
Q

What causes, excluding liver function can prolong the prothrombin time?

A

Drugs (warfrin)
Bile malabsorbtion causing relative Vit K deficiency
Consumptive (sepsis)/congenital (Haemophillia) coaguopathies

24
Q

The reference ranges for LFTs change around the country. Can people have liver disease and normal LFTs?

A

Yes- all in the history and presentation

25
Q

What drugs can cause a change in LFTs?

A

Antibiotics, antidepressants, Statins, NSAIDs (naproxen and diclofenac), anti-epileptics, anti-TB drugs, OTC drugs

26
Q

What is the half life of albumin?

A

10 days

27
Q

WHat is the ALT half life?

A

47 hours

28
Q

What is the AST half life?

A

17 hours

29
Q

Which is more liver specific AST or ALT?

A

ALT

30
Q

What is the LFT picture for Acute hepatocyte injury?

A

AST:ALT ratio >2 is suggestive of alcohol cause (normal is 0.8)

31
Q

What are the mimic/overlap conditions of acute hepatic injury?

A 
Coeliac disease (Use tTG to exclude)
Muscle disorders (Use Creatinine to exclude)
Adrenal deficiency
Anorexia
32
Q

What is the test for Autoimmune hepatitis?

A

Anti smooth muscle antibodies serology

33
Q

What is the test for Wilsons disease?

A

Caeruplasmin- Low because the copper accumulates in tissues rather than serum

34
Q

What is the test for haemochromatosis?

A

Ferratin (acute phase protein) raised above 500

35
Q

What are the causes of isolated hyperbilirubinaemia that is unconjugated?

A

Haemolytic anaemia.

Impaired hepatic bilirubin uptake (heart faiule or portosystemic shunts (TIPSS), Drugs (rifampicin)

36
Q

What is the genetic disease whichleads to impaired bilirubin conjugation?

A

Gilbert’s syndrome.

Can also occur in hyperthyroidism and advanced liver disease

37
Q

What can lead to hyperbilirubinaemia that is conjugated?

A

Extrahepatic: Cholelithiasis, PSC, Cholingiocarcinoma, Head of Pancreas mass, acute/chronic pancreatitis.
Intrahepatic: Sepsis/hypoperfusion, cirrosis, TPN, acute hepatitis, Drgs (steroid, ripampicin, chlorpromazine.

38
Q

What are the signs of acute liver failure? IMPORTANT

A

Jaundice, coagulopathy and encephalopathy

39
Q

What is a Fibroscan?

A

test used to measure the elasticity of the liver- tries to aviod biopsies.

40
Q

What are the signs of congestive hepatitis?

A

Dilated IVC and hepatic vein with right heart failure.

41
Q

What causes splenomegaly in young people?

A

EBV or CMV- no contact sports

42
Q

When do you worry about herpes simplex virus?

A

Pregnant or immunocomprimised.

Not everyone has a rash and it is foetotoxic

GI (48 decks)

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