LFTs and jaundice

Question 1

RBCs are broken down by the ____ to produce _____. Bilirubin is un/conjugated in the ____ to produce bile. Bile is stored in the _____.

Answer 1

RBCs are broken down by the spleen to produce bilirubin. Bilirubin is conjugated in the liver to produce bile. Bile is stored in the gall bladder.

Question 2

unconjugated/conjugated bilirubin is water soluble/insoluble and causes dark urine.

Answer 2

unconjugated bilirubin is water soluble and causes dark urine.

Question 3

unconjugated/conjugated bilirubin is water soluble/insoluble and causes normal urine.

Answer 3

conjugated bilirubin is water insoluble and causes normal urine.

Question 4

what are some signs of hyperbilirubinaemia?

Answer 4

icterus (jaundice), raised LFTs, itch, yellow skin/sclera, dark urine, pale stools.

Question 5

clinical features of hyperbilirubinaemia appear when levels are >___mmol/L

Answer 5

> 40mmol/L

Question 6

three main causes for jaundice an examples

Answer 6

pre-hepatic (haemolytic anaemia)
hepatic (cirrhosis, hepatitis)
post-hepatic (obstructive, cholelithiasis)

Question 7

person has jaundice but normal urine and normal stools. What is the cause?

Answer 7

pre-hepatic jaundice e.g haemolytic anaemia. normal normal LFTs and raised unconjugated bilirubin

Question 8

a person presents with jaundice, dark urine normal normal stools, what is the cause of jaundice?

Answer 8

hepatic
raised LFTs (AST/AST)
raised unconjugated bilirubin which is water soluble and causes dark urine.

Question 9

a person presents with jaundice, dark urine and pale stools - what is the cause?

Answer 9

obstructive (post-hepatic) jaundice e.g. cholelithiasis
abnormal LFTs (raised ALP/GGT)
other causes: pancreatic head cancer, cholangiocarcinoma

Question 10

three markers of true liver function?

Answer 10

albumin, conjugated bilirubin, prothrombin time

Question 11

what are some signs of low albumin and when do they appear.

Answer 11

after a few weeks, the patient will have oedema, leukonychia and abnormal pharmacokinetics

Question 12

which (8) clotting factors are made by the liver ?

Answer 12

I, II, V, VII, IX, X, XII, XIII

Question 13

positive murphys sign indicates ____?

Answer 13

acute cholecystitis (inflammation of the gall bladder secondary to gall stones)

Question 14

name the components of charcots triad, what does it indicate?

Answer 14

fever, RUQ pain, and jaundice

indicated ascending cholangitis (infection of the gall bladder)

Question 15

markers of liver biochemistry?

Answer 15

transaminases (ALT/AST)
ALP (alkaline phosphate)
GGT (gammaglutamyltransferase)

Question 16

hepatic jaundice LFT pattern

Answer 16

raised ALT/AST > ALP

Question 17

raised ALP indicates what?

Answer 17

obstructive, post-hepatic jaundice or bony mets/osteosarcoma

Question 18

acute rise in GGT occurs in…

Answer 18

alcohol consumption

Question 19

which liver enzyme is the most specific marker of liver damage (AST or ALT)?

Answer 19

ALT (alanine transminase) is a more specific marker of liver injury than AST