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Liver GI - AM > LFTs, Jaundice and Bilirubin, Investigations > Flashcards

LFTs, Jaundice and Bilirubin, Investigations Flashcards

1
Q

pre-hepatic cause of elevated bilirubin?

A

haemolysis - increase quantity of bilirubin

impaired transport

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2
Q

hepatic cause of elevated bilirubin?

A

parenchymal damage
defective uptake
defective conjuagtion
defective excretion

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3
Q

post-hepatic cause of elevated bilirubin?

A

obstructive

defective transport of bilirubin by biliary ducts

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4
Q

what is bilirubin?

A

by product of haeme metabolism

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5
Q

what and where is bilirubin generated?

A

in the spleen, by senescent RBCs

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6
Q

when is bilirubin a) conjugated, and b) unconjugated?

A

a) conjugated when solubilised by liver

b) unconjugated when initially bound to albumin

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7
Q

what are aminotransferases?

A

enzymes, present in heptaocytes

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8
Q

which is more specific, ALT or AST?

A

ALT

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9
Q

what is the function of aldosterone?

A

hormone that affects blood pressure, also regulates Na and K in blood

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10
Q

what does AST/ALD ration indicate? what does it suggest?

A

ALD - alcohol liver disease,

suggests parenchymal involvement

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11
Q

what is alkaline phosphatase?

A

enzyme, present in bile duct

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12
Q

elevated alkaline phosphatase indicates..?

A

obstruction or liver infiltration

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13
Q

where is alkaline phosphatase present, other than liver?

A

bone, placenta, intestines - therefore doesn’t always indicate problem with the liver

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14
Q

what is gamma GT?

A

non specific liver enzyme

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15
Q

when is there elevated gamma GT?

A

alcohol use

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16
Q

what is gamma GT useful for?

A

confirming that elevated alkaline phosphatase has come from liver

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17
Q

what can also elevate gamma GT levels?

A

NSAIDs

18
Q

what is albumin important for?

A

indicating synthetic liver function levels

19
Q

what does decreased albumin suggest?

A

CLD - chronic liver disease

20
Q

what other causes of low albumin are possible?

A

kidney disorders and malnutrition

21
Q

what does prothrombin time indicate?

A

the level of liver dysfunction

22
Q

what is prothrombin time used for?

A

calculating scores to decide stage of liver disease as well as who gets liver transplants

23
Q

what does creatinine measure?

A

kidney function

24
Q

what does creatinine determine?

A

survival from liver disease, also need for transplant

25
Q

what does cirrhosis result in?

A

splenomegaly, hypersplenism, liver scarring

26
Q

what is platelet count and cirrhosis indirect markers of?

A

portal hypertension

27
Q

normal levels of bilirubin?

A

17μmol/L

28
Q

bilirubin levels in jaundice?

A

34μmol/L (doubled)

29
Q

when bilirubin is conjugated (i.e. hepatic and post-hepatic causes of jaundice) what symptoms present?

A

dark coloured urine as bilirubin has been excreted by kidneys

30
Q

history - prehepatic jaundice?

A

history of anaemia, fatigue, dyspnoea, chest pain

acholuric jaundice

31
Q

history - hepatic jaundice?

A

IVDU, drugs, ascites, vatical bleeding, encephalopathy

32
Q

history - post hepatic Jaundice?

A

abdo pain, cholestasis, itching, pale stools, high coloured urine

33
Q

examination - prehepatic jaundice?

A

pallor, splenomegaly

34
Q

examination - hepatic jaundice?

A

CLD signs - spider naevi, gynaecomastia

ascites, flapping tremor

35
Q

examination - post hepatic jaundice?

A

Courvoisier’s sign - palpable gall bladder

36
Q

Tests for Jaundice

A

liver screen -
hep B&C serology, serum immunoglobulins, Alpha 1 anti trypsin, Caeruloplasmin and Cu, fasting glucose and lipid profile.

37
Q

investigations for Jaundice?

A

most important - US of abdomen

38
Q

what will US of abdomen show?

A

whether its extra/intrahepatic obstruction, site and causes of obstruction, evidence of portal hypertension, staging of disease

39
Q

US v.s. MRI/CT

A

US - cheap, no radiation (CT), widely available, high specificity, low sensitivity
MRI/CT - expensive, radiation (CT), better for pancreas, high sensitivity and specificity

40
Q

ERCP v.s. MRCP

A

MRCP - diagnostic, no radiation or complications
ERCP - therapeutic, radiation, sedation issues (cardio and rest), procedural issues (pancreatitis and cholangitis), failure rate of 10%

41
Q

PTC - uses

Percutaneous Transhepatic Cholangiogram

A

more invasive and is used for more severe obstructions -

hilar stenting, when ERCP is not available

42
Q

uses of EUS - endoscopic ultrasound

A

characterising pancreatic masses, staging of tumours, FNAs of tumours/cysts

Liver GI - AM (2 decks)

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