Liver 101 - Jess Davies teaching Flashcards
Where is ALT produced?
Liver and muscle
When might ALT be increased?
Liver pathologies
Also other muscle things like rhabdomyolysis
Where is AST produced?
Liver, muscles, RBCs
What would the ratio of ALT to AST be if the pathology was specific to the liver?
ALT>AST
Where is ALP produced?
Liver, bone & placenta
When is ALP elevated?
Elevated in OBSTRUCTIVE disease
Where is GGT produced?
Just after liver?
When is GGT elevated?
Elevated in OBSTRUCTIVE disease
When is bilirubin elevated?
Obstruction
Haemolysis
Acute hepatitis
Cirrhosis
What’s elevated in obstruction?
ALP
GGT
Bili
What are synthetic liver function tests?
Albumin
aPTT
PT
What stuff does the liver synthesise?
Thrombopoietin Bile salt Lipid metabolism Glycogen storage and release Protein synthesis and metabolism Bilirubin conjugation, excretion and recycling Hormone inactivaiton Drug metabolism Essential in innate immunity
What hormones does the liver inactivate?
Oestrogen Glucagon Insulin Glucocorticoids PTH NOTE: also converts Cholecalciferol —> 25hydroxycholecalciferol
Which protein does the liver not synthesise?
Immunoglobulins
Causes of acute hepatitis
Viral hepatitis
Autoimmune hepatitis
Acute drug induced liver injury (DILI)
Alcoholic hepatitis
What would the ALT to AST ratio be in acute hepatitis?
Acute hepatitis will give you a significant rise in transaminases (a transaminitis), with ALT»_space;AST
What would the ALT to AST ratio be in alcoholic hepatitis? i.e. exception to acute hep rule?
AST 2.5 x greater than ALT
Symptoms and signs of viral hepatitis
Fever Malaise Jaundice Hepatomegaly Anorexia
What would you screen for in autoimmune hepatitis, type 1?
NOTE: you'd also screen for immunoglobulin levels ANA ASM (MAIN ONE) AAA (anti actin) anti-SLA (soluble liver antigen)
What would you screen for in autoimmune hepatitis, type 2
NOTE: you’d also screen for immunoglobulin levels
Anti liver/kidney microsome 1 (anti-LKM1)
Antibody to liver cytosol antigen (ALC-1)
What drugs might cause acute drug induced hepatitis?
Antibiotics
Antivirals
Immunosuppressants
Symptoms of liver cirrhosis
Malaise/fatigue Bruising/bleeding easliy Anorexia/weight loss Feeling of enlarged abdomen Swollen legs/belly Jaunice itch (pruittis) Hand tremors
Signs of liver cirrhosis
Spier naevi Palmar erythema Bruises Hepatosplenomegaly Ascites Jaundice Xanthoma Finger clubbing Caput medusae Gynecomastia Fever Leukonichia Thigh oedema Encephalopathy Purpura Hepatic halitosis Hepatoceleoma
What is hepatic halitosis?
Ketones in breath
What would suggest synthetic dysunction?
Low albumin (below 28 = poor prognosis) High PT and aPTT
What else might AST>ALT suggest
Decompensated alcoholic cirrhosis
What might the FBC show in liver disease and why?
Anaemia
Low platelet time?
Low white cell count (splenomegaly)
Hyponatremia
High creatinine hepatorenal syndrome)
Hyperglycemia
