Liver

Question 1

Functions

Answer 1

Bile production
Carb, protein and lipid metabolism. 
Protein synthesis 
Vit D synthesis
Detox
Vitamin and mineral storage
Phagocytosis

Question 2

LFTs

Answer 2

• heptocellular damage-
  ALT- live specific
  AST- also heart and skeletal muscle
  AST/ALT ratio- 2 or more indicates alcoholic liver disease, especially if high gamma GT too.
  Less than 1 indicates viral hep.
  Over 4 in wilsons disease
  Often less than or equal to 1 in A/CKI or steatosis. So toxic or ischaemic injury.
  Gamma GT- high in fatty liver, chronic hepC, other chronic liver disease due to BD damage and fibrosis. ALD marker.
• cholestasis-
  Bilirubin-
  ALP- cholestasis or bone disorder.
• synthetic function
  Albumin- low if poor nutrition, renal disease, loss of liver function.
  PTT-
  Total protein (albumin and globulins)- globulin increases as albumin falls usually. Globulin high in chronic active hep, and alcoholic hep. Also acute infection, chronic inflammatory disease, and multiple myeloma.
• alcoholic liver disease- AST v high, ALT high. AST/ALT ratio over 2. MCV very high.
• hep C- AST bit high, ALT very high. AST/ALT under 1. MCV normal.
• non alcoholic fatty liver- AST high, ALT very high. AST/ALT under 1. MCV bit high.

Question 3

pre hepatic haemolytic jaundice

Answer 3

Lab-
Get high unconjugated. High reticulocytes. High LDH. Low haptoglobin as it binds free Hb.
Causes-
Inherited- RBC mem defect, Hb abnormalities, metabolic defects.
Congential hyperbilrubin- Gilbert’s syndrome lack gluconyl transferase.
Acquired- Immune, mechanical, infection, drugs, burns.

Question 4

hepatic parenchymal jaundice- cant conjugate or eliminate

Answer 4

Lab-
Mixed conjugated and unconjugated high. High AST and ALT. Slow PTT. High ALP maybe.
Causes-
Congential- Gilbert’s.
Inflammation- Hep viruses, EBV, AI, alcohol, haemochromatosis, wilsons.
Drugs eg paracetamol.
Cirrhosis- alcohol, chronic hep, metabolic disorder.
Tumour- HCC, mets.

Question 5

Post hepatic cholestatic jaundice

Answer 5

Lab-
High conjugated. Bilirubin in dark urine, no urobilinogen.
High ALP. Maybe high AST and ALT.
Causes-
Intrahepatic- hepatitis, drugs, cirrhosis, primary biliary cirrhosis.
Extra hepatic- gallstone, stricture, pancreatitis, sclerosing cholangitis, CA (pancreas head, ampulla, cholangiocarcinoma, porta hepatis LNs, liver mets).

Question 6

Hepatitis

Answer 6

Diagnosis- 
Acute- high AST and ALT. Jaundice. 
Chronic- low albumin, low CFs. 
Causes-
Viral hep A, B, C. AI. Drugs eg methyldopa. Hereditary eg wilsons, a1 antiT deficiency.