Liver Flashcards
What is a splenomegaly?
enlargement of the spleen due to an increased resistance to blood flow in the liver, causing higher pressure in the portal venous system.
What is acanthosis nigricans?
A velvety discoloration of body creases and folds
What tissues are associated with AST (SGOT) liver enzymes?
Liver, skeletal muscle, cardiac muscle and kidney
What tissues are associated with ALT (SGPT) liver enzymes?
Only the liver = high levels mean liver cell injury
What enzymes are used to detect liver bile duct damage?
Cholestatic enzymes! They indicate disease to biliary system.
What are examples of cholestatic enzymes used to detect liver bile duct damage?
Alkaline phosphatase: enzyme from bile ducts, placenta and bone turnover = don’t use this value to evaluate bile duct condition in kids (high bone turnover) or pregnant women
Gamma-glutamyl transferase: only high if liver damage (better detection in all kinds of patients). GGT can be high after having a lomft to drink due to alcohol-induced liver inflammation → very sensitive enzyme
What are the different clin presentations of liver damage/disease?
First-time elevations = may be acute injury such as hepatitis A or alcohol-induced liver enzymes
Acute hepatitis = A or E, which is the inflammation of hepatocytes
Chronic hepatitis = B or C
Cholestasis = blockage of bile ducts (large and small)
Cirrhosis = liver inflammation, not always due to alcohol, fat accumulation or chronic hepatitis
Jaundice = accumulation of bilirubin causing yellowing of eyes
What might be the cause of bruising and deteriorating eyesight associated with the liver?
Both vitamin A and K are fat soluble vitamins, which respectively play a role in vision and bruising. The digestion of fat requires bile from the gallbladder, so if these vitamins aren’t properly absorbed, there might be a problem with the bile duct (blockage), causing low secretion of bile. This is usually characterized with elevated ALT (due to blockage, will have liver cell damage) and really high ALP levels (due to the blockage of bile ducts).
What is the difference between bilirubin and direct-bilirubin?
High levels of bilirubin are usually due to a high rate of RBC breakdown (breakdown of heme). Direct-bilirubin levels that are elevated indicate that the liver is having problems secreting the conjugated (direct) bilirubin, which could cause liver problems if accumulated in high amounts in the liver.
What is INR and what does it indicate?
INR (or International Normalized Ratio) is an indicator of how much your blood will clot. The higher the number, the thinner the blood, so the more time it will take for the blood to clot. Vitamin K is used to make blood clotting factors in the liver.
What is severe acute hepatitis?
It is when liver functions aren’t working properly, such as making blood clotting factors and having an elevated INR, this causes the patient to die quickly.
What are the clinical features of acute hepatitis?
→ can improve on its own
- Symptoms: fatigue, anorexia, nausea, jaundice
- ALT elevation: >10-fold
- Prognosis: usually self-limited
- Treatment: supportive
What are the clinical features of chronic hepatitis?
→ some have symptoms, some never will
Symptoms: variable
- ALT elevation: 1.5-10-fold
- Prognosis: variable, at risk for progression
- Treatment: at underlying cause
What are the different diseases that are cases of acute hepatitis and what are the clues/tests?
Hepatitis A: exposure history (clinical clues), IgM anti-HAV (diagnosis test)
Hepatitis B: risk factors (clinical clues), HBsAg, IgM anti-HBc (diagnosis test)
Drug-induced: compatible agent and timing (clinical clues), improvement after d/c agent (diagnosis tests). I.e. Tylenol at low doses is safest thing, but if overdose, can kill liver right away.
Alcoholic hepatitis: History of alcohol excess, ALT > 2, AST < 400 (clinical clues), biopsy (bx), improvement with abstinence (diagnosis tests). AST is higher than ALT (due to a vitamin B deficiency bc of malnourishment)
Ischemic hepatitis: history of hypotension (clinical clues), rapid improvement of ALT (diagnosis tests). → Lack of blood flow to the liver
What are the different diseases that are cases of chronic hepatitis and what are the clues/tests?
Hepatitis C: risk factors (clinical clues), anti-HCV, HCV RNA (diagnosis tests)
Hepatitis B: risk factors (clinical clues), HBsAg (diagnosis tests)
NASH or NAFL: obesity, DM, hyperlipidemia (clinical clues), US, liver biopsy (diagnosis test)
Hemochromatosis: arthritis, DM, family history (clinical clues), iron studies, gene test (diagnosis test)
Alcoholic liver disease: History of alcohol excess (clinical clues), biopsy, improvement with abstinence (diagnosis tests)
Autoimmune hepatitis: ALT 200-500, female, other autoimmune disease (clinical clues), ANA, ASMA (diagnosis tests)
Why is itchiness related to cholestatic?
Because bile acids will deposit in skin and make it itchy.