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Clinical Biomed yr2 > liver and renal disease > Flashcards

liver and renal disease Flashcards

1
Q

functions of the kidnye

A 
regulate vol of fluid in blood
electrolyte balance
acid-base balance
excretion of waste products
vit D metabolism
EPO
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2
Q

what electrolytes does the kidney control

A 
sodium
potassium
chloride
calcium
magnesiom
phosphate
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3
Q

glomerular filtration rate

A

GFR
measreument of wast products in plasma
vol of fluid filteresd through all glomeruli per time unit

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4
Q

eGFR

A

estimated glomerular filtration rate

based on equation validated against gokd standard of renal clearance test

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5
Q

what waste products can be measured for the kidney

A

creatinine ( waste of muslce breakdown)

urea (breakdown of proteins and amino acids)

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6
Q

renal function releated tests

A

acid0ase balance
plasma phosphate
plasma calcium
urinary proteins

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7
Q

acid base balance relevance to kidneys

A

decreased excretion by the kidney

renal failure leads to metabolic acdosis, more H ions and more carbonic acid

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8
Q

relevance of urinary protein measurements in kiendye

A

glomeruli manage causes proteins to leake into tubules and these cannot reabsorp the protein back
as renal disease progresse, proteins get larger leading to proteinurina

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9
Q

low GFR

A

low renal function or failure

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10
Q

causes of acute renal failure

A 
hypovolaemia due to blood loss dehydration/shock
acute glomerular inflamation
drugs
muscle breakdown
obstrution of renal flow
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11
Q

biochem changes due t actue renal failure

A
  • low GFR
  • rapid loss of urine vol
  • accumulation of waste products, urea and creatinine
  • accumulation of electrolytes, potassium and phosphate
  • accumulation of acids, noHion excretion
  • impairment of other renal function
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12
Q

causes of chronic renal failure

A

gradual decline of function over years

  • diabetes
  • hypertention
  • disases affecting glomeruli
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13
Q

rhabdomylosis

A

breakdown of muscle
myoglobin leaked into blood
filtered by kidney but damages it leading to severe renal issues

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14
Q

what is type 2 renal failure

A

chronic
eGFR between 0-15
very bad, most dever

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15
Q

biochem changes in chronic renal failure

A

same as acute but slowly

  • accumulation of wast products, urea and ceantnine
  • accumulation of electrolytes
  • no H ion excretion
  • functions impaired
  • low vit D production
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16
Q

why is creatinine a bad measure of renal function and failure

A

only starts rising and accumlating whne over 70% of function is lost

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17
Q

role of the kidney in electrolyte balance

A

sodium and water, balance coupled
kidney balances this using hormones
- adrenals: renin, angiotensin,aldosterone axis(Ha, H2O and K)
- pos pit ADH affects water balance

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18
Q

what is electrolyte imbalance (too little)

A

hyponatraemia
loss of Na and or excess water
low osmotic pressure
can lead to fluid moving to brain causing swelliing which is bad

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19
Q

too much electrolytes

A

hypernatramiae
loss of water, too much NA
water drawn out of brain cells leading to shrinkage which is bad

20
Q

hyperkalaemia

A

higher plasma potassium
caused by:
- haemolysis, high intake, high rena absoption or chronic renal failure

21
Q

why is hyperkalaemia important

A

can lead to arrythmias

22
Q

hypokalamiae

A

low serum potasium levels
reduced renal absoption and low nintake of K
leads to arrythmias and muscle weakness

23
Q

outline of bilirubin metabolism

A 
Hb processed in spleen to haem then biibrin then to plasma when bound to albumin
this goe to liver
conjugated with glucoronicacid
now to small intestine
processed by bacteria
sterocolbilin made
24
Q

liver functions

A
  • bilirubin excretion
  • gucose hoemostaisis
  • cholesterol metabolism
  • clotting factors production
  • detoxification of drugs
  • amino acid catbolism
  • protein synthesis
25
Q

liver function tests

A 
ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
ALP (alkaline phosphatase)
Total bilirubin
Albumin
GGT (gamma glutamyl transpeptidase)
26
Q

3 main liver function tests

A

bilirubin
albumin
prothombin time clotting

27
Q

ALT and AST tests

A

alanine aminotransferase
aspartate aminotransferase

enzymes involved in tranfer of amino groups and metabolism
released into blood when hepatocytes damaged

28
Q

ALP test

A

alkaline phosphatse test

enzymes found in blood whne pressure in billlary ducts increases

29
Q

gamma glutamyl transpeptiade test

A

enzyme present in hepatocytes
enzyme blood lvels increase:
- when pressure inside ducts increaases
- sysnthesis induced by alchocol and drugs

30
Q

albumin test

A

this protein is made in the liver and carriers things in the blood maintaining osmotic pressure
low albulin: sever liver disase

31
Q

bilirubin test

A

product of RBC cycling

high levels indicate liver problem or hepatic block

32
Q

use of prothombin time for liver test

A

measures clotting time

If liver isn’t working well, less clotting factors being made therefore blood will take longer to clot

33
Q

when is ammonia measured for liver function

A

in neonates only with severe ilness

in adults it doesnt correlate with liver disease so not helpful

34
Q

main ctegories of liver disease

A
  • Hepatitis: Inflammation/infection and hepatocyte damage
  • Cholestasis: impairment of bile flow
  • Mixed hepatitis /cholestasis
  • Tumours and other infiltrative diseases
  • Alcoholic liver disease
35
Q

hepatitiscasues

A
  • viral infection of liver
  • epstein barr virus
  • overdose of alchol or drugs
  • autoimmune
  • Ischaemia
36
Q

what does hepatiis lead to

A 
hepatocytes damages
- they relese enyes into blood leading to high levels which is bad
- ALt and AST HIGH
- serum bilirubin high
clotting may also be impaired
37
Q

fulminant hepatitis

A 
massive liver inflamation
- hypoglycamia, hypoalbinuaemia
sever clotting impairement
high ALT and AST
high ammonia
38
Q

Cholestasis

A

impairment of blood flow
eg gall stones
bilirubin appears in urine and its brown but pale stools

39
Q

functional tests for cholestasis

A

ALP very high

very high bilirubin

40
Q

what is mixes hepatitis and cholestasis

A

damage of both herpatocytes and bile duct cells

  • sepsis
  • immunosuressant drugs
  • autoimmune liver disease
    aminotransferases and ALPmildly raised
41
Q

effect of liver tumours or finction

A

usualy normlal functions untill very advanced tumour

42
Q

what does chronic alchol intake do to the liver?

A

high GGT

large red cell vol, macrocytosis

43
Q

what happens to someone with chonic

alchol liver disease after stopping intake

A

GGT goes back to normal in 3-4 weeks

44
Q

consequences of chonic alchol liver diseae

A
  • fatty liver
  • acute hepatitis
  • liver cirrhosis
45
Q

when will GGT be raised

A

marker for alchol intake

Clinical Biomed yr2 (22 decks)

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