liver and renal disease

Question 1

functions of the kidnye

Answer 1

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

Question 2

what electrolytes does the kidney control

Answer 2

sodium
potassium
chloride
calcium
magnesiom
phosphate

Question 3

glomerular filtration rate

Answer 3

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

Question 4

eGFR

Answer 4

estimated glomerular filtration rate

based on equation validated against gokd standard of renal clearance test

Question 5

what waste products can be measured for the kidney

Answer 5

creatinine ( waste of muslce breakdown)

urea (breakdown of proteins and amino acids)

Question 6

renal function releated tests

Answer 6

acid0ase balance
plasma phosphate
plasma calcium
urinary proteins

Question 7

acid base balance relevance to kidneys

Answer 7

decreased excretion by the kidney

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

Question 8

relevance of urinary protein measurements in kiendye

Answer 8

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

Question 9

low GFR

Answer 9

low renal function or failure

Question 10

causes of acute renal failure

Answer 10

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

Question 11

biochem changes due t actue renal failure

Answer 11

• 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

Question 12

causes of chronic renal failure

Answer 12

gradual decline of function over years

• diabetes
• hypertention
• disases affecting glomeruli

Question 13

rhabdomylosis

Answer 13

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

Question 14

what is type 2 renal failure

Answer 14

chronic
eGFR between 0-15
very bad, most dever

Question 15

biochem changes in chronic renal failure

Answer 15

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

Question 16

why is creatinine a bad measure of renal function and failure

Answer 16

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

Question 17

role of the kidney in electrolyte balance

Answer 17

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

Question 18

what is electrolyte imbalance (too little)

Answer 18

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

Question 19

too much electrolytes

Answer 19

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

Question 20

hyperkalaemia

Answer 20

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

Question 21

why is hyperkalaemia important

Answer 21

can lead to arrythmias

Question 22

hypokalamiae

Answer 22

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

Question 23

outline of bilirubin metabolism

Answer 23

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

Question 24

liver functions

Answer 24

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

Question 25

liver function tests

Answer 25

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

Question 26

3 main liver function tests

Answer 26

bilirubin albumin prothombin time clotting

Question 27

ALT and AST tests

Answer 27

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

Question 28

ALP test

Answer 28

alkaline phosphatse test | enzymes found in blood whne pressure in billlary ducts increases

Question 29

gamma glutamyl transpeptiade test

Answer 29

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

Question 30

albumin test

Answer 30

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

Question 31

bilirubin test

Answer 31

product of RBC cycling | high levels indicate liver problem or hepatic block

Question 32

use of prothombin time for liver test

Answer 32

measures clotting time | If liver isn't working well, less clotting factors being made therefore blood will take longer to clot

Question 33

when is ammonia measured for liver function

Answer 33

in neonates only with severe ilness | in adults it doesnt correlate with liver disease so not helpful

Question 34

main ctegories of liver disease

Answer 34

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

Question 35

hepatitiscasues

Answer 35

- viral infection of liver - epstein barr virus - overdose of alchol or drugs - autoimmune - Ischaemia

Question 36

what does hepatiis lead to

Answer 36

``` 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 ```

Question 37

fulminant hepatitis

Answer 37

``` massive liver inflamation - hypoglycamia, hypoalbinuaemia sever clotting impairement high ALT and AST high ammonia ```

Question 38

Cholestasis

Answer 38

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

Question 39

functional tests for cholestasis

Answer 39

ALP very high | very high bilirubin

Question 40

what is mixes hepatitis and cholestasis

Answer 40

damage of both herpatocytes and bile duct cells - sepsis - immunosuressant drugs - autoimmune liver disease aminotransferases and ALPmildly raised

Question 41

effect of liver tumours or finction

Answer 41

usualy normlal functions untill very advanced tumour

Question 42

what does chronic alchol intake do to the liver?

Answer 42

high GGT | large red cell vol, macrocytosis

Question 43

what happens to someone with chonic | alchol liver disease after stopping intake

Answer 43

GGT goes back to normal in 3-4 weeks

Question 44

consequences of chonic alchol liver diseae

Answer 44

- fatty liver - acute hepatitis - liver cirrhosis

Question 45

when will GGT be raised

Answer 45

marker for alchol intake