Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHASE 2A MEDICINE - ANJALI createdd > Liver + Biliary system > Flashcards

Liver + Biliary system Flashcards

1
Q

What are the functions of the liver?

A

-Protein synthesis: albumin, clotting factors -Glucose and fat metabolism -Immune defense: reticukoendothelial system -Detoxification and excretions: drugs and hormones, ammonia, billirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens when ammonia detoxification of the liver is impaired?

A

Hepatic encephalopathy due to ammonia build up (can cross the BBB):

  • Converted into glutamien –> osmotic imbalance in brain –> cerebral oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens when metabolism of carbs goes wrong?

A

Hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens when albumin production goes wrong?

A
  • Oedema
  • Ascites
  • Leukonychia (whitening on the nail bed due to low protein)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens when clotting factor production fails ?

A

Easy bleeding and bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens when bilirubin regulation is impaired?

A

Jaundice, stool and urine changes, pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens when the immune function of the liver goes wrong?

A

Spontaneous bacterial infections can occur - bacterial peritonitis (usually following ascites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What zone of the liver is most prone to injury?

A

Zone 3-rea around the central vein is most prone to ischaemic damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 broad types of kidney injury?

A

Acute and Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Aetiology of acute liver disease

A
  • Viral: HepA,B,EBV
  • Drugs
  • Alcohol
  • Vascular
  • Obstruction
  • Congestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Aetiology of Chronic liver disease

A
  • Alcohol
  • Viral-HepB,HepC
  • Autoimmune
  • Metabolic: iron, copper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of acute liver disease?

A
  • Malaise
  • Nausea
  • Anorexia
  • Jaundice

rare: Confusion, bleeding, pain, hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of Chronic Liver disease?

A
  • Ascites
  • Oedema
  • Malaise
  • Anorexia
  • Pruritis
  • Clubbing
  • Palmar erythema
  • Xanthelasma
  • Spider Naevia
  • Dupuytren’s contracture
  • Hepatmegaly
  • Bleeding: haematemesis, easy bruising

rare: jaundice, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the possible outcomes in acute and chronic liver injury

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are LFTs and what do they tell you?

A
  • Serum bilirubin
  • Serum Albumin
  • Prothrombin time -INR

Liver function - synthetic function of the liver - gage severity of liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is liver biochemistry (hepatic enzymes) and what do they tell you?

A
  • Aminotransferases: AST, ALT
  • ALP (alkaline phosphatase)
  • GGT (gamma glutamyl transpeptidase)

Dont give an index of liver function but can indicate inflammation or damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Non liver causes of hypoalbuminaemia?

A
  • Malnutrition
  • Urinary protein loss
  • Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are aminotransferases?

A
  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT

Transaminases that are contained in hepatocytes and leak into the blood with liver cell damage

19
Q

What is AST?

A
  • Aspartate aminotransferase (AST)
  • Mitochondrial enzyme (80%), 20% in cytoplasm
  • Also present in the heart, muscle, kidney and brain
  • High levels seen in: hepatic necrosis, MI, muscle injury and congestive heart failure
20
Q

What non hepatic conditions cause a raised AST?

​

A
  • MI
  • Kidney disease - hepatic necrosis
  • Muscle injury
  • Congestive heart failure
21
Q

Is AST or ALT more specific to liver disease?

A

ALT: rise is only seen in liver disease

22
Q

Where is ALP present?

A

Alkaline phosphatase is present in

  • Hepatic canalicular and sinusoidal membranes
  • bone
  • intestine
  • placenta
23
Q

When is serum ALP raised?

A
  • Intra/extra hepatic cholestatic disease of any cause (due to increased synthesis): Cholestatic jaundice, Hepatic infiltrations, Cirrhosis
  • Bone disease: osteomalacia, hypoparathyroidism, pagets disease
24
Q

What non hepatic causes can cause a raised ALP

A

Bone disease:

  • osteomalacia
  • Hypoparathyroidism
  • Pagets disease
25
Q

How can the origin of ALP be determined (raised ALP)?

A
  • Electrophoretic separation of isoenzymes or bone specific monoclonal antibodies
  • Clinical practice: if the gamma-GT is also abnormal ,ALP is presumed to come from the liver
26
Q

What is GGT?

A

Gamma-glutamyl transpeptidase

Microsomal enzyme present in the liver and many other tissues. Acitivity can be induced by numerous drugs (phenytoin, warfarin, rifampicin and alcohol)

27
Q

What can induce GGT activity?

A
  • Alcohol
  • Phenytoin
  • Warfarin
  • Rifampicin

many drugs

28
Q

What is GGT a sensitive indicator of?

A

Alcoholic liver disease

29
Q

When is GGT raised?

A
  • Mild elevations common – even with minimal alcohol consumption
  • Fatty liver disease
  • Cholestasis: rises in parallel with ALP
  • Alcohol intake/ AFLD
30
Q

If ALP is normal but there is raised gamma glutamyl transpeptidase, what could this indicate?

A

Useful guide to alcohol intake

31
Q

In the absence of other LFT abnormalities but a slight raised gamma-glutamyl transpeptidase, what should be done?

A

Can be safely ignored

32
Q

What is PT?

A

Measures extrinsic pathway- clotting cascade

33
Q

When is the globulin fraction raised?A

A

Autoimmune hepatitis. If the globulin fraction falls –> succseful therapy

34
Q

What is jaundice?

A

Yellowing of the skin and slcera due to hyperbilirubinaemia

35
Q

What is the classification of jaundice?

A

Unconjugated or conjugated

36
Q

What is the cause of unconjugated jaundice?

A

Pre-hepatic causes:

  • Haemolytic jaundice (haemolysis of red cells)
  • Congenital: Gilberts
37
Q

What are the causes conjugated jaundice?

A
  • Intrahepatic (due to failure of bile secretion)
  • extrahepatic (due to a large duct obstruction of bile flow)
38
Q

What are the causes of extrahepatic cholestasis?

A
  • Common duct stones
  • Carcinoma: bile duct, head of pancreas, ampulla
  • Biliary stricture
  • Sclerosing cholangitis
  • Pancreatic pseudocyst
39
Q

What are the causes of intrahepatic cholestasis?

A
  • Viral hepatitis
  • Drugs
  • Alcoholic disease
  • Cirrhosis
  • Autoimmune cholangitis
  • Pregnancy
  • Recurrent idiopathic cholestasis
  • Some congenital disorders
  • Infiltrations
40
Q

Difference in clinical presentation between pre-hepatic and cholestatic jaundice

A
  • Cholestatic: pale stools and dark urine, serum bilirubin is conjugated, maybe itching, LFTS abnormal
  • Pre-hepatic: Normal urine and stools, not itching and normal LFTs
41
Q

Jaundice presentation - what questions should you ask?

A
  • Dark urine? Pale stools? Itching? –> Cholestatic cause
  • What are your symptoms? (biliary pain, rigorsm abdomen swelling, weight loss)
  • PMHx: biliary disease/ intervention/ malignancy/HF/blood products/autoimmune disease
  • Drug history: drugs/herbal meds started recently
  • social history: Alcohol, foreign travel, sex, IVDU, certain foods
  • FHx/ system review - not that helpful
42
Q
A
43
Q

Jaundice presentation: What investigations?

A
  • Viral Markers: HepA,B,C
  • Ultrasound examination
  • Liver biochemistry

PHASE 2A MEDICINE - ANJALI createdd (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions