liver biochemistry Flashcards by Niamh Walsh

where is the liver located?

Located under the diaphragm in the RUQ

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what is the structure of the liver?

2 lobes
Highly vascular structure
Made up of about 300 billion cells

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what are the functions of the liver?

Homeostasis
Metabolism
Synthesis
Immunological
Storage
Production of
bile

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what does the liver homeostasis?

glucose

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what does the liver control the metabolism of?

Carbohydrates
Protein
Fats
Steroid hormones
Insulin
Bilirubin
Drugs
Toxins

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what does the liver control the synthesis of?

Protein
Clotting factors
Cholesterol

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what is the livers immunological function?

Mobilise the macrophage system
Kupffer Cells

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what does the liver store?

Fat soluble vitamins
Glycogen

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what does the liver secrete?

bile salts

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what are the different types of liver diseases?

Cholestatic
Hepatocellular disease
– Steatosis
– Hepatitis
Fibrosis
Cirrhosis

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what is the difference between acute and chronic liver disease?

acute:
– Mild
– Self-limiting
– Develop into chronic disease
* Chronic
– Structural changes
→Compromise liver function

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what are the symptoms of liver disease?

Initially:
– Non-specific
– Easily fatigued
– Nausea
Often:
– Loss of appetite
– Weight loss

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when are symptoms of liver disease most apparent? what are they?

Apparent in decompensated liver disease
Loss of muscle from arms and legs
Swelling of the abdomen and lower body
Abdominal pain
Pruritus
Bruising
Bleeding – gums, nose

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when are symptoms of liver disease most apparent? what are they?

Apparent in decompensated liver disease
Loss of muscle from arms and legs
Swelling of the abdomen and lower body
Abdominal pain
Pruritus
Bruising
Bleeding – gums, nose

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what are some signs of liver disease?

jaundice, fever, finger clubbing,white nails, oedema, varices, pigmentated ulceration of the skin

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what are some causes of liver disease?

alcohol
viral infections- eg hep a,b,c,d,e
malignancy
immune disease
drugs and toxins

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what is the marker of liver dysfunction?

Use a combination of factors:
–LFTs and additional tests
–Diagnosis
–Signs and symptoms

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what are the standard LFTs?

– Albumin
– ALT
– AST
– GGT
– ALP
– Bilirubin
* Also need to remember:
– Clotting screen

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what use would testing albumin be in liver disease?

Half life: 20 days
– Acute liver disease: normal
– Useful guide to the severity of chronic liver
disease
– Consider extrahepatic causes for low levels

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when is alanine transferase released? - ALT

Released from hepatocytes when they are
damaged

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what may ALT indicate?

a drug induced reaction

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what is more specific to the liver ALT or AST?

ALT

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when is asparate transferase released- AST

released from hepatocytes when they are damaged

where is AST primarily found?

in mitochondria- also in heart, kidnets, lung muscle and RBC

what markers in liver function tests tend to ruse and fall at the same time?

AST and ALT

what does the ratio of AST: ALT indicate?

may help in making a diagnosis more or less likely

what would the levels be in hepatocellular injury?

AST lower than ALt chronic liver disease

what would the levels of established cirrhosis be?

AST>ALT – AST:ALT of 2:1 or greater * Alcoholic Liver Disease * Especially if rise in GGT

what is GGT?

Gamma-Glutamyl transpeptidase (0 – 50 IU/L) – Enzyme

where is GGT present? when is it released?

Hepatocytes, biliary epithelial cells, kidney, pancreas, intestine, prostate – Released in all types of liver dysfunction

what would the presence of GGT indicate?

indicate alcohol abuse or if they are taking enzyme inducing drugs

what is ALP?

Alkaline phosphatase it is an isoenzyme

where is ALP produced?

produced in hepatocytes

when would ALP be raised?

raised in cholestatic disease Isolated rise may not be associated with liver dysfunction

what is bilirubin?

breakdown product of RBC

what happens when bilirubin is transported into the liver?

bilirubin is conjugated

when would bile levels rise?

– When damage to the liver occurs, resulting in jaundice – Biliary tract obstruction – Haemolysis

what are the clotting factors in the liver?

prothrombin- produced in the liver, vit K dependent

what is prothrombin time?

– Marker of synthetic function – Time taken for a clot to form – Exclude vitamin K deficiency

what additional tests can be preformed in addition to liver function tests?

– Ultrasound – Doppler – Biopsy – Computed Tomography (CT) – ERCP – MRI

what are some of the complications with liver disease?

* Portal hypertension * Ascites * Encephalopathy * Bleeding varices * Spontaneous bacterial peritonitis (SBP) * Pruritus * Deranged clotting * Hepatorenal syndrome (HRS)

what is portal hpt? how do you treat?

Increased pressure in portal venous system – Collateral veins develop – Contribute to ascites and encephalopathy * Treatment: – Propranolol

what is ascites and how do you treat it?

* Swollen abdomen – Accumulation of fluid – Reduction in serum albumin – Portal hypertension – Decrease in aldosterone metabolism * Treatment: – Low sodium diet – Mobilise excess fluid * Diuretics * Paracentesis

when does encephalopathy occur?

occurs with significant liver dysfunction – Altered permeability of the BBB * Ammonia – Altered mental state, asterixis

how do you treat encephalopathy?

– Aim is to reduce ammonia in circulatory system – Lactulose – Antibiotics * Rifaximin

what is bleeding varices?

Upper GI bleeding – Occurs in 50% of patients with end stage liver disease

what are the aims of treatment with bleeding varices?

– Stop or slow down blood loss – Treat hypovolaemic shock – Prevent recurrent bleeding

how do you prevent bleeding varices?

– Propranolol and endoscopic ligation – Carvedilol

how do you treat bleeding varices?

– Vasopressin or its analogue (terlipressin) – Somatostatin or its analogue (octreotide) – Balloon tamponade

what is the treatment and prophylaxis of spontaneous bacterial peritonitis?

– Acute * IV antibiotics – Prophylaxis * High risk patients * Quinolones

what is pruritis and how is it treated?

Deposition of bile salts within the circulation * Treatment: – Depends on severity * Moisturising and cooling agents * Ursodeoxycholic acid * Antihistamines * Anion exchange resins

what could be the underlying cause of muscle cramps?

diuretic induced vitamin D deficiency

what treatment would you give for muscle cramps?

quinine sulphate

what are the s/e of quinine sulphate?

* Thrombocytopenia * Cardiotoxicity

what pain relief can you give in liver disease?

DO NOT USE NSAIDs * Opioids – Morphine – Oxycodone – Fentanyl * Paracetamol

what considerations should be made in liver disease?

hepatic blood flow portosystemic shunting reduced hepatic cell mass reduction in protein binding side effects

what are the main drug-induced liver diseases?

– Statins – NSAIDs – Penicillin’s which may present weeks or months after stopping due to half life