Liver Biochemistry Flashcards
What are the common features of acute liver disease? (3)
Mild
Self limiting
Can progress to chronic disease
What are the common features of chronic liver disease? (2)
Structural changes - compromised liver function.
What are the initial symptoms of liver disease? (3)
Non-specific
Easily fatigued
Nausea
What are the common symptoms of liver disease? (2)
Appetite loss
Weight loss
What are the common symptoms of decompensated liver disease? (7)
Muscle loss from arms and legs
Abdomen/lower body swelling
Ab. Pain
Pruritis
Bruising
Bleeding - gums, nose.
What are the signs of liver disease? (23)
Jaundice
Fever
Dupytren’s contracture
Palmar Erythema
Finger clubbing
Spider naevi
White nails
Splenomegaly
Purpura
Gynacomastia
Ascites
Bruising and bleeding
Altered liver mass
Oedema
Pigmented skin ulceration
Dilated abdominal blood vessels
Varies
Neurological changes
Hepatic Flap
Xanthelasma
What are the causes of liver disease? (7)
Alcohol (Alcohol liver disease)
Viral infections (Hep. A-E)
Fatty liver (NASH, NAFLD)
Malignancy (HCC)
Immune disease (Autoimmune hepatitis)
Inherited and metabolic disorders (Alpha1-antitrypsin deficiency, Wilson’s disease)
Drugs and toxins (Paracetamol, Phenytoin, oral contraceptives, MTX)
What are the main features of ALT? (5)
Alanine transferase (0-40IU/L):
- Released from hepatocytes when they’re damaged.
- Cytosol enzyme.
- More specific to the liver than AST.
- Also indicate drug-induced reaction.
What are the main features of AST? (6)
Aspartame Transferase (0-40IU/L):
- Released from hepatocytes when damaged.
- Primarily found in mitochondria.
- Also present in the heart, pancreas, kidney, lung, muscle and RBC.
- AST + ALT tend to rise and fall at the same time.
- May indicate a possible drug-induced reaction.
What are the LFT results of hepatocellular injury? (1)
AST < ALT = chronic liver disease
What is the LFTs results for established liver cirrhosis? (3)
AST > ALT
AST: ALT = 2:1 or greater
Especially if GGT is high.
What are the main features of GGT? (6)
Gamma-glytamyl transpeptidase (0-50IU/L):
- Enzyme
- Hepatocytes, biliary epithelial cells, kidney, pancreas, intestine, prostate.
- Released in all types of liver dysfunction.
- Indicate alcohol abuse.
- If taking enzyme inducing drugs.
What are the main features of ALP? (6)
Alkaline Phosphatase (30-120IU/L):
- Check local range
- Isoenzyme
- Produced in hepatocytes.
- Raised in cholestatic disease.
- Isolated rise may not be associated with liver dysfunction.
What are the main features of Bilirubin? (5)
5-21umol/L
Breakdown RBC product.
Transported to the liver, attached to albumin.
In the liver, bilirubin is conjugated.
Excreted via bile.
What factors causes a rise in bilirubin? (3)
When damage to the liver occurs resulting in jaundice.
Biliary tract obstruction
Haemolysis
What are the main features of Prothrombin? (2)
Produced in the liver.
Vitamin K dependent
What are the main features of Prothrombin time? (4)
12-16 seconds
Marker of synthetic function
Time taken for a clot to form
Excludes vitamin K deficiency.
What are the common symptoms of hypoalbuminemia? (5)
Oedema
Appetite changes
Muscle breakdown
Dry skin
Abnormal weight gain.
What are the potential causes of hypoalbuminemia? (4)
HF
Diabetes
Vitamin deficiencies
Severe burns
What additional tests is considered for assessing liver function? (6)
US
Doppler
Biopsy
CT
ERCP
MRI
What tool is used to grade severity? (1)
Child-Pugh classification.
What are the main features of portal hypertension as a liver disease complication? (3)
Increased pressure in portal venous system where collateral veins develop and contributes to ascites and encephalopathy.
Tx:
- Carvedilol
- Propranolol
What are the main features of ascites as a liver disease complication? (3)
Swollen abdomen due to fluid accumulation, reduction in serum albumin, portal hypertension, decrease in aldosterone metabolism.
Tx:
- Low sodium diet
- Mobilise excess fluid = diuretics/ paracentesis.
What are the main features of encephalopathy as a liver disease complication? (6)
Occurs with significant liver dysfunction:
- Altered BBB permeability (ammonia)
- Altered mental state, asterixis
Tx:
- Aim to reduce ammonia in circulatory system
- Lactulose
- ABx = Rifaximin.
What are the main features of bleeding varices as a liver disease complication? (10)
Upper GI bleed: End stage liver disease (50%)
Tx Aims:
- Stop or slow down blood loss.
- Treat hypovolaemic shock.
- Prevent recurrent bleeding
Prevention of bleeding:
- Propranolol + endoscopic ligation
- Carvedilol
Bleeding Treatment:
- Vasopressin or analogue (Terlipressin)
- Somatostatin or analogue (octreotide)
- Balloon Tamponade
PPI use:
- Associated with increased complications in cirrhosis, use with caution.
What are the main features of spontaneous bacterial peritonitis as a liver disease complication? (5)
Complication of cirrhosis:
- Acute bacterial infection of ascitic fluid.
Tx:
- Acute: IV ABx
Prophylaxis:
- High risk px
- Quinolones
What are the main features of pruritis as a liver disease complication? (5)
Common and distressing:
- Bile salt deposition within the circulation.
Tx:
- Depends on severity: Moisturising/cooling agents, ursodeoxycholic acid, antihistamines, anion exchange resins.
Explain the management of alcohol withdrawal. (4)
Palliative care:
- CIWA-Ar
- Scoring system
- BZP
- Moderate to severe withdrawal: Reduced mortality, duration of withdrawal symptoms, seizures, delirium tremens.
Explain the main features of muscle cramps. (3)
Cause:
- Diuretics
- Vitamin D deficiency
Tx:
- Quinine sulphate: S/E - hrombocytopenia, cardiotoxicity.
Explain the management of pain. (3)
Don’t use NSAIDs
Opioids: Morphine, Oxycodone, Fentanyl.
Paracetamol
What do you need to consider for pharmacokinetics of liver disease? (8)
ADME
Reduced hepatic blood flow (increase in systemic bioavailability of oral drugs undergoing 1st pass metabolism)
Portosystemic shunting (60% blood supply altered)
Reduced hepatic cell mass (severe disease, drugs extensively metabolised via liver)
Reduced protein binding (lower serum albumin, highly protein drugs, drug free concentration increased)
What do you need to consider for pharmacodynamics of liver disease? (5)
S/E:
- Exacerbations of complications (e.g. opioids, BZP, Diuretics, NSAIDs)
Give e.g. of drugs that can induce liver disease. (3)
Statins
NSAIDs
Penicillin
How long can drug-induced liver disease symptoms present? (1)
Weeks or months after the medication has been started or even stopped.
