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Y1 - Gatrointestinal > Liver Biochemistry and Jaundice > Flashcards

Liver Biochemistry and Jaundice Flashcards

1
Q

What is the liver enclosed in?

A

Capsule covered by visceral peritoneum

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2
Q

What does the falciform ligament do?

A

Divides the left lobe and the larger right lobe

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3
Q

What is a hepatic lobule?

A

A smaller hexagonal division of lobes

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4
Q

What does a hepatic lobule consist of?

A

Portal triad
Hepatocytes in linear cords
Capillary network and central vein
Lymphatics and vagus nerve

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5
Q

What is the functional unit of the hepatic lobule?

A

Liver acinus

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6
Q

What are sinusoids?

A

Capillaries with fenestrated epithelium that carry blood towards to central vein

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7
Q

What is the space of Disse?

A

The part of the liver between a hepatocyte and a sinusoid

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8
Q

What carbohydrate metabolism does the liver do?

A

Anabolism and catabolic of sugars

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9
Q

What fat metabolism does the liver do?

A

Break down and synthesis
Processing chylomicron remnants
Lipoprotein and cholesterol synthesis

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10
Q

What protein metabolism does the liver do?

A

Synthesis of proteins like albumin
Transamination and deamination of amino acids
Conversion of ammonia to urea

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11
Q

What hormones does the liver deactivate?

A

Insulin
Glucagon
ADH
Steroid hormones

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12
Q

What molecules does the liver store?

A 
Vit B12
Vit A, D, E, K (fat-soluble)
Iron
Copper
Glycogen
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13
Q

What is drug metabolism?

A

The breakdown of drugs to facilitate excretion

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14
Q

What happens in phase 1 of drug metabolism?

A

The polarity of the drug is increased by oxidation, reduction or hydrolysis in order to permit conjugation

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15
Q

What molecule plays a big role in phase 1 of drug metabolism?

A

Cytochrome P450

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16
Q

What happens in phase 2 of drug metabolism?

A

Polarity is further increased by adding a reactive group to the drug to result in an inactive product which can be excreted

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17
Q

Which blood tests are included in LFTs?

A 
AST
ALT
ALP
GGT
Bilirubin
Albumin
Prothrombin time
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18
Q

Which are the ‘true’ LFTs and what does that mean?

A

Bilirubin
Albumin
PT
Ones involved in the synthesis of proteins that give a measure of whether the liver is making stuff

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19
Q

Which structures is ALT present in?

A

Liver

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20
Q

What increases the levels of ALT?

A

Hepatocellular injury

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21
Q

Which structures is AST present in?

A 
Liver
Heart
Skeletal muscle
Kidneys
Brain
RBC
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22
Q

What increases the levels of AST?

A 
Liver injury
MI
Pancreatitis
Haemolytic anaemia
Renal or MSK disease
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23
Q

What does a higher level of AST than ALT indicate?

A

Muscle injury

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24
Q

What is AST a marker of?

A

How acute hepatocellular damage is

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25
What is ALT a marker of?
Hepatocellular injury
26
Which structures is ALP present in?
Liver Bile duct Bone Placenta
27
What alters the level of ALP?
``` Biliary obstruction Liver disease Bone pathology Thyroid abnormality Pregnancy ```
28
What is ALP a marker of?
Cholestasis
29
Which structures is GGT present in?
``` Liver Bile ducts Kidney Pancreas Gallbladder Spleen Heart Brain ```
30
What alters the level of GGT?
Biliary obstruction Liver and pancreas disease CV disease Alcohol abuse
31
What does an increase in ALT and AST indicate?
Hepatocellular injury
32
What does an increase in ALP and GGT indicate?
Cholestasis
33
What does a more than 10 fold increase in ALT and a less than 3 fold increase in ALP indicate?
Predominately hepatocellular injury
34
What does a less than 10 fold increase in ALT and a more than 3 fold increase in ALP indicate?
Cholestasis
35
What is the primary marker of cholestasis?
ALP
36
How are GGT and ALP used to narrow down a cause?
If ALP is increased, look at GGT If GGT is also increased this suggests biliary epithelial damage and bile flow obstruction, therefore indicating choletasis If only ALP is increased the cause is likely to not be the liver
37
What is highly suggestive of cholestasis?
Marked increase in ALP and GGT
38
What is the relationship between GGT and alcohol?
GGT is elevated by large alcohol abuse, especially if disproportionate increase compared to ALT and others
39
What is AST < ALT suggestive of?
Chronic liver disease
40
What is AST > ALT suggestive of?
Acute alcoholic hepatitis
41
What is the normal ratio of AST:ALT?
0.8
42
What ratio of AST:ALT is suggestive of alcohol abuse?
>2
43
What is the diagnosis likely to be if AST and ALT are both very high, >1000 U/L?
Almost certainly hepatitis
44
What will AST levels never surpass in chronic alcoholic disease?
>1000
45
What conditions are indicated when AST levels are elevated to more than 20 times normal?
Viral hepatitis Muscle trauma Surgery Drug induced hepatic trauma
46
What conditions are indicated when AST levels are elevated to 10-20 times normal?
Alcoholic cirrhosis | MI
47
What conditions are indicated when AST levels are elevated to 5-10 times normal?
Chronic cirrhosis
48
What conditions are indicated when AST levels are mildly elevated?
Steatosis Liver metastases PE
49
When is albumin synthesised?
In a functioning liver
50
What is the function of albumin?
Intravascular osmotic pressure
51
What may cause albumin levels to fall?
Cirrhosis Inflammation in the acute phase decreases albumin temporarily Protein-losing enteropathy, nephrotic syndrome
52
What is prothrombin time?
The time taken for blood to clot
53
What conditions can raise PT?
Liver disease in the absence of secondary causes | Reduced production of clotting factors
54
What is bilirubin?
A breakdown product of haemoglobin
55
When is bilirubin conjugated?
When it has been taken up in the liver
56
When is jaundice visible?
Bilirubin >60mmol/L
57
Does conjugated or unconjugated bilirubin have an effect on the colour of urine, and what is that effect?
Conjugated bilirubin causes darker urine
58
What causes pale and bulky stools (steatorrhoea)?
Bile (containing bilirubin) and lipase cannot reach the bowel due to blockage, fat is therefore not absorbed and cause this appearance of stools
59
What is pre-hepatic jaundice?
Excessive red cell breakdown overwhelms the liver | Decrease in conjugated and increase in unconjugated bilirubin
60
What is hepatocellular jaundice?
Liver loses conjugating ability and cirrhosis compresses the biliary tree
61
What is post-hepatic jaundice?
Obstruction to biliary drainage but bilirubin is stilll conjugated in the liver
62
What does dark urine and pale stools indicate?
Post-hepatic cause
63
What does normal urine and normal stools indicate?
Pre-hepatic cause
64
What does dark urine and normal stools indicate?
Hepatic cause
65
What are ALT, AST, ALP and GGT like in acute hepatocellular damage?
ALT - very elevated AST - very elevated ALP - normal or elevated GGT - normal or elevated
66
What are ALT, AST, ALP and GGT like in chronic hepatocellular damage?
Everything is normal or elevated
67
What are ALT, AST, ALP and GGT like in cholestasis?
ALT - normal or elevated AST - normal or elevated ALT - very elevated GGT - very elevated
68
What could be the cause if the patient is jaundiced but ALP and ALT are normal?
Gilbert's syndrome | Haemolytic anaemia
69
What is Gilbert's syndrome?
Disorder of bilirubin processing in the liver where there is increased unconjugated bilirubin in the blood with normal LFTs which can produce jaundice during illness, alcohol or stress
70
What is haemolytic anaemia?
Abnormal breakdown of red blood cells | Fatigue, SOB, jaundice
71
What are causes of acute hepatocellular jaundice?
Poisoning Infection Liver ischaemia
72
What are the causes of chronic hepatocellular jaundice?
``` Chronic liver diseases PBC, PSC Pregnancy Autoimmune hepatitis Haemochromatosis Wilson's disease ```
73
What are the causes of obstructive jaundice?
Gallstones Strictures Tumours Congenital biliary atresia

Y1 - Gatrointestinal (31 decks)

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