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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
Q

What is ALT a marker of?

A

Hepatocellular injury

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26
Q

Which structures is ALP present in?

A

Liver
Bile duct
Bone
Placenta

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27
Q

What alters the level of ALP?

A 
Biliary obstruction
Liver disease
Bone pathology
Thyroid abnormality
Pregnancy
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28
Q

What is ALP a marker of?

A

Cholestasis

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29
Q

Which structures is GGT present in?

A 
Liver
Bile ducts
Kidney
Pancreas
Gallbladder
Spleen
Heart
Brain
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30
Q

What alters the level of GGT?

A

Biliary obstruction
Liver and pancreas disease
CV disease
Alcohol abuse

31
Q

What does an increase in ALT and AST indicate?

A

Hepatocellular injury

32
Q

What does an increase in ALP and GGT indicate?

A

Cholestasis

33
Q

What does a more than 10 fold increase in ALT and a less than 3 fold increase in ALP indicate?

A

Predominately hepatocellular injury

34
Q

What does a less than 10 fold increase in ALT and a more than 3 fold increase in ALP indicate?

A

Cholestasis

35
Q

What is the primary marker of cholestasis?

36
Q

How are GGT and ALP used to narrow down a cause?

A

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
Q

What is highly suggestive of cholestasis?

A

Marked increase in ALP and GGT

38
Q

What is the relationship between GGT and alcohol?

A

GGT is elevated by large alcohol abuse, especially if disproportionate increase compared to ALT and others

39
Q

What is AST < ALT suggestive of?

A

Chronic liver disease

40
Q

What is AST > ALT suggestive of?

A

Acute alcoholic hepatitis

41
Q

What is the normal ratio of AST:ALT?

42
Q

What ratio of AST:ALT is suggestive of alcohol abuse?

43
Q

What is the diagnosis likely to be if AST and ALT are both very high, >1000 U/L?

A

Almost certainly hepatitis

44
Q

What will AST levels never surpass in chronic alcoholic disease?

45
Q

What conditions are indicated when AST levels are elevated to more than 20 times normal?

A

Viral hepatitis
Muscle trauma
Surgery
Drug induced hepatic trauma

46
Q

What conditions are indicated when AST levels are elevated to 10-20 times normal?

A

Alcoholic cirrhosis

MI

47
Q

What conditions are indicated when AST levels are elevated to 5-10 times normal?

A

Chronic cirrhosis

48
Q

What conditions are indicated when AST levels are mildly elevated?

A

Steatosis
Liver metastases
PE

49
Q

When is albumin synthesised?

A

In a functioning liver

50
Q

What is the function of albumin?

A

Intravascular osmotic pressure

51
Q

What may cause albumin levels to fall?

A

Cirrhosis
Inflammation in the acute phase decreases albumin temporarily
Protein-losing enteropathy, nephrotic syndrome

52
Q

What is prothrombin time?

A

The time taken for blood to clot

53
Q

What conditions can raise PT?

A

Liver disease in the absence of secondary causes

Reduced production of clotting factors

54
Q

What is bilirubin?

A

A breakdown product of haemoglobin

55
Q

When is bilirubin conjugated?

A

When it has been taken up in the liver

56
Q

When is jaundice visible?

A

Bilirubin >60mmol/L

57
Q

Does conjugated or unconjugated bilirubin have an effect on the colour of urine, and what is that effect?

A

Conjugated bilirubin causes darker urine

58
Q

What causes pale and bulky stools (steatorrhoea)?

A

Bile (containing bilirubin) and lipase cannot reach the bowel due to blockage, fat is therefore not absorbed and cause this appearance of stools

59
Q

What is pre-hepatic jaundice?

A

Excessive red cell breakdown overwhelms the liver

Decrease in conjugated and increase in unconjugated bilirubin

60
Q

What is hepatocellular jaundice?

A

Liver loses conjugating ability and cirrhosis compresses the biliary tree

61
Q

What is post-hepatic jaundice?

A

Obstruction to biliary drainage but bilirubin is stilll conjugated in the liver

62
Q

What does dark urine and pale stools indicate?

A

Post-hepatic cause

63
Q

What does normal urine and normal stools indicate?

A

Pre-hepatic cause

64
Q

What does dark urine and normal stools indicate?

A

Hepatic cause

65
Q

What are ALT, AST, ALP and GGT like in acute hepatocellular damage?

A

ALT - very elevated
AST - very elevated
ALP - normal or elevated
GGT - normal or elevated

66
Q

What are ALT, AST, ALP and GGT like in chronic hepatocellular damage?

A

Everything is normal or elevated

67
Q

What are ALT, AST, ALP and GGT like in cholestasis?

A

ALT - normal or elevated
AST - normal or elevated
ALT - very elevated
GGT - very elevated

68
Q

What could be the cause if the patient is jaundiced but ALP and ALT are normal?

A

Gilbert’s syndrome

Haemolytic anaemia

69
Q

What is Gilbert’s syndrome?

A

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
Q

What is haemolytic anaemia?

A

Abnormal breakdown of red blood cells

Fatigue, SOB, jaundice

71
Q

What are causes of acute hepatocellular jaundice?

A

Poisoning
Infection
Liver ischaemia

72
Q

What are the causes of chronic hepatocellular jaundice?

A 
Chronic liver diseases
PBC, PSC
Pregnancy
Autoimmune hepatitis
Haemochromatosis
Wilson's disease
73
Q

What are the causes of obstructive jaundice?

A

Gallstones
Strictures
Tumours
Congenital biliary atresia

Y1 - Gatrointestinal (31 decks)

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