Liver damage Flashcards
What is the function of SER, RER & lysosomes in the liver?
- SER=bilirubin conjugation, drug detoxification
- RER=protein, lipid, enzyme synthesis
- L=intracellular scavengers (copper,ferritin)
What are LFTs?
- Bilirubin
- Albumin
- Alkaline phosphotase
- ALT
- Total protein
- GGT
What specific things are being tested for with:
- urea
- albumin
- Cholesterol
- Prothrombin
- U&P=clotting factors, aa metabolism, urea synthesis, vit K
- A=synthesis & catabolism
- C=synthesis& lipoproteins
What test can be used for suspected hepatocyte damage?
- Aminotransferase
- ALT, AST- intracellular only released in damage
- ALT more specific for liver
- AST found in muscles, RBC
- α-fetoprotein in hepatocellular carcinoma
What test can be used for suspected biliary tract damage?
- Impaired excretory function=inc conjugated bilirubin
- ALP= elevated due to inc production (cirrhosis, tumours, infiltrative disease, cholestasis)
- γGT=elevated due to structural damage (alcohol, HF, kidney damage, prostatic&pancreatic disease)
What are biochemical markers of fibrosis?
-ELF score: hyaluronic acid, PIIINP, TIMP-1
What bilirubin levels cause jaundice?
- Serum level >40-50
- Unconjugated= pre & hepatic
- Conjugated=hepatic & post
What are causes of pre & post hepatic jaundice
- Hyperbilirubinaemia
- Pre=haemlysis (rhesus incompatibility), ineffective erythropoiesis (spherocytosis)
- Post=gallstones, cholangitis, cancer, biliary stricture
What are causes of conjugated/unconjugated jaundice?
- C=impaired excretion, inherited (Dubin-Johnson, rotor), intrahepatic obstruction
- U=Microsomal, inherited (Gilberts), pre-microsomal
What are inborn errors of bilirubin metabolism?
- Dec activity of UDP transferase= Gilbert’s/Crigler
- Red ability to excrete bilirubin glucuronide= ROTOR, Dubin-Johnson
What blood results would be obtained from someone with:
- Hepatitis
- Obstructive jaundice
- H= AST/ALT elevated, normal ALP
- U=AST/ALT normal, ALP elevated
What test results can be found from the urine of someone with jaundice?
- Prehepatic= no urinary bilirubin
- Posthepatic=dark urine & pale stools
What test can be carried out on the liver for suspected:
- Hepatocellular cancer
- Primary Biliary Cirrhosis
- Wilson’s disease
-HC=AFP
PBC=Anti mitochondrial antibodies
-Urine/plasma copper, liver biopsy, Caeruloplasmin
What are the systemic effects of liver disease?
- Oestrogen: gynaecomastia, spider naevi, liver palms, testicular atrophy
- Pigmentation
- Bruising
- Ascites
- Encephalopathy
- Osteomalacia/porosis
- Clubbing
What are the functions of the pancreas?
- Exocrine: Bicarb, digestive enzymes
- Endocrine: Insulin, glucagon, pancreatic polypeptide
