liver disease Flashcards
standard LFTs (7)
- Alanine transaminase (ALT)
- Aspartate aminotransferase (AST)
- Alkaline phosphatase (ALP)
- Gamma-glutamyltransferase (GGT)
- Bilirubin
- Albumin
- AI4P
(8. PT)
what are the parameters of the childs pugh score (5)
- bilirubin
- albumin
- INR
- ascites
- encephalopathy
what is the childs pugh score
score that acts as a predictor of complications/mortality of cirrhosis
examples of drugs that can induce liver injury
- carbamezapine
- methyldopa
- minocycline
- macrolide abx (e.g. Azithromycin, clarithromycin)
- nitrofurantonin
- statins
- sulphonamides
- terbinaphone
- methotrexate
- chlorpromazine
what cells lay down fibrotic tissue when hepatocytes are damaged
hepatic stellate cells
what is the metavir score (liver)
a system used to assess the extent of inflammation and fibrosis by histopathological evaluation in a liver biopsy of patients with hepatitis C
metavir score stages (5)
F0 - no fibrosis
F1 - portal fibrosis without septa (mild)
F2 - portal fibrosis with a few septa -> bridging (moderate)
F3 - numerous septa without cirrhosis (sever)
F4 - cirrhosis -> nodular transformation totally surrounded by fibrosis
what is bridging in liver fibrosis
formation of a continuous ridge between the central vein + potal vein or 2 central veins or 2 portal veins of a liver acinar unit
at what metavir stage is there concern
F2 - bridging beginning to occur
what is fibroscanning
a type of ulstrasound scan used to measure the level of fibrosis of the liver -> fibrotic liver is stiffer and so the US wave is reflected back more
where do ALT and AST originate from
the hepatocytes
why is PT/INR checked in liver disease
the liver makes clotting factors 2, 7 ,9 and 10 => damage to the liver will reduce production of these leading to longer clotting time
what is choleostasis
alteration in bile flow
what does an isolated raised ALP indicate the source of the pathology is
a non-liver source e.g. bone
what does a raised ALP and GGT indiacte the source of the pathology is
hepatobilary souce -> obstructive liver disease or biliary problem
what is fulminant hepatic failure and what markers are raised
acute liver failure -> no pre-existing disease but a clear insult has occured to cause it
markers:
raised INR, ALT, bilirubin, ammonia (leads to brain swelling and multiple organ failure)
what is acute on chronic liver failure (ACLF)
chronic liver disease with and acute picture -> acute hepatic decompensation, organ failure and a high risk of short-term mortality
what is intrahepatic choleostasis
failure of liver cells to make bile at levelof canaliculus
what is extra hepatic cholestasis
large duct obstruction
hepatic liver injury picture LFTs
ALT > 5x upper limit
ALP < 2x upper limit
cholestatic liver injury picture LFTs
ALT < 2x upper limit
APT >5x upper limit
mixed liver injury picture LFTs
ALT 2-5x upper limit
ALP 2-5x upper limit
why might COPD history be important in liver history
early emphysema may indicate an alpha-1-antitrypsin deficency (AAT is produced by the liver and acts to protect the lungs)
why is travel history important in liver disease
risk of tropical disease, hepatitis etc.
examples of signs of chronic liver disease on examination (7)
- jaundice
- spider naevi
- gynacomasteia
- clubbing
- ascites
- palmar erythema
- bruising easily
signs of portal hypertension (4)
- oesophageal varices -> can present in haematemesis or malena
- splenomegaly
- dilated abdominal veins (caput medusa)
- rectal varices (haemorrhoids)
4 liver causes for extremely high ALT (>1000)
- ischaemia (known Heart failure w new onset ischaemia/arrhythmia -> interruption to blood flow causing death of hepatocytes)
- drug induced (e.g. paracetemol overdose!)
- viral hepatitis
- acute biliary obstruction
4 non liver causes for extremely high ALT (>1000)
- haemolysis
- myositis/myopathy
- strenuous exercise
- sepsis
what will fasting lipids in NAFLD show
high cholesterol, low LDL
what is haemochromatosis
an disorder where iron-binding protein accumulates in various tissues, typically leading to liver damage, diabetes mellitus, and bronze discoloration of the skin
what is the audit-c score
Alcohol Use Disorders Identification Test -> a questionnaire to routinely assess the nature and severity of alcohol misuse
when is intervention necessary according to the audit-c score
0-4 -> no action
5-11 -> brief intervention (>3 if over 65yro)
11+ -> likely dependent on alcohol, may need specialist help
how many units is a standard pint of beer
2.3 units
how many units is a standard (175ml) glass of wine
2.3 units
what does an isolated high bilirubin indicate?
gilbert’s syndrome (can’t conjugate bilirubin due to enzyme deficency)
what does high bilirubin and deranged LFTs indicate
bile flow problem
what symptoms will intrahepatic cholestasis present with (2)
pruritis, fatigue
what must be excluded in pts w isolated high bilirubin
haemolysis -> check reticulocyte count, LDH, haptoglobin
what does high bilirubin in the blood but absent in urine indicate
it is entirely unconjugated as can’t get into the urine
