Liver Function Tests Flashcards

0
Q

Causes of liver disease

A
Infection
Adverse drug reaction 
Alcohol abuse
Obesity 
Cancer
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1
Q

Signs of hepatic disease

A
Jaundice
Pruritis 
Nausea and vomiting 
Hepatomegaly 
Ascites
Spider naevi
Dark urine and pale stools
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2
Q

Normal blood concentrations

A
Bilirubin 5-17micromol/l
Hepatocellular:
Alanine (ALT) <50iU/l
Obstruction:
Alkaline phosphatase 39-17iU/l
Gamma-glutamyl transpeptidase 0-70iU/l male 0-40iU/l female
Synthetic function: 
Albumin 30-48g/l 
Coagulation INR 1-1.2
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3
Q

Stages of haem breakdown

A
Haem-> iron+globin
     |
Biliverdin
     |
Insoluble bilirubin
      |
Liver
     |
Soluble bilirubin 
Biliary excretion
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4
Q

Conditions where bilirubin might be altered

A

Biliary obstruction (choleostasis)
Hepatocellular damage
Haemolysis

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5
Q

Conditions where aminotransferases maybe altered

A

Hepatocellular damage
Leak out of damaged cells-> large increase in blood
Detection of paracetamol overdose
ALT more specific to liver damage

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6
Q

Conditions where Alkaline phosphatase might be altered

A

Present in canicular and sinusoid membranes of liver
Increased in choleostasis
But also produced by bone and placenta so increased in pregnancy
Raised in infiltration of the liver-> metastasis

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7
Q

Conditions where Gamma GT’s might be altered

A
Present in manny tissues
Increased by induction
Alcohol 
Carbamazepine
Barbiturates
Phenytoin
Rifampincin
Increased in choleostasis 
May be increased in cellular damage
Look at mean corpuscular volume as we'll
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8
Q

Conditions where albumin might be altered

A

Measure of synthetic activity of the liver

Indicates a change over longer term-> 16-24 days

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9
Q

International normalised ratio

A

Prothrombin time
Indicates synthetic activity
Coagulation factors have a short half life so indicates change acute and chronic

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10
Q

Hepatitis LFT results

A
ALT and AST raised 
ALP increased or normal 
Bilirubin increased or normal
GGT increased or normal
Albumin only effected in late stages 
INR raised or normal
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11
Q

Cholestasis LFT results

A
ALP raised
GGT raised 
Bilirubin raised  as not excreted 
ALT and AST raised or normal
Albumin normal, synthetic function not effected by choleostasis 
INR raised or normal
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12
Q

LFT chronic liver disease

A
GGT raised
Bilirubin raised
Albumin decreased
INR increased
ALP, ALT, AST raised or normal
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13
Q

Pre hepatic jaundice

A

Problem before liver
Insoluble bilirubin produced faster than the liver can conjugate it
Haemolytic anaemias such as spherocytosis
Gilbert’s syndrome-> decreased UDP- glucuranosyl transferase-> conjugated bilirubin

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14
Q

Hepatocellular jaundice

A

Transaminases leak out
Liver can’t conjugate bilirubin
Reduced excretion

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15
Q

Choleostasis

A
Cholesterol blockage of bile duct 
Intra hepatic:
Primary biliary cirrhosis-> autoimmune damage to duct
hepatocellular damage
Pregnancy
Extra hepatic:
Gall stones
Cancer in head of pancreas
16
Q

Obstructive jaundice

A

Choleostasis
GGT and ALP not excreted so are raised
Liver can conjugate but not excrete bilirubin
Water soluble bilirubin excreted in urine

17
Q

Other complications, ascites

A

Accumulation of fluid in peritoneal cavity
Oedema secondary to hypoproteinaemia
Sodium retention due to secondary hyperaldosteronism
Portal hypertension
Treat with diuretics or surgery

18
Q

Encephalopathy

A
Neuropsychiatric symptoms 
Personality changes
Disorientation 
Confusion and drowsiness
Sensitivity to centrally acting drugs
Ammonia produced by gut isn't exerted by liver-> reacts with neurotransmitters 
Rx. Neomycin/metronidazole and lactulose
19
Q

Other complications of liver disease

A

Impaired coagulation
Gastric bleeding rx ranitidine
Bleeding of oesophageal varies rx beta blockers, octreotide