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S1 Pharmacology > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

What is the largest solid organ in the body, weighing around 1.5 kg?

A
  • The liver
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2
Q

Where is the liver located in the body?

A
  • In the right hypochondrium, extending to the epigastrium.
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3
Q

Which structure effectively divides the liver into a right and left lobe?

A
  • The falciform ligament
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4
Q

How many blood supplies does the liver receive, and what are they?

A
  • 2 blood supplies
  • the hepatic portal vein,
  • the hepatic artery
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5
Q

What is the function of the hepatic portal vein in liver perfusion ?

A
  • It carries blood from the intestine before distribution to the general circulation.
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6
Q

What is the role of the hepatic artery in liver perfusion?

A
  • It supplies the liver with oxygen and nutrients.
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7
Q

What are the 7 primary physiological functions of the liver?

A
  1. Detoxification
    1. Glucose homeostasis
    2. Lipid homeostasis
    3. Protein synthesis and metabolism
    4. Bile acid metabolism and transport
    5. Hormone regulation
    6. Immunological function
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8
Q

How does the liver detoxify drugs?

A
  • occurs via cytochrome P450 enzymes
  • in a two-stage process involving oxidation and conjugation reactions.
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9
Q

What role does the liver play in glucose homeostasis?

A
  • The liver regulates blood glucose levels by storing and releasing glucose as needed.
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10
Q

How is the liver involved in lipid homeostasis?

A
  • liver synthesizes, stores, and metabolizes lipids, including cholesterol and triglycerides.
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11
Q

What proteins are synthesized and metabolized by the liver?

A
  • liver synthesizes, stores, and metabolizes lipids, including cholesterol and triglycerides.
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12
Q

How does the liver regulate hormones?

A
  • It conjugates oestrogen.
    • It metabolizes and regulates thyroxine (T4).
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13
Q

What immunological function does the liver perform?

A
  • The liver helps protect the body by filtering blood and producing immune-related proteins.
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14
Q

Can liver function tests (LFTs) be used in isolation?

A
  • No, LFTs should be used in context.
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15
Q

Name the standard parameters included in liver function tests (7)

A
  1. Alkaline phosphatase (AP)
    1. Alanine aminotransferase (ALT)
    2. Aspartate aminotransferase (AST)
    3. Gamma-glutamyl transferase (GGT)
    4. Bilirubin
    5. Albumin
    6. Total protein
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16
Q

Which parameter is not officially an LFT but is still useful in assessing liver function?

A
  • Clotting screen
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17
Q

What are the soluble cytoplasmic enzymes?

A
  • AST & ALT
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18
Q

What are the membrane - associated enzymes ?

A
  • AP & GGT
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19
Q

What does Alkaline Phosphatase (AP) refer to ?

A
  • A widely distributed set of isoenzymes.
20
Q

Where is hepatic AP produced, and when is its production increased?

A
  • Hepatic AP is produced by hepatocytes
  • its production increases with damage to the biliary system.
21
Q

What 3 conditions can cause increased levels of Alkaline Phosphatase (ALP)?

A
  • Cholestasis - obstruction to normal movement within the biliary system
  • Bone disease – Paget’s disease, bone malignancy, growth in teenagers
  • Pregnancy – elevated at the end of pregnancy and beyond, especially with breastfeeding.
22
Q

What are the two key aminotransferases measured in liver function tests?

A
  • Aspartate aminotransferase (AST).
  • Alanine aminotransferase (ALT).
23
Q

Where is AST widely distributed in the body?

A
  • Liver, heart, pancreas, lung, RBCs, and skeletal muscle.
24
Q

How do AST and ALT typically behave during liver injury ?

A
  • They tend to rise and fall in unison and are often discussed together.
25
Q

What do increased serum levels of aminotransferases indicate?

A
  • Hepatocellular damage or inflammation
26
Q

Where are high concentrations of GGT found in the body?

A
  • Liver, kidneys, pancreas, intestine, and prostate.
27
Q

What does elevated GGT indicate when raised alongside Alkaline Phosphatase (AP)?

A
  • Hepatobiliary disease
28
Q

In which conditions is GGT often elevated?

A
  • Alcoholic liver disease (ALD).
  • As a result of certain adverse drug reactions (ADRs).
29
Q

Why is albumin a useful measure of hepatic functional capacity?

A
  • most albumin is manufactured in the liver, making it a good indicator of liver function.
30
Q

What is the half-life of albumin, and what does it signify?

A
  • Around 20 days, reflecting a relatively long-term picture of disease.
31
Q

By how much can albumin levels decrease in cirrhotic patients?

A
  • Up to 50%
32
Q

Why is albumin important in terms of drug binding?

A
  • most acidic drugs are strongly bound to albumin
33
Q

In which conditions can albumin levels also be altered?

A
  1. Crohn’s disease.
    1. Malnutrition.
    2. Malignancy.
    3. Nephrotic syndrome.
34
Q

Which plasma proteins are most significant in liver function?

A
  • Albumin and clotting factors
35
Q

Name some additional plasma proteins produced by the liver ( don’t need to know in detail )

A
  1. Alpha-fetoprotein
    1. Gamma-globulins
    2. Transferrin
    3. Ferritin
    4. α1-antitrypsin
36
Q

What does INR stand for, and what is its significance?

A
  • International Normalized Ratio
  • it measures blood clotting, indicating liver function related to clotting factor production.
37
Q

What is considered an abnormal INR?

A
  • An INR greater than 1.3
38
Q

How is INR affected in patients with liver disease?

A
  • Patients with chronic or acute liver disease may have elevated INRs due to impaired clotting factor production.
39
Q

How can INR be used in the context of paracetamol poisoning?

A
  • It can serve as a marker of hepatocellular damage.
40
Q

3 main causes of jaundice based on bilirubin metabolism ?

A
  • increased production of bilirubin / decreased uptake (pre-hepatic)
  • decreased metabolism (intra-hepatic)
  • decreased excretion (hepatic + extra-hepatic)
41
Q

What conditions are associated with unconjugated hyperbilirubinaemia ?

A
  • Haemolysis
    • Gilberts syndrome
    • Crigler-Najjar syndrome
    • Drugs e.g. rifampicin
42
Q

What conditions are associated with conjugated hyperbilirubinaemia ?

A
  • Intra or extra-hepatic cholestasis
    • Acute Hepatitis
    • Cirrhosis
43
Q

Stages of Bilirubin metabolism

A
  • unconjugated bilirubin binds to albumin in blood
  • dissociates from albumin in the hepatic sinusoid, it is taken up by hepatocytes
  • unconjugated bilirubin conjugated with glucuronic acid by UDP-glucuronosyltransferase to conjugated bilirubin
  • conjugated bilirubin converted to urobilinogen in the small intestine by bacterial proteases
  • 10% of urobilinogen reabsorbed into hepatocyte via hepatic portal vein
  • 90% in feces
44
Q

What is the significance of raised ALP and GGT in liver function tests?

A
  • ALP raised solely consider bone-related causes such as: vitamin D deficiency
  • ALP + GGT raised: indicates cholestasis (biliary obstruction or dysfunction)
45
Q

What does greater than10x increase in ALT + less than 3x increase in ALP indicate?

A
  • hepatocellular injury, such as acute hepatitis or liver cell damage
46
Q

What does less than 10x increase in ALT + greater than 3x increase in ALP indicate ?

A
  • cholestasis
47
Q

What does a sole increase in ALP suggest?

A
  • bone pathology

S1 Pharmacology (33 decks)

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