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A13THP @ UoN > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

What is the safe weekly alcohol limit?

A

0-21 units/wk for men
0-14 units/wk for women
Not drunk in 1/2 bouts
2-3 alcohol free days a week

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2
Q

What are the signs and symptoms of Liver Disease?

A 
Jaundice and Pruritis
Nausea/Vomiting
Hepatomegaly
Ascites
Dark urine and pale stools (cholestasis)
Spider naevi (alcoholic liver disease)
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3
Q

What is the major infective cause of liver damage?

A

Viral hepatitis

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4
Q

What are the major ADRs leading to liver damage?

A 
Halothane
Paracetamol overdose
Clavulanic acid
Valproate
Amiodarone
Herbals
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5
Q

What are the major lifestyle causes of liver disease?

A

Obesity

Alcohol abuse

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6
Q

What cancerous conditions lead to liver disease?

A

Primary cancer

Secondary metastases

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7
Q

What are the main factors measured in an LFT?

A

Hepatocellular
Obstruction
Synthetic Function
Bilirubin

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8
Q

What values are measured when assessing hepatocellular health?

A 
Alanine Aminotransferases (<45 iU/L)
Aspartate Aminotransferases (<50 iU/L)
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9
Q

What values are measured when assessing obstruction?

A 
Alkaline Phosphatase (39-117 iU/L)
Gamma-glutamyl transpeptidase/transferase (0-70 iU/L m, 0-40 iU/L f)
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10
Q

What values are measured when assessing synthetic function?

A

Albumin (30-48 g/L)

INR (1-1.2)

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11
Q

What are the normal values for Bilribuin?

A

5-17 umol/L

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12
Q

Describe Bilirubin physiology

A

Produced from breakdown of RBCs
Haem-Biliverdin-Bilirubin
Liver conjugates, makes water soluble
Excreted as bile

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13
Q

What is the main effect of increased levels of Bilirubin?

A

Jaundice

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14
Q

When are levels of Bilirubin increased?

A

Bilary obstruction (cholestasis)
Hepatocellular damage
Haemolysis

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15
Q

How is Bilirubin excreted?

A

5-10% as stercobilinogen in stools

Majority undergoes enterohepatic cycling

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16
Q

When are the Aminotransferases raised?

A

Markedly raised in hepatocellular damage

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17
Q

Which Aminotransferase is a more specific marker of liver damage?

A

Alanine Aminotransferase (ALT)

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18
Q

What do levels of ALT >2x greater than upper limits correspond with?

A

Biopsy proven liver disease

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19
Q

Where is Alkaline Phosphatase normally found?

A

Present in canalicular/sinusoidal membranes

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20
Q

When is Alkaline Phosphatase raised?

A

Markedly raised in Cholestasis

21
Q

What are Gamma Glutyltransferases?

A

Microsomal enzymes present in many tissues

22
Q

When is Gamma Glutyltransferase raised?

A 
Increased by induction
-Alcohol (even small amounts)
-Carbamazepine
-Barbiturates
-Phenytoin
-Rifampicin
Increased in cholestasis
Increased in cellular damage
23
Q

What does Albumin represent?

A

Synthetic activity of Liver over the long term

24
Q

What is the T1/2 of Albumin?

A

T1/2 = 16-24 days

25
Q

What is the Prothrombin Time?

A

Measure of coagulation and synthetic activity

26
Q

Does the Prothrombin Time indicate acute or chronic damage?

A

Both

Coagulation factors have a short half life

27
Q

What LFT results would be typical of Acute Hepatitis?

A 
ALT &amp; AST - Increased
ALP - Increased/Normal
Bilirubin - Increased/Normal
GGT - Increased/Normal
Albumin - Normal
INR - Increased/Normal
28
Q

What LFT results would be typical of Cholestasis?

A 
ALT &amp; AST - Increased/Normal
ALP - Increased
Bilriubin - Increased
GGT - Increased
Albumin - Normal
INR - Increased/Normal
29
Q

What LFT results would be typical of Chronic Liver Disease?

A 
ALT &amp; AST - Increased/Normal
ALP - Increased/Normal
Bilirubin - Increased
GGT - Increased
Albumin - Decreased
INR - Increased
30
Q

What is Jaundice?

A

Hyperbilirubinaemia resulting in yellow colouration of the skin/sclera

31
Q

What level of Bilirubin is found in Jaundice?

A

> 35-50 umol/L

32
Q

What further symptoms develop from Jaundice?

A

Pruritis

Nausea

33
Q

What is Prehepatic Jaundice?

A

Jaundice occuring when water insoluble, unconjugated Bilirubin is produced faster than the liver can conjugate it

34
Q

What are the main causes of Prehepatic Jaundice?

A

Haemoylsis/Haemolytic anaemias

Gilbert’s Syndrome (reduced levels of UDP-glucuronosyl transferase)

35
Q

What is Hepatocellular Jaundice?

A

Loss of transaminases
Liver unable to conjugate Bilirubin
Reduced Bilirubin excretion

36
Q

What is Cholestasis?

A

Disorder where Bile cannot flow from the liver to the duodenum

37
Q

What are the two types of Cholestasis?

A

Intrahepatic

Extrahepatic

38
Q

Describe Intrahepatic Cholestasis

A

Cholestasis occurring within the liver

  • Primary bilary cirrhosis (autoimmune damage to bile ducts)
  • Hepatocellular damage
  • Pregnancy w/ unknown cause
39
Q

Describe Extrahepatic Cholestasis

A

Cholestasis occurring outside the liver

  • Gallstones
  • Calcified head of pancreas
40
Q

Describe Obstructive Jaundice

A

Jaundice caused by cholestasis
Liver CAN convert insoluble-soluble bilirubin
CANNOT excrete bilirubin in bile, only in urine

41
Q

What are the signs/symptoms of Obstructive Jaundice?

A

GGT & ALP - Elevated
Pale stools
Dark urine
Bilirubin in urine

42
Q

What are the most common complications of liver disease?

A

Jaundice
Ascites
Encephalopathy

43
Q

How does Jaundice present?

A

Nausea

Pruritis

44
Q

How should Jaundice be treated pharmacologically?

A

Colestyramine

45
Q

How does Ascites present?

A

Accumulation of fluid in the peritoneal cavity

  • Oedema
  • Sodium Retention
  • Portal Hypertension
46
Q

How should Ascites be treated?

A

Sprinolactone + Furosemide + salt restriction

47
Q

How does Encephalopathy present?

A

Changes in personality
Disorientation
Confusion/drowsiness

48
Q

How should Encephalopathy be treated?

A

Neomycin/Metronidazole + Lactulose

49
Q

What are less common complications of liver disease?

A 
Impaired coagulation
Gastric bleeding (Ranitidine)
Bleeding oesophageal varices (B-Blockers, Octreotide)

A13THP @ UoN (19 decks)

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