Liver Function Tests Flashcards
What does the liver produce ?
Clotting factors
Albumin
Lipids
Hormones
What does the liver convert ammonia into ?
Urea
What vitamins and minerals does the liver store ?
Iron
Copper
B12
A, D, E and K
What is bilirubin a measure for ?
High levels of Bilirubin shows a dysfunctioning liver or blockage in the system.
What do aminotransferases show ?
They are enzymes present in hepatocytes, ALT and AST, if there levels are high then it shows there is liver damage.
What does a high (2 or more) AST/ALT ratio indicate ?
ALT is specific for the liver but if the AST/ALT ratio is high shows alcoholic liver damage.
What does high levels of alkaline phosphate indicate ?
Indicates a blockage or inflammation in the bile ducts
Where is alkaline phosphate also found ? (2)
Bones
Intestines
What does Gamma GT show ?
It’s a liver enzyme who’s levels increase with alcoholic liver damage. Can be used to confirm source of ALP.
Apart from alcohol what can also raise levels of Gamma GT ?
NSAID’s
What do albumin levels shows ?
They are important in testing liver function, used to calculate the levels of liver disease.
Why are creatine levels tested ?
Shows kidney function and is used to determine overall survival from liver disease.
Why is platelet count important ?
Platelets are low in patients with liver disease as Thrombopoietin levels are low. It is an indirect indication of portal hypertension.
Why is Thrombopoietin important ?
Its a hormone needed for platelet production
What are the signs of portal hypertension/liver disease ?
- Jaundice
- Varices
- Ascites
- Hepatic encephalopathy
At what level is jaundice detectable in plasma ?
34 micromol/L
What are the 3 classifications of jaundice ?
Pre-hepatic
Hepatic
Post-hepatic
At what stage does bilirubin become conjugated ?
Hepatic stage
What 2 things may cause pre-hepatic jaundice ?
Haemolysis
Impaired transport
What other signs would the patient have in pre-hepatic jaundice ?
Splenomegaly
Anemia
Chest pain
Fatigue
What 3 things may cause hepatic jaundice ?
Defective conjugation
Defective uptake
Defective excretion
How might a patient present with hepatic jaundice ?
Ascites
Variceal bleeding
Hepatic encephalopathy
Gynaecomastia
What may cause post-hepatic jaundice ?
Defective transport of bilirubin in the bile ducts
How might post hepatic jaundice present ?
Pale stools
Dark urine
Abdominal pain
What investigations should be done in a patient with jaundice ?
Copper, ferritin, Hep B and C
Ultrasound of the abdomen
MRCP/ERCP
What is PTC used for ?
Percutaneous Transhepatic Cholangiogram
Used when ERCP isn’t possible due to an obstruction or previous surgery. Dye is injected into the bile duct and x-rays are taken. Can also be used to stent or unblock bile ducts.
What is EUS ?
Endoscopic Ultrasound
Done using a probe, biopsy may be taken. Used for looking at pancreatic masses and staging tumours .
Define chronic liver disease
Liver disease that persists beyond 6 months
What should all patients with new onset ascites have ?
A paracentesis
What is measured via paracentesis ?
Protein and albumin levels
Cell count
SAAG gradient (Serum ascites albumin gradient)
What does a SAAG gradient >1.1g/dl mean ?
Portal hypertension related e.g. heart failure or cirrhosis
What does a SAAG gradient <1.1g/dl mean ?
Non portal hypertension related e.g. infections and pancreatitis
Define transudative
Fluid is pushed through capillaries due to high pressure, proteins stay in vessel e.g. albumin
Define exudative
Fluid moves between cells due to inflammation, albumin also leaks out
What are the treatment options for ascitic patients ? (3)
TIPS procedure
Large volume paracentesis
Liver transplantation
How is bleeding from varices controlled ?
- A, B, C
- Wide bore cannula and IV fluids
- Blood transfusion
- Emergency endoscopy - Band ligation, clipping
- Give Terlipressin to control bleeding
- May need a Sengtaken Blakemore tube for uncontrolled bleeding
Define Hepatic Encephalopathy
Confusion due to liver disease