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Liver Function Tests Flashcards

1
Q

What does the liver produce ?

A

Clotting factors
Albumin
Lipids
Hormones

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2
Q

What does the liver convert ammonia into ?

A

Urea

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3
Q

What vitamins and minerals does the liver store ?

A

Iron
Copper
B12
A, D, E and K

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4
Q

What is bilirubin a measure for ?

A

High levels of Bilirubin shows a dysfunctioning liver or blockage in the system.

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5
Q

What do aminotransferases show ?

A

They are enzymes present in hepatocytes, ALT and AST, if there levels are high then it shows there is liver damage.

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6
Q

What does a high (2 or more) AST/ALT ratio indicate ?

A

ALT is specific for the liver but if the AST/ALT ratio is high shows alcoholic liver damage.

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7
Q

What does high levels of alkaline phosphate indicate ?

A

Indicates a blockage or inflammation in the bile ducts

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8
Q

Where is alkaline phosphate also found ? (2)

A

Bones

Intestines

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9
Q

What does Gamma GT show ?

A

It’s a liver enzyme who’s levels increase with alcoholic liver damage. Can be used to confirm source of ALP.

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10
Q

Apart from alcohol what can also raise levels of Gamma GT ?

A

NSAID’s

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11
Q

What do albumin levels shows ?

A

They are important in testing liver function, used to calculate the levels of liver disease.

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12
Q

Why are creatine levels tested ?

A

Shows kidney function and is used to determine overall survival from liver disease.

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13
Q

Why is platelet count important ?

A

Platelets are low in patients with liver disease as Thrombopoietin levels are low. It is an indirect indication of portal hypertension.

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14
Q

Why is Thrombopoietin important ?

A

Its a hormone needed for platelet production

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15
Q

What are the signs of portal hypertension/liver disease ?

A
  • Jaundice
  • Varices
  • Ascites
  • Hepatic encephalopathy
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16
Q

At what level is jaundice detectable in plasma ?

A

34 micromol/L

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17
Q

What are the 3 classifications of jaundice ?

A

Pre-hepatic
Hepatic
Post-hepatic

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18
Q

At what stage does bilirubin become conjugated ?

A

Hepatic stage

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19
Q

What 2 things may cause pre-hepatic jaundice ?

A

Haemolysis

Impaired transport

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20
Q

What other signs would the patient have in pre-hepatic jaundice ?

A

Splenomegaly
Anemia
Chest pain
Fatigue

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21
Q

What 3 things may cause hepatic jaundice ?

A

Defective conjugation
Defective uptake
Defective excretion

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22
Q

How might a patient present with hepatic jaundice ?

A

Ascites
Variceal bleeding
Hepatic encephalopathy
Gynaecomastia

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23
Q

What may cause post-hepatic jaundice ?

A

Defective transport of bilirubin in the bile ducts

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24
Q

How might post hepatic jaundice present ?

A

Pale stools
Dark urine
Abdominal pain

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25
Q

What investigations should be done in a patient with jaundice ?

A

Copper, ferritin, Hep B and C
Ultrasound of the abdomen
MRCP/ERCP

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26
Q

What is PTC used for ?

A

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.

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27
Q

What is EUS ?

A

Endoscopic Ultrasound

Done using a probe, biopsy may be taken. Used for looking at pancreatic masses and staging tumours .

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28
Q

Define chronic liver disease

A

Liver disease that persists beyond 6 months

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29
Q

What should all patients with new onset ascites have ?

A

A paracentesis

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30
Q

What is measured via paracentesis ?

A

Protein and albumin levels
Cell count
SAAG gradient (Serum ascites albumin gradient)

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31
Q

What does a SAAG gradient >1.1g/dl mean ?

A

Portal hypertension related e.g. heart failure or cirrhosis

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32
Q

What does a SAAG gradient <1.1g/dl mean ?

A

Non portal hypertension related e.g. infections and pancreatitis

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33
Q

Define transudative

A

Fluid is pushed through capillaries due to high pressure, proteins stay in vessel e.g. albumin

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34
Q

Define exudative

A

Fluid moves between cells due to inflammation, albumin also leaks out

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35
Q

What are the treatment options for ascitic patients ? (3)

A

TIPS procedure
Large volume paracentesis
Liver transplantation

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36
Q

How is bleeding from varices controlled ?

A
  • 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
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37
Q

Define Hepatic Encephalopathy

A

Confusion due to liver disease

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38
Q

How is Hepatic Encephalopathy graded ?

39
Q

How is Hepatic Encephalopathy treated ?

A
  • Need to treat underlying cause
  • Laxative if constipated
  • Antibiotics if infected
40
Q

Patients who have Hepatocellular carcinoma usually have what other clinical disease ?

A

Hep B or C with cirrhosis

41
Q

How is Hepatocellular carcinoma diagnosed ?

A

USS, CT, AFP

42
Q

What is the treatment for Hepatoceullar carcinoma ? (4)

A

Transplantation
Hepatic resection
Chemotherapy (TACE)
Radio-frequency ablation

43
Q

Which Hep viruses are enteral ?

44
Q

Which Hep viruses are paraenteral ?

A

B, C and D

45
Q

Which Hep versus have a self-limiting course ?

46
Q

Which Hep versus have a chronic course ?

A

B, C and D

47
Q

How is Hep A and E transmitted ?

A

Faecal oral route, sexual contact and via blood products

48
Q

How is Hep A and E diagnosed ?

A

Via IgM antibodies

49
Q

How is Hep A and E treated ?

A

Symptomatic medication

50
Q

Is there an immunisation for Hep A ?

A

Yes it is given to lab workers, travellers and IVDU’s

51
Q

How is Hep B and D transmitted ?

A

Sexual contact and blood products

52
Q

How is Hep B and D diagnosed ?

A

Blood tests for surface antigen (HBSAg), Hep D antibodies, USS for liver damage

53
Q

How is Hep B and D treated ? (2)

A

Antivirals

Pegylated interferon

54
Q

How is Hep C transmitted ?

A

Sexual contact and blood products

55
Q

How is Hep C diagnosed ?

A

Blood test for antibodies and PCR

USS

56
Q

How is Hep C treated ?

A

Antivirals

57
Q

What are the 3 stages of NAFLD ?

A

Steatosis
Steatohepatitis
Cirrhosis

58
Q

How do you investigate NAFLD ?

A

Liver biopsy (PTC)
USS
Bloods

59
Q

How is NAFLD scored ?

A

> 3 high risk

60
Q

Name 3 autoimmune liver diseases ?

A

PBC
PSC
Autoimmune hepatitis

61
Q

What is elevated and what is positive when investigating PBC ?

A

IgM elevated

AMA positive

62
Q

How do you treat PBC ?

63
Q

What is found positive in PSC ?

64
Q

How is PSC diagnosed ?

65
Q

How is PBC diagnosed ?

A

If AMA negative do a Liver biopsy

66
Q

What is elevated in autoimmune hepatitis ?

67
Q

How is autoimmune hepatitis diagnosed ?

A

Elevated enzymes - ANA, SNA and LKM1

Liver biopsy

68
Q

How to decide priority in cirrhosis for transplantation ?

A

Child Pugh score
UKELD score
MELD score

69
Q

Define orthotopic

A

Occurs in the usual place e.g. liver transplantation is orthotropic

70
Q

What medication is needed after liver transplantation ? (3)

A

Antibiotics
Anti-fungals
Steroids

71
Q

Which Hep strains can cause serious liver damage if they get severe enough ?

A

A, B and E

72
Q

What part of haemoglobin forms bilirubin ?

A

The haem part when it is broken down in the spleen

73
Q

Describe the enterohepatic circulation from the breakdown of haemoglobin

A

Haemoglobin is broken down in the spleen into haem and globin. Haem then becomes bilirubin. Bilirubin is taken up by hepatocytes from circulation and conjugates and excreted into the biliary system. Once in the biliary system it makes it way into the intestine where it is taken up via reabsorption.

74
Q

Define cholestasis

A

Accumulation of bile within hepatocytes or bile canaliculi

75
Q

Is PBC more common in males or females ?

76
Q

What is seen in the blood in PBC ?

A

AMA and elevated ALP

77
Q

Describe what happens to the bile ducts in PBC ?

A

Granulation of the bile ducts progressing to cirrhosis due to autoimmune disease

78
Q

Describe what happens to the bile ducts in PSC ?

A

Chronic inflammation and fibrosis of the bile ducts. Progresses to cirrhosis

79
Q

What bowel disease is PSC associated with ?

80
Q

Which cancer is PSC associated with ?

A

Cholangiocarcinoma

81
Q

Liver tumour mets what are the common primary sites ? (4)

A

Breast
Lung
Melanoma
Colon

82
Q

What does chronic cholecystitis lead to ?

A

Fibrosis and inflammation of the gallbladder

83
Q

What can cause bile duct obstruction ?

A

Tumours
ExternaL compression
Gallstones
Strictures

84
Q

What might bile duct obstruction lead to ?

A

Cirrhosis
Ascending Cholangitis
Pancreatitis

85
Q

Define Cholesterolosis

A

Buildup of cholesteryl esters and they stick to the wall of the gallbladder forming polyps

86
Q

What are the two different types of gallstones ?

A

Cholesterol and pigment

87
Q

What are the risk factors for gallstones ?

A

Pregnancy
Over 40
Female
Obesity

88
Q

How do gallstones present ?

A 
Colicky pain spreads to shoulders 
Loss of appetite 
Itchy skin 
Diarrhoea 
Fever
N/V
89
Q

What are gallstones in the bile duct known as ?

A

Choledocholithiasis

90
Q

What may gallstone in the bile ducts lead to ?

A

Pancreatitis or ascending Cholangitis

91
Q

How do you investigate gallstones ?

A

LFT’s
USS (dilated ducts )
MRCP

92
Q

What is the gold standard treatment ?

A

Laproscopic cholecystectomy

93
Q

What types of tumours are most ampullary types ?

A

Adenocarcinoma or adenomas

94
Q

What type are cancers of the gallbladder ?

A

Cholangiocarcinomas

Alimentary (12 decks)

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