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Liver failure GIM week 3 > Liver function tests > Flashcards

Liver function tests Flashcards

1
Q

Whats cholestasis

A

Inability of liver to secrete bile into duodenum

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2
Q

What is one manifestation of liver disease

A

Hepatomegaly (occurs in alcoholic patients mostly)

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3
Q

signs and symptoms of liver disease

A

Jaundice and pruritus (intense itching of skin)
Nausea and vomiting
Hepatomegaly
Ascites
Dark urine and pale stools in cholestasis
Spider nave in alcoholic liver disease

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4
Q

What is jaundice due to

A

Increased level of bilirubin

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5
Q

Causes of liver damage

A

Can be acute or chronic

  • Infection
  • Adverse drug reaction
  • Alcohol abuse
  • Obesity (cirrhosis)
  • Cancer
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6
Q

What test to do to see if there is hepatocellular damage in kidneys

A

Aminotransferases

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7
Q

How to test if there is obstruction in the kidneys

A

Alkaline phosphatase

Gamma GT

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8
Q

How to test if there is damage to synthetic function of kidney

A

Albumin

Coagulation (INR)

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9
Q

when are levels of bilirubin increased

A
  • Bilary obstruction (cholestasis)
  • Hepatocellular damage
  • Haemolysis
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10
Q

When is bilirubin mainly increased

A

Breakdown of RBCs

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11
Q

How is bilirubin formed and excreted

A

1) RBCs broken down
2) Iron and global reused, biliverdin is formed from haem and reduced to bilirubin
3) Bilirubin is unconjugated and water insoluble
4) The liver conjugates bilirubin to make it water soluble and excreted as bile

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12
Q

What are the different aminotransferases that you test for when testing for hepatocellular damage

A

AST (aspartate)

ALT (alanine)

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13
Q

When would aminotransferase levels be particularly raised

A

paracetamol overdose

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14
Q

How can you use aminotransferase tests to see if there is alcoholic liver disease

A

If the AST:ALT ratio is more than 2:1

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15
Q

Why are alkaline phosphatases tested

A

TO check for cholestasis

-However can also be raised in infiltration of liver e.g. metastasis

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16
Q

When are Gamma GTs raised

A

alcohol
Cholestasis
Cellular damage

17
Q

What does INR indicate

A

Synthetic activity and coagulation - indicates both acute and chronic damage

18
Q

When to take LFT when starting a new drug treatment

A

Before and during treatment to see if there has been any change

19
Q

What test results would you expect to see in acute hepatitis

A

Increased ALT and AST (aminotransferases)

increased or normal: ALP, bilirubin, GGT, INR and Normal Albumin

20
Q

What test results would you expect to see in cholestasis

A

Increased: ALP, GGT, bilirubin
Normal or increased: ALT, AST, INR
normal: albumin

21
Q

What test results would you expect to see in chronic liver disease

A

Increased: Bilirubin, albumin and INR (sometimes GGT)

Normal or increased: ALP, ALT and AST

22
Q

What is prehepatic jaundice

A

Water insoluble unconjugated bilirubin produced faster than liver can conjugate it for excretion
-OFten due to haemolytic (haemolytic anaemias such as spherocytosis)

23
Q

What is Gilberts syndrome

A

patients have reduced level of UDP which makes bilirubin more soluble so they have more bilirubin than normal

24
Q

What is hepatocellular jaundice

A

Liver damaged so can’t process bilirubin and make it water soluble

25
Q

Causes of intrahepatic cholestasis

A
  • Primary biliary cirrhosis: -autoimmune damage to bile ducts
  • Hepatocellular damage
  • IN pregnancy with unknown cause
26
Q

Causes of extra hepatic cholestasis

A
  • Gallstones

* Ca head of pancreas

27
Q

What is obstructive jaundice

A

Cholestasis

  • GGT and ALP not excreted and are elevated
  • liver can convert insoluble bilirubin in the liver to water soluble bilirubin
  • But cannot excrete bilirubin in the bile so pale stools
  • Water soluble bilirubin excreted in the urine so dark urine and bilirubin in the urine conforms obstructive jaundice
28
Q

What is NASH

A

Non-alcoholic steatohepatitis

  • Most common liver disease. Non-alcoholic fatty liver with insulin resistance. Fat accumulates in liver, inflammation and can progress to cirrhosis
  • Associated with obesity
  • Responds to weight loss
29
Q

How to treat jaundice

A

Colestyramine

30
Q

How to treat ascites

A

Spironolactone (+furosemide+ NaCl restriction)

31
Q

What is encephalopathy

A

Neuropsychiatric symptoms which are presented as:

  • Changes in personality
  • Disorientation
  • Confusion and drowsiness
  • Sensitivity to centrally acting drugs
32
Q

How to treat encephalopathy

A

Neomycin/metronidazole and lactulose

33
Q

Complications of liver disease and how to treat

A 
Impaired coagulation
Gastric bleeding (prescribe ranitidine)
Bleeding oesophageal varies (prescribe beta blockers)
34
Q

What does a fibroscan measure

A

Elasticity

Liver failure GIM week 3 (10 decks)

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