Liver & GI Flashcards
1
Q
What are the multiple roles of the liver?
A
Metabolism of carbohydrates, proteins, liver and bilirubin; excretion/secretion; detoxification; storage of essential compounds.
2
Q
What is the consequence of nonfunctional liver?
A
Death results in 24 hours due to hypoglycemia.
3
Q
What supplies blood to the liver?
A
Portal vein, hepatic artery.
4
Q
What are the characteristics of the liver?
A
Smooth, hard, dense, heavy, and large organs.
5
Q
What happens during the first pass metabolism?
A
Everything that goes in gets detoxified through the liver.
6
Q
What is portal vein stenosis?
A
Narrowing of the artery that can cause problems originating in the liver.
7
Q
What is cirrhosis?
A
Damage of the liver which is not reversible, typically seen in older populations.
8
Q
What is bilirubin?
A
Major waste product of heme, principle pigment of bile.
9
Q
What is the lifespan of red blood cells (RBC)?
A
Approximately 120 days.
10
Q
What is the heme portion converted to?
A
Bilirubin.
11
Q
What is the role of UDP-uridine diphosphate glucuronosyltransferase?
A
Enzyme needed for the conjugation of bilirubin.
12
Q
What does conjugation of bilirubin achieve?
A
Makes bilirubin water soluble.
13
Q
What are the three P’s in relation to bilirubin?
A
Plasma, pee, and poop.
14
Q
What is jaundice?
A
Yellowing of the skin and sclera due to elevated bilirubin levels.
15
Q
What are the four categories of jaundice?
A
- Prehepatic
- Hepatic
- Posthepatic
- Cholestatic
16
Q
What is Gilbert’s disease?
A
A genetic mutation leading to intermittent unconjugated hyperbilirubinemia.
17
Q
What is Kernicterus?
A
Bilirubin deposits in the brain of neonates leading to brain damage and death.
18
Q
What is the treatment for neonatal jaundice?
A
Phototherapy, exchange transfusions, pharmacological intervention, IVIG.
19
Q
What is the most common cause of cirrhosis in North America?
A
Chronic alcoholism.
20
Q
What are common symptoms of cirrhosis?
A
- Fatigue
- Nausea
- Jaundice
- Weight loss
- GI bleed
- Itchiness
- Swelling legs and abdomen
21
Q
What is Reye’s Syndrome?
A
A disease found primarily in children, often associated with aspirin ingestion during a viral syndrome.
22
Q
What is the De Ritis ratio?
A
AST/ALT ratio used to indicate cirrhosis or alcoholism.
23
Q
What is cholestasis?
A
Stoppage or obstruction of the flow of bile.
24
Q
What elevated enzymes indicate cholestatic liver disease?
A
- ALP
- GGT
- AST
- ALT
25
What is the common source of Hepatitis A?
Contaminated food and drinking water.
26
What is the primary mode of transmission for Hepatitis C?
Primarily by transfusion.
27
What does HBsAg indicate?
Presence of Hepatitis B virus.
28
What is the significance of Anti-HBs?
Indicates past infection and not susceptible for future infection.
29
What is the main liver function test for bilirubin?
Measured by the diazo method.
30
What is the reference range for total bilirubin in adults?
3.4-17.1 µmol/L.
31
What is the normal range for total bilirubin in adults?
3.4-17.1 umol/L
## Footnote
Total bilirubin levels can indicate liver function and health.
32
What is the normal range for direct (conjugated) bilirubin in adults?
0-3.4 umol/L
## Footnote
Direct bilirubin is water-soluble and can indicate liver or biliary issues.
33
What is the normal range for indirect (unconjugated) bilirubin in adults?
3.4-13.7 umol/L
## Footnote
Unconjugated bilirubin is not water-soluble and can indicate hemolysis.
34
What is the normal range for bilirubin in full-term infants at 24 hours?
34.2-102.6 umol/L
## Footnote
Elevated bilirubin levels in newborns can lead to jaundice.
35
What is the significance of urobilinogen in urine and feces?
Colorless and gets oxidized; increased levels indicate hemolytic disease and hepatitis.
## Footnote
Absence of urobilinogen can be associated with biliary obstruction.
36
What is the most common liver enzyme measured?
AST, ALT, ALP, GGT, LDH
## Footnote
These enzymes help assess liver function and damage.
37
What does bilirubin indicate in relation to liver function?
Indirectly indicates liver function; elevated levels can suggest liver dysfunction.
## Footnote
Jaundice can be a clinical sign of elevated bilirubin.
38
What is delta bilirubin?
Reconjugated bilirubin bound to albumin
## Footnote
It can indicate liver function and the presence of liver disease.
39
What is the preferred condition for bilirubin testing?
Fasting is preferred due to lipemia interference.
## Footnote
Hemolyzed samples can affect bilirubin results.
40
What happens to bilirubin when exposed to light?
It is destroyed by light, losing 30-50% of its concentration per hour.
## Footnote
Samples should be protected from light to preserve analytes.
41
What is the role of haptoglobin in hemolysis?
Haptoglobin decreases as it binds free hemoglobin.
## Footnote
It is produced in the liver.
42
What does a lack of stercobilinogen in stool indicate?
Chalk/grey stool color
## Footnote
This can indicate biliary obstruction.
43
Which liver enzyme is most affected by hemolysis?
LDH
## Footnote
LDH can increase due to hemolysis.
44
Which liver enzyme is the least affected by hemolysis?
GGT
## Footnote
GGT levels remain relatively stable in hemolytic conditions.
45
What is the significance of elevated ammonia in liver disease?
It indicates poor prognosis and can lead to coma.
## Footnote
Elevated ammonia is a result of liver dysfunction.
46
What is the relationship between GGT and ammonia levels?
They are proportional; elevation in GGT correlates with elevation in ammonia.
## Footnote
This can indicate liver disease severity.
47
Which analyte is the best indicator of hepatobiliary damage?
ALT
## Footnote
Elevated ALT is often associated with liver injury.
48
What is the characteristic of jaundice?
Increased unconjugated serum bilirubin level.
## Footnote
Jaundice can be classified into prehepatic, hepatic, and posthepatic types.
49
What is a classic sign of a blocked bile duct?
Negative urine urobilinogen
## Footnote
Other signs include pale-colored stool and negative fecal urobilinogen.
50
What condition is classified as prehepatic jaundice?
Acute hemolytic anemia
## Footnote
Other conditions include Gilbert's disease and hemolytic jaundice.
51
What is the significance of a high AST/ALT ratio?
A ratio of 2 indicates alcoholism and cirrhosis.
## Footnote
This ratio can help differentiate causes of liver damage.
52
What factors require vitamin K for synthesis?
Factors 2, 7, 9, 10
## Footnote
Vitamin K is essential for coagulation factor synthesis and can be given in cases of obstruction.
53
What can cause elevated alkaline phosphatase (ALP)?
Hepatobiliary obstruction, bone disorders, pregnancy
## Footnote
Elevated ALP should be evaluated alongside GGT for differential diagnosis.
54
What does a normal GGT with elevated ALP suggest?
It is likely related to bone disorders.
## Footnote
If GGT is elevated with ALP, hepatobiliary obstruction is suspected.
55
What physiological condition can elevate serum alkaline phosphatase?
Third trimester pregnancy
## Footnote
Physiological changes during pregnancy can affect liver enzyme levels.
56
What are the two main functions of the pancreas?
Endocrine (secretes hormones) and exocrine (enzymes-digest food)
## Footnote
The pancreas plays a crucial role in regulating blood sugar and aiding digestion.
57
What type of fluid does the pancreas secrete?
Clear, colourless, watery, and alkaline pancreatic fluid
## Footnote
This fluid is essential for neutralizing stomach acid and aiding in digestion.
58
What hormones are produced by the pancreas for glucose monitoring?
Insulin and glucagon
## Footnote
Insulin lowers blood sugar levels, while glucagon raises them.
59
Which hormones control pancreatic activity?
Secretin and cholecystokinin (CCK)
## Footnote
These hormones regulate the secretion of pancreatic fluids and enzymes.
60
What is the role of secretin in pancreatic function?
Produces bicarbonate-rich fluid
## Footnote
Secretin is synthesized in response to acidic components in the duodenum.
61
What is Zollinger-Ellison Syndrome?
Pancreatic cell tumors with overproduction of gastrin
## Footnote
This condition leads to excessive gastric acid production.
62
What is a common cause of pancreatitis?
Autodigestion due to reflux of bile or duodenal contents into the pancreatic duct
## Footnote
Often associated with alcohol abuse or biliary tract diseases.
63
What are the typical laboratory findings in pancreatitis?
Increased amylase, lipase, triglycerides, calcium
## Footnote
These markers indicate pancreatic inflammation or damage.
64
What is cystic fibrosis?
Inherited dysfunction of mucous and exocrine glands throughout the body
## Footnote
It often presents as intestinal obstruction in newborns and lung infections in childhood.
65
What is the significance of sweat chloride determinations in cystic fibrosis?
Significantly elevated sodium and chloride levels indicate CF
## Footnote
A value >60 mmol/L is diagnostic in children.
66
What enzyme is more specific for pancreatic disorders, amylase or lipase?
Lipase
## Footnote
Lipase is more specific for diagnosing acute pancreatitis.
67
What is the effect of plasma triglycerides on amylase levels?
Plasma triglycerides suppress or inhibit amylase
## Footnote
This can lead to normal amylase levels despite acute pancreatitis with hyperlipidemia.
68
What test is largely replaced by the hydrogen breath test?
Lactose tolerance test
## Footnote
This test measures the body's ability to break down lactose.
69
What does an increased lipase level indicate?
Diagnosis of acute pancreatitis
## Footnote
Lipase levels rise 4-8 hours after the onset of pancreatitis.
70
Fill in the blank: The primary function of the pancreas includes secreting _______.
[enzymes that digest food]
## Footnote
These enzymes are critical for the digestion of carbohydrates, proteins, and fats.
71
True or False: Cystic fibrosis primarily affects the pancreas.
False
## Footnote
While the pancreas is affected, cystic fibrosis involves mucous glands throughout the body.
72
What is the relationship between triglycerides and pancreatitis?
Increased lipids can cause pancreatitis
## Footnote
Patients with high triglyceride levels are at higher risk for developing pancreatitis.
73
What is the significance of the amylase level in acute pancreatitis?
Rises 5-8 hours, peaks in 24, then returns to normal in 3-5 days
## Footnote
Amylase is less specific than lipase for pancreatic disorders.
74
What does the lactase enzyme do?
Breaks down lactose into glucose and galactose
## Footnote
The lactose tolerance test measures the increase in glucose levels after lactose ingestion.
75
What is a common bacterial infection associated with cystic fibrosis?
Pseudomonas aeruginosa
## Footnote
This bacterium frequently infects the lungs of individuals with CF.
76
What is the role of pilocarpine in sweat chloride testing?
Stimulates sweat production for measurement
## Footnote
The test uses iontophoresis to administer pilocarpine.
77
What is the normal range for lipase in laboratory tests?
<38 U/L
## Footnote
Levels above this can indicate pancreatic dysfunction.
