Liver Problems Flashcards
What are the functions of the liver?
- Factory for producing essential proteins including albumin
- Produces clotting factors
- Essential role in absorption and metabolism of fats and other food stuffs
- Storage of glycogen, minerals and other substrates
- Metabolism and excretion of toxic products in the body
What is included in LFTs?
-Bilirubin (total and split)
-ALT/AST (alanine aminotransferase/aspartate aminotransferase)
-Alkaline phosphatase
Gamma glutamyl transferase (GGT)
When is ALT/AST elevated?
In hepatocellular damage (hepatitis)
When are alkaline phosphatase and GGT elevated?
Biliary disease
What tests are used to assess the function of the liver?
- Coagualtion (prothrombin time (PT)/INR, APTT)
- Albumin
- Bilirubin
- Blood glucose
- Ammonia
How can paediatric liver disease manifest?
- JAUNDICE
- Incidental finding of abnormal blood test
- Symptoms/signs of chronic liver disease
What are the signs of chronic liver disease in children?
- Encephalopathy
- Jaundice
- Epistaxis
- Cholestasis
- Ascites
- Hypotonia
- Peripheral neuropathy
- Rickets secondary to vit D deficiency
- Varices with portal hypertension
- Spider naevi
- Muscle wasting
- Bruising and petechiae
- Spleomegaly
- Hypersplenism
- Hepatorenal failure
- Liver palms
- Clubbing
- Loss of fat stores
- Growth failure
What is jaundice?
- Yellow discolouration of skin and tissues due to accumulation of bilirubin
- Usually most obvious in sclera
When is jaundice usually visible?
Total bilirubin >40-50umol/l
What is diagnosis of infant jaundice dependent on?
- Bilirubin metabolism
- Age
How is bilirubin metabolised?
- Post mature RBC broken down in the reticuloendothelial system to bilveridan
- Converted to unconjugated bilirubin
- Bound to albumin and conjugated in the liver
- Mixes with bile in gallbladder and enters small intestine
- Coverted to urobilinogen and excreted by the kidneys as urine or in faeces
What is the solubility of conjugated bilirubin?
- Water soluble
- Fat insoluble
What is the solubility of unconjugated bilirubin?
- Fat soluble
- Water insoluble
When does pre-hepatic jaundice occur?
Excess of unconjugated birlirubin
When does intrahepatic jaundice occur?
-Excess of conjugated and unconjugated bilirubin jaundice due to issue within the liver
When does post-hepatic jaundice occur?
Excess of conjugated bilirubin normally due obstruction
What is early neonatal jaundice?
- <24 hours old
- ALWAYS PATHOLOGICAL
What can cause early neonatal jaundice?
- Haemolysis
- Sepsis
What is intermediate neonatal jaundice?
Occurs between 24hours and 2 weeks of age
What can cause intermediate neonatal jaundice?
- Physiological
- Breast milk
- Sepsis
- Haemolysis
What is prolonged neonatal jaundice?
Occurs after 2 weeks of age
What can cause prolonged neonatal jaundice?
- Extrahepatic obstruction
- Neonatal hepatitis
- Hypothyroidism
- Breast milk
Why does physiological jaundice occur?
- Shorter RBC life span in infants (80-90 days)
- Relative polycythaemia
- Relative immaturity of liver function
What type of jaundice is physiological jaundice?
Unconjugated