Liver Problems Flashcards
What are the functions of the liver?
- Produces essential proteins including albumin and clotting factor
- Absorption and metabolism of fat, carbahydrate and protein
- Storage of glycogen, vitamins and minerals
- Metabolism and excretion of toxic products in the body
What is included in LFTs
- Bilirubin (total and split)
- ALT/AST
- 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 - best test for liver function
- prothrombin time (PT) / INR
- APTT
- Albumin
- Bilirubin
How can paediatric liver disease manifest?
- Jaundicece - usually most obvious in sclera
- Incidental finding of abnormal blood test
- Symptoms/signs of chronic liver disease
What are the signs of chronic liver disease in children?
- Encephalopathy
- Jaundice
- Cholestasis
- Ascites
- Rickets secondary to vit D deficiency
- Varices with portal hypertension
- Spleomegaly
- Finger clubbing
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