Liver Problems COPY 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 >40-50 micromol/l
What is infant jaundice classification dependent on?
- Bilirubin metabolism
- Pre-hepatic, hepatic, post hepatic
- Age
- Early (<24 hours), Intermediate (24 hours to 2 weeks), Prolonged (>2 weeks)
What is the solubility of conjugated and unconjugated bilirubin?
- Water soluble
- Fat 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
When does physiological jaundice occur?
After the 1st day of life as it takes time for RBC to break down
Why does jaundice occur with breast fed babies?
-Exact reason for prolongation of jaundice in breastfed infants unclear -Inhibition of UDP by progesterone metabolite? -Increased enterohepatic circulation?
What type of jaundice is breast milk jaundice?
Unconjugated
How long can breast milk jaundice persist?
Up to 12 weeks from birth
Apart from breast milk and physiological what other causes of unconjugated infant jaundice are there?
-Sepsis -Haemolysis (excessive) -Abnormal conjugation
Why might there be excessive haemolysis in a baby leading to jaundice?
-ABO incompatibility -Rhesus disease -Bruising/cephalhaematoma -Red cell membrane defects (e.g. spherocytosis) -Red cell enzyme defects (e.g. G6PD)