PBL Flashcards
What are some nucleating factors which help solubilise cholesterol out of bile solution to form cholesterol monohydride crystals?
Mucous glycoproteins, non-mucous glycoproteins, Ca, immunoglobulin and possible FFAs.
What is bouveret’s syndrome?
Gallstones that erode through the gallbladder wall, forming a cholystoenteric fistula which may leads to duodenal obstruction.
Define biliary colic.
This refers to the pain that occurs when gallstone are passe which may be blocking a bile duct.
Generally lasts >15-30.minutes with severe, steady pain in RUQ.
Define cholecystitis.
Inflammation of the gallbladder, usually caused by gallstones blocking the biliary ducts.
Associated with biliary pain > 5 hours, Murphy’s sign, fever.
Define Cholangitis.
Infection of the biliary tree, commonly caused by surgical injuries, benign strictures or obstruction.
Diffuse RUQ pain, not classic Murphy’s , jaundice, fever, putty/clay coloured stools, pruritus.
Define blood borne disease.
A disease that can be spread through contamination of an infected individual’s blood or other bodily fluids.
What is ALT?
Alkaline aminotransferase.
A protein commonly found in hepatocytes and in the kidney. It is usually in low concentrations, high concentrations indicate liver cell damage, and commonly hepatitis.
What is AST?
Asparate aminotransferase.
This is an enzyme found throughout the body but mostly in the heart and liver. It is released when liver or muscle cells are damaged.
How is the AST: ALT interpreted?
In most liver diseases, ALT is higher than AST —> low AST/ALT ratio.
The exception is alcoholic hepatitis, cirrhosis, hep C and the last few days of acute hepatitis or injury from bile duct obstruction. In these cases AST/ALT will be high.
What is ALP?
Alkaline phosphatase.
An enzyme related to the bile ducts, but it is also produced in bone, intestines and during pregnancy.
ALP may be elevated when bile ducts are blocked or in liver cancer or cirrhosis.
What does the bilirubin in the LFT relate to?
Increased bilirubin that is mainly unconjugated —> haemolytic anaemia, transfusion reactions, cirrhosis.
Increased bilirubin that is mainly conjugated —> viral hepatitis, drug reactions, blocked bile ducts.
What is interpreted from albumin in a LFT?
Albumin is produced by the liver; thus decreased levels of albumin = impaired liver function or kidney disease (unable to preserve proteins).
What is interpreted from total protein in a LFT?
The level of protein in the blood is usually stable, reflecting a balance between protein production and degradation/excretion.
Decreased total protein = impaired liver function, damaged kidneys
What is GGT?
Gamma gutamyl transferase.
Helps to determine the cause of increased ALP.
Both ALP and GGT are elevated in bile duct and liver disease, however, only ALP increases in bone disease.
Increased GGT is also related to alcohol consumption.
What is lactate dehydrogenase?
A non-specific marker of tissue damage.
