Theme 11 L8: Investigation of Liver and Pancreatic Disease

Question 1

In liver disease, why do the following symptoms occur?

• gynaecomastia
• spider naevi
• liver palms
• testicular atrophy

Answer 1

oestrogen excess

Question 2

What is measured in a routine LFT

Answer 2

• alkaline phosphatase (ALP)
• ALT
• bilirubin
• albumin
• total protein
• GGT (glutamyl transferase)

Question 3

What do you test for in primary biliary cirrhosis?

Answer 3

anti mitochondrial antibodies

Question 4

What is measured for diagnosing hepatocellular cancer?

Answer 4

AFP

Question 5

Why is ALP elevated in biliary tract damage?

Answer 5

due to increased production of enzymes by cells lining the bile canaliculi and overflow into blood

Question 6

When is gamma glutamyltransferase (yGT) elevated>

Answer 6

structural damage of the liver e.g alcohol, fatty liver, heart failure

Question 7

What are the features of primary sclerosing cholangitis?

Answer 7

• progressive disease characterised by diffuse inflammation and fibrosis of the biliary system
• men affected more than women
• autoimmune and often related to IBD
• progression over years from minor elevations of ALP to a very severe cholestatic condition with deep jaundice

Question 8

What are the biochemical markers of fibrosis?

Answer 8

ELF score:
PIINP
TIMP-1
Hyaluronic acid

Question 9

How do you calculate:

1. Unconjugated bilirubin
2. Conjugated bilirubin

Answer 9

1. pre-hepatic and hepatic

2. post-hepatic and hepatic

Question 10

Bilirubin reaches the kidney bound to albumin. It is then excreted out of the kidney as what?

Answer 10

urobilin

Question 11

In gilbert’s syndrome and crigler-najjar, which enzyme has decreased activity in bilirubin metabolism?

Answer 11

UDP Glucuronyl transferase

Question 12

If you have an elevated AST and ALT, but a normal ALP, what is the problem?

Answer 12

hepatitis

Question 13

If you have a normal AST/ALT but elevated ALP, what is the problem?

Answer 13

obstructive jaundice

Question 14

What are the potential biochemical features of acute pancreatitis?

Answer 14

• uraemia
• hypoalbuminaemia
• hypocalcaemia
• hyperglycaemia
• metabolic acidosis
• abnormal LFTs

Question 15

What are the causes of pancreatitis? (I GET SMASHED mnemonic)

Answer 15

Idiopathic
Gall stones
Ethanol (alcohol)
Trauma
Steroids
Mumps / malignancy
Autoimmune
Scorpion stings
Hypercalcemia / hypertriglycerdidemia
ERCP
Drugs