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### > Week 10: Liver Biochemistry > Flashcards

Week 10: Liver Biochemistry Flashcards

1
Q

What are the general symptoms for acute liver disease? (3)

A

Mild
Self-limiting
Progressive to chronic.

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2
Q

What are the general features that indicate chronic liver disease? (1)

A

Structural changes = affects liver function

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3
Q

What are the initial symptoms of liver disease? (3)

A

Non-specific
Easily Fatigued
Nausea

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4
Q

What are the common symptoms of liver disease? (2)

A

Appetite/Weight loss

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5
Q

What is the difference between compensated and decompensated liver disease? (1)

A

Compensated: Liver function maintained after liver damage.

Decompensated: Liver function compromised after liver damage.

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6
Q

What are the symptoms of decompensated liver disease? (6)

A

Arms/Legs muscle loss
Abdomen + lower body swelling
Ab. Pain
Pruritus
Bruising
Gums/Nose Bleeding

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7
Q

What are the signs of liver disease? (9)

A

Jaundice
Palmar Erythema
Finger Clubbing
Spider Naevi
Ascites (ab. swelling)
Dilated Ab. blood vessels
Varices
Neurological changes
Hepatic Flap
Xanthelasmas

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8
Q

What are the causes of liver disease? (7)

A

Alcohol
Viral infections (Hep. A-E)
Fatty Liver
Malignancy (HCC)
Immune Disease (Autoimmune Hepatitis)
Inherited + Metabolic Disorders (Wilson, a1-antitrypsin deficiency)
Drugs + Toxins

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9
Q

Give e.g. of drugs that can cause liver disease. (4)

A

Paracetamol
Phenytoin
Oral Contraceptives
Methotrexate

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10
Q

What is the reference range for albumin?

A

34-45g/L

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11
Q

Where in the body is albumin made? (1)

A

Made in the liver.

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12
Q

What is the half-life of Albumin? (1)

A

Half-life = 20 days.

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13
Q

What is the general level of albumin in acute liver disease? (1)

A

Normal

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14
Q

Explain the importance of Albumin. (1)

A

Useful guide to severity of chronic liver disease.

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15
Q

What causes is considered when albumin levels are low? (1)

A

Extrahepatic

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16
Q

What are the symptoms of hypoalbuminemia? (5)

A

Oedema
Appetite changes
Muscle breakdown
Dry Skin
Ab. weight gain

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17
Q

What are the potential causes of hypoalbuminemia? (4)

A

Heart Failure
Diabetes
Vitamin deficiency
Severe burns

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18
Q

What are the general features for ALT? (4)

A

A.K.A. Alanine Transferase
Released from hepatocytes when damaged.
Cytosol enzyme
Liver specific than AST
Also indicates drug-induced reaction.

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19
Q

What is the reference range for ALT? (1)

A

0-40 IU/L

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20
Q

What is the reference range for AST?

A

0-40 IU/L

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21
Q

What are the general features for AST?

A

A.K.A. Aspartate Transferase
Released from hepatocytes when damaged.

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22
Q

Which part of the body can you find AST? (6)

A

Heart
Pancreas
Kidney
Lung
Muscle
RBC

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23
Q

What is the AST:ALT ratio for hepatocellular injury? (2)

A

AST < ALT
Chronic liver disease

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24
Q

What is the AST:ALT ratio for established cirrhosis? (4)

A

AST > ALT
2:1 or greater
Alcoholic Liver Disease
Esp. if GGT = increased.

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25
Q

What is GGT? (6)

A

A.K.A. Gamma-Glutamyl Transpeptidase
Enzyme
Released in all types of liver dysfunction
Indicator for alcohol abuse
Enzyme inducing drugs

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26
Q

Where in the body is GGT found? (6)

A

Hepatocytes
Biliary Epithelial Cells
Kidneys
Pancreas
Intestine
Prostate

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27
Q

What is the reference range for GGT? (1)

A

0-50IU/L

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28
Q

What is ALP? (3)

A

Alkaline Phosphatase
Isoenzyme

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29
Q

Where is ALP produced? (1)

A

Hepatocytes

30
Q

What disease state causes an increase in ALP levels?

A

Cholestatic disease

31
Q

What does an isolated rise in ALP not indicate?

A

Liver dysfunction

32
Q

What is Bilirubin? (4)

A

Breakdown RBC product
Transported to liver, attached to albumin.
Billirubin is conjugated in the liver.
Excreted via bile.

33
Q

What is the reference range for Bilirubin? (1)

A

5-21umol/L

34
Q

What factors can increase bilirubin levels? (4)

A

Liver damage resulting to jaundice.
Biliary tract obstruction
Haemolysis

35
Q

What is prothrombin? (2)

A

Made in the liver
Vit. K dependent

36
Q

What is the range of prothrombin time? (1)

A

12-16 seconds

37
Q

What is prothrombin time? (3)

A

Time taken for clot to form.
Marker of synthetic function.
Excludes vit. K deficiency.

38
Q

Outline the complications associated with liver disease. (5)

A

Portal hypertension
Ascites
Encephalopathy
Bleeding Varices
Spontaneous Bacterial Peritonitis (SBP)

39
Q

What is portal hypertension? (3)

A

Increase pressure in portal venous system.
Collateral veins develop.
Contributes to ascites + encephalopathy.

40
Q

What are the treatment options for portal hypertension? (2)

A

Carvedilol
Propanolol

41
Q

What is ascites?

A

Swollen abdomenW

42
Q

What factors cause ascites? (4)

A

Fluid acccumulation
Low serum albumin
Portal hypertension
Decrease in aldosterone metabolism

43
Q

What are the treatment options for ascites?

A

Low sodium diet
Mobilise fluid excess:
- Diuretics
- Paracentesis

44
Q

What are the possible causes of encephalopathy? (3)

A

Occurs with significant liver dysfunction.
Altered BBB permeability (ammonia)
Altered mental state
Asterixis

45
Q

What is the main treatment aim for encephalopathy? (1)

A

Reduce ammonia in circulatory system.

46
Q

What are the treatment options for encephalopathy? (2)

A

Lactulose
Antibiotics (Rifaximin)

47
Q

What are the treatment aims for bleeding varices? (3)

A

Stop/delay blood loss
Treat hypovolaemic shock
Prevent recurrent bleeding.

48
Q

What are the preventative measures for bleeding (bleeding varices)? (2)

A

Propranolol + endoscopic ligation
Carvedilol

49
Q

What are treatment options for bleeding varices? (3)

A

Vasopressin or Terlipressin
Somatostatin or Octreotide
Balloon Tamponade

50
Q

What do you need to consider for using PPIs? (1)

A

Complications can arise in cirrhosis -
Use with caution

51
Q

What is spontaeneous bacterial peritonitis? (3)

A

Complication of cirrhosis.
Acute bacterial infection of ascitic fluid.
Mortality (40-70%)

52
Q

What are the treatment options for acute SBP? (1)

A

IV antibiotics

53
Q

What are the treatment options for prophylactic SBP? (2)

A

For high risk patients
Quinolones (use with caution)

54
Q

What is pruritus? (1)

A

Bile salt deposition within the circulation.

55
Q

What are the treatment options for pruritus? (5)

A

Depends on severity:
- Moisturising and cooling agents
- Ursodeoxycholic acid
- Antihistamines
- Anion exchange resins

56
Q

Explain the importance of CIWA-Ar for managing alcohol withdrawal.

A

CIWA-Ar - scoring system. Monitors alcohol withdrawal and guides need for pharmacological therapy i.e. BZPs.

57
Q

What is the treatment aims for alcohol withdrawal? (4)

A

Reduces:
- Mortality
- Withdrawal symptoms duration
- Seizures
- Delirium Tremens

58
Q

What are the potential cause of muscle cramps? (2)

A

Diuretics
Vit. D deficiency

59
Q

What is the treatment for muscle cramps? (1)

A

Quinine Sulphate

60
Q

What are the common side effects for Quinine Sulphate when used for muscle cramps? (2)

A

Thrombocytopenia (low platelet count)
Cardiotoxicity

61
Q

What do you need to consider when treating pain for patients with liver disease? (5)

A

Don’t use NSAIDs

Opioids: Morphine, Oxycodone, Fentanyl

Paracetamol

62
Q

What factors do you need to consider for hepatic blood flow? (2)

A

Reduced
Increase in systemic bioavailabilty of oral drugs undergoing 1st pass metabolism

63
Q

What main factor do you need to consider for portosystemic shunting?

A

60% blood supply diverted

64
Q

What factors do you need to consider for reduced hepatic cell mass? (2)

A

Severe disease = 30% capacity
Drugs extensively metabolised in liver.

65
Q

What factors do you need to consider for reduction in protein binding? (3)

A

Lower serum albumin
Highly protein drugs
Drug free conc. = increased.

66
Q

Give e.g. of drugs that can exacerbate liver complications. (4)

A

Opioids
Benzodiazepines
Diuretics
NSAIDs

67
Q

Give e.g. of drugs that can induce liver disease.

A

Statin
NSAIDs
Penicillins

(Can present in weeks/months after medication is started/stopped)

68
Q

High GGT, bilirubin and ALP means that the patient will have cholestasis.
– True – False

A

True

69
Q

High ALT and AST means that the patient has hepatotoxicity. (T/F?)

A

False

70
Q

Which of these drugs WILL cause liver impairment?
Digoxin
Rifampicin
Statins

A

Statins

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