Week 3.1 - LFT's and Jaundice Flashcards

1
Q

What nutrients does the liver store?

A

glycogen, vitamin A, D, B12 and K, copper, iron

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2
Q

What are 8 liver function tests?

A
  • alkaline phosphatase
  • aminotransferase
  • albumin
  • bilirubin
  • creatine
  • gamma GT
  • prothrombin
  • platalet count
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3
Q

Why is bilirubin test significant?

A

biproduct of haem metabolim. high level is result of excess haemolysis, parenchymal issue and obstructive issue

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4
Q

Why is alkaline phosphatase test significant?

A

directly produced as enzyme in bile ducts. obstruction causes elevated levels. not specific - other organs have ALP too.

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5
Q

Why is Gamma GT test significant?

A

non-specific liver enzyme. if ALP and this both elevated, confirms liver source of ALP

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6
Q

Why is aminotransferases test significant?

A

enzymes in hepatocytes and bile ducts. ALT more specific than AST, but ratio of both help diagnose alcohol liver disease. suggest hepatocyte involvement

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7
Q

Why is albumin test significant?

A

albumin made in liver. if low, chronic liver disease suggested.

also low if lost from body due to renal issue, or in malnutrition

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8
Q

Why is prothrombin time significant?

A

made in liver. shows degree of liver dysfunction. helps assessing who needs transplant and when

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9
Q

Why is creatine test significant?

A

considered kidney function but has implications on liver disease. also determines survival and who needs transplant

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10
Q

Why is platelet count significant?

A

low platelets is result of hypersplenism. this is caused by portal hypertension. so indirect marker of portal hypertension

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11
Q

What symptoms occur when the liver stops working(4)?

A
  • jaundice
  • variceal bleeding
  • ascites
  • hepatic encephalopathy
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12
Q

What is jaundice?

A

yellowing of the skin due to excess circulating bilirubin

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13
Q

What are the 3 types of jaundice?

A

pre hepatic, hepatic and post hepatic

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14
Q

What suggests pre-hepatic cause?

A
  • normal colour of urine as bile is unconjugated so not in liver.
  • history of anaemia
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15
Q

What suggests hepatic cause?

A
  • bright urine
  • liver disease
  • decompensation - ascites, variceal, bleeding, hepatic encephalopathy
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16
Q

What suggests post-hepatic cause?

A

bright urine
abdominal pain
cholestasis

17
Q

What may you see on examination of pre, hepatic and post?

A

pre - splenomegaly, pallor
hepatic - chronic liver disease, spider veins, ascites, asterixis
post - palpable gallbladder

18
Q

How do you investigate jaundice via screening? whats beneficial?

A

ultrasound - shows:
- extrahepatic or intrahepatic,
- what and where,
- portal hypertension,
- splenimegaly,
- cancer and staging

19
Q

What tests can you do for jaundice to investigate?

A
  • liver screen
  • hep B/C serology
  • autoantibody profile
  • serum IgG
  • ferritin and transferrin
  • copper levels
  • fasting glucose
  • lipid profile
20
Q

What is CT/MRI vs ultrasound argument?

A

CT more expensive and radiation, but they both have greater sensitivity. ultrasound has low sensitivity. ultrasound widely available.

21
Q

ERCP vs MRCP?

A

ERCP injects dye, goes in via endoscopy and can take out stones and put in stents. Therapeutic sand diagnostic. needs sedation - complications.

MRCP is a scanner - claustrophobia. only diagnostic

22
Q

What is a cholidoscope?

A

smaller endoscope that can get into papilla. for cholidocholithiasis

23
Q

When do we use PTC?

A

if ERPC isnt possible and need to go higher up in bile duct. need to puncture liver from top to enter - more invasive

24
Q

Why is EUS special?

A

can take fine needle aspiration of tumours and cysts - biopsies, and view canaliculi. can stage tumours

25
Q

When would you carry out a liver biopsy?

A
  • assess jaundice and liver disease when no biliary dilatation.
  • gives definite diagnosis of certain conditions, e.g. autoimmune hepatitis,
  • confirms others like PBC. can stage alsohol hepatitis and NAFLD.