Wk 10: Biochemistry: Liver (tests) Flashcards
Name the different types of liver disease in order of severity
- Cholestatic
- Hepatocellular disease: steatosis + hepatitis
- Fibrosis
- Cirrhosis
What is chronic liver disease characterised by?
Structural changes - compromise liver function
What are the initial symptoms in liver disease?
- Non-specific
- Easily fatigued
- Nausea
- Loss of appetite
- Weight loss
What are the symptoms of decompensated liver disease?
- Loss of muscle from arms + legs
- Swelling of abdomen + lower body
- Abdominal pain
- Pruritus
- Bruising
- Bleeding gums + nose
What are the signs of liver disease?
- Jaundice
- Ascites
- Finger clubbing
- Palmer erythema
- Spider navei
- Dupuytren’s contracture
What are the causes of liver disease?
- Alcohol
- Viral infection
- Fatty liver
- Inherited metabolic disorders
- Drugs + toxins
Give examples of viral infections that cause liver disease
Hep A, B, C, D + E
Give examples of fatty liver that cause liver disease
NASH + NAFLD
Give an example of an inherited + metabolic disorder that causes liver disease
- Alpha 1-antitrypsin deficiency
- Wilsons disease
Give an example of drugs that causes liver injury
- Paracetamol
- Phenytoin
- Oral contraceptives
- Methotrexate
What indicates hepatocellular injury?
- AST lower than ALT
- Chronic liver disease
What indicates alcoholic liver disease?
- AST:ALT = 2:1 or greater
- Inc GGT
What is gamma-glutamyl transpeptidase?
- Indicates alcohol abuse
- Indiacted enzyme inducing drug reaction
Give examples of why bilirubin levels may increase
- Damage to liver resulting in jaundice
- Biliary tract obstruction
- Haemolysis
What is the clotting factors in the liver?
Prothrombin - vit K dependent
What is the prothrombin time + what is it used for?
- Marker of synthetic function
- Time taken for clot to form
- Exclude vit K deficiency
What is the usual prthrombin time?
12-16 seconds
What are the indicators of hepatitis?
Inc ALT + AST
What are the indicators of acute liver disease?
Sig rise ALT + AST
What are the indicators of chronic liver disease?
- Normal-mild rise ALT + AST
- Inc ALP + bilirubin
- Red albumin
- Rise in prothrombin time
What tools are used to grade severity of liver dysfunction?
Child-pugh classification
What is cirrhosis indicated by?
Liver enzymes not elevated much
Give examples of drugs that cause drug induced liver disease
- Statin
- NSAID
- Penicillin
Who is more at risk of cholestatic jaundice?
- Co-amoxiclav + flucloxacillin
- > 26
- Treatment > 2wks
- Male
What are the risk factors for developing corrhosis?
- T2 diabetes
- Cholesterol
- Male
- > 50
