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MO1 > liver biochemistry > Flashcards

liver biochemistry Flashcards

1
Q

where is the liver located?

A

Located under the diaphragm in the RUQ

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2
Q

what is the structure of the liver?

A
  • 2 lobes
  • Highly vascular structure
  • Made up of about 300 billion cells
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3
Q

what are the functions of the liver?

A
  • Homeostasis
  • Metabolism
  • Synthesis
  • Immunological
  • Storage
  • Production of
    bile
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4
Q

what does the liver homeostasis?

A

glucose

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5
Q

what does the liver control the metabolism of?

A
  • Carbohydrates
  • Protein
  • Fats
  • Steroid hormones
  • Insulin
  • Bilirubin
  • Drugs
  • Toxins
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6
Q

what does the liver control the synthesis of?

A
  • Protein
  • Clotting factors
  • Cholesterol
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7
Q

what is the livers immunological function?

A
  • Mobilise the macrophage system
  • Kupffer Cells
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8
Q

what does the liver store?

A
  • Fat soluble vitamins
  • Glycogen
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9
Q

what does the liver secrete?

A

bile salts

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10
Q

what are the different types of liver diseases?

A
  • Cholestatic
  • Hepatocellular disease
    – Steatosis
    – Hepatitis
  • Fibrosis
  • Cirrhosis
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11
Q

what is the difference between acute and chronic liver disease?

A

acute:
– Mild
– Self-limiting
– Develop into chronic disease
* Chronic
– Structural changes
→Compromise liver function

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12
Q

what are the symptoms of liver disease?

A
  • Initially:
    – Non-specific
    – Easily fatigued
    – Nausea
  • Often:
    – Loss of appetite
    – Weight loss
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13
Q

when are symptoms of liver disease most apparent? what are they?

A
  • Apparent in decompensated liver disease
  • Loss of muscle from arms and legs
  • Swelling of the abdomen and lower body
  • Abdominal pain
  • Pruritus
  • Bruising
  • Bleeding – gums, nose
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13
Q

when are symptoms of liver disease most apparent? what are they?

A
  • Apparent in decompensated liver disease
  • Loss of muscle from arms and legs
  • Swelling of the abdomen and lower body
  • Abdominal pain
  • Pruritus
  • Bruising
  • Bleeding – gums, nose
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14
Q

what are some signs of liver disease?

A

jaundice, fever, finger clubbing,white nails, oedema, varices, pigmentated ulceration of the skin

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15
Q

what are some causes of liver disease?

A

alcohol
viral infections- eg hep a,b,c,d,e
malignancy
immune disease
drugs and toxins

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16
Q

what is the marker of liver dysfunction?

A

Use a combination of factors:
–LFTs and additional tests
–Diagnosis
–Signs and symptoms

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17
Q

what are the standard LFTs?

A

– Albumin
– ALT
– AST
– GGT
– ALP
– Bilirubin
* Also need to remember:
– Clotting screen

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18
Q

what use would testing albumin be in liver disease?

A

Half life: 20 days
– Acute liver disease: normal
– Useful guide to the severity of chronic liver
disease
– Consider extrahepatic causes for low levels

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19
Q

when is alanine transferase released? - ALT

A

Released from hepatocytes when they are
damaged

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20
Q

what may ALT indicate?

A

a drug induced reaction

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21
Q

what is more specific to the liver ALT or AST?

A

ALT

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22
Q

when is asparate transferase released- AST

A

released from hepatocytes when they are damaged

23
Q

where is AST primarily found?

A

in mitochondria- also in heart, kidnets, lung muscle and RBC

24
Q

what markers in liver function tests tend to ruse and fall at the same time?

A

AST and ALT

25
Q

what does the ratio of AST: ALT indicate?

A

may help in making a diagnosis more or less likely

26
Q

what would the levels be in hepatocellular injury?

A

AST lower than ALt
chronic liver disease

27
Q

what would the levels of established cirrhosis be?

A

AST>ALT
– AST:ALT of 2:1 or greater
* Alcoholic Liver Disease
* Especially if rise in GGT

28
Q

what is GGT?

A

Gamma-Glutamyl transpeptidase (0 – 50 IU/L)
– Enzyme

29
Q

where is GGT present? when is it released?

A

Hepatocytes, biliary epithelial cells, kidney,
pancreas, intestine, prostate
– Released in all types of liver dysfunction

30
Q

what would the presence of GGT indicate?

A

indicate alcohol abuse
or if they are taking enzyme inducing drugs

31
Q

what is ALP?

A

Alkaline phosphatase
it is an isoenzyme

32
Q

where is ALP produced?

A

produced in hepatocytes

33
Q

when would ALP be raised?

A

raised in cholestatic disease
Isolated rise may not be associated with liver
dysfunction

34
Q

what is bilirubin?

A

breakdown product of RBC

35
Q

what happens when bilirubin is transported into the liver?

A

bilirubin is conjugated

36
Q

when would bile levels rise?

A

– When damage to the liver occurs, resulting in
jaundice
– Biliary tract obstruction
– Haemolysis

37
Q

what are the clotting factors in the liver?

A

prothrombin- produced in the liver, vit K dependent

38
Q

what is prothrombin time?

A

– Marker of synthetic function
– Time taken for a clot to form
– Exclude vitamin K deficiency

39
Q

what additional tests can be preformed in addition to liver function tests?

A

– Ultrasound
– Doppler
– Biopsy
– Computed Tomography (CT)
– ERCP
– MRI

40
Q

what are some of the complications with liver disease?

A
  • Portal hypertension
  • Ascites
  • Encephalopathy
  • Bleeding varices
  • Spontaneous bacterial peritonitis (SBP)
  • Pruritus
  • Deranged clotting
  • Hepatorenal syndrome (HRS)
41
Q

what is portal hpt? how do you treat?

A

Increased pressure in portal venous
system
– Collateral veins develop
– Contribute to ascites and encephalopathy
* Treatment:
– Propranolol

42
Q

what is ascites and how do you treat it?

A
  • Swollen abdomen
    – Accumulation of fluid
    – Reduction in serum albumin
    – Portal hypertension
    – Decrease in aldosterone metabolism
  • Treatment:
    – Low sodium diet
    – Mobilise excess fluid
  • Diuretics
  • Paracentesis
43
Q

when does encephalopathy occur?

A

occurs with significant liver
dysfunction
– Altered permeability of the BBB
* Ammonia
– Altered mental state, asterixis

44
Q

how do you treat encephalopathy?

A

– Aim is to reduce ammonia in circulatory system
– Lactulose
– Antibiotics
* Rifaximin

45
Q

what is bleeding varices?

A

Upper GI bleeding
– Occurs in 50% of patients with end stage liver
disease

46
Q

what are the aims of treatment with bleeding varices?

A

– Stop or slow down blood loss
– Treat hypovolaemic shock
– Prevent recurrent bleeding

47
Q

how do you prevent bleeding varices?

A

– Propranolol and endoscopic ligation
– Carvedilol

48
Q

how do you treat bleeding varices?

A

– Vasopressin or its analogue (terlipressin)
– Somatostatin or its analogue (octreotide)
– Balloon tamponade

49
Q

what is the treatment and prophylaxis of spontaneous bacterial peritonitis?

A

– Acute
* IV antibiotics
– Prophylaxis
* High risk patients
* Quinolones

50
Q

what is pruritis and how is it treated?

A

Deposition of bile salts within the circulation
* Treatment:
– Depends on severity
* Moisturising and cooling agents
* Ursodeoxycholic acid
* Antihistamines
* Anion exchange resins

51
Q

what could be the underlying cause of muscle cramps?

A

diuretic induced
vitamin D deficiency

52
Q

what treatment would you give for muscle cramps?

A

quinine sulphate

53
Q

what are the s/e of quinine sulphate?

A
  • Thrombocytopenia
  • Cardiotoxicity
54
Q

what pain relief can you give in liver disease?

A

DO NOT USE NSAIDs
* Opioids
– Morphine
– Oxycodone
– Fentanyl
* Paracetamol

55
Q

what considerations should be made in liver disease?

A

hepatic blood flow
portosystemic shunting
reduced hepatic cell mass
reduction in protein binding
side effects

56
Q

what are the main drug-induced liver diseases?

A

– Statins
– NSAIDs
– Penicillin’s
which may present weeks or months after stopping due to half life

MO1 (50 decks)

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