Hepatology Flashcards
Out of the transaminases, which is more specific for liver damage?
ALT (l for liver)
In which situations does alk phos become raised, but it’s not due to a disease?
Produced by bones and placenta as well as liver, so becomes raised during pregnancy and adolescence
ALP is raised, how could you differentiate causes?
Other LFTs normal= bone
Osteomalacia, paget’s, fracture, metastases (not osteoporosis)
LFTs abnormal= cholestatis (liver disease or gallstone, PSC, PBC) + coeliacs
What blood tests tell you about the synthesising abilities of the liver?
Albumin
Prothrombin time
Bilirubin
What liver function tests and FBC findings are characteristic of alcoholic liver disease?
2:1 of AST:ALT
Normal Alk Phos
Raised y-GT
FBC: raised MCV
How do blood tests differ between hepatocellular liver injury caused by alcoholism Vs viral hepatitis or non-alcoholic fatty liver?
AlcoholIc: AST raised more than ALT
Viral + NASH: ALT > AST
(Ah STop drinking)
Difference between cholestasis, cholangitis, cholecystitis and biliary colic? How do they present differently?
Cholestasis: obstruction of bile excretion- in liver or bile duct (jaundice)
Cholecystitis: gallbladder inflammation (fever, no jaundice)
Cholangitis: bile duct inflammation (fever + jaundice)
Biliary colic: stone in bile duct, no inflammation (no fever)
Anti-mitochondrial antibodies
Raised IgM levels
In a jaundiced patient
Primary biliary cirrhosis
Patient has is jaundiced with raised conjugated bilirubin with high CRP, you suspect autoimmune hepatitis or primary biliary cirrhosis. What tests?
AMA Abs + high IgM for primary biliary cirrhosis
(anti-mitochondrial Abs)
ANA Abs + high IgG for autoimmune hepatitis
(Anti-nuclear Abs)
Raised ferritin and diabetes?
Haemochromatosis, may have liver failure and joint pain from iron deposition too
Mirizzi’s syndrome?
A stone in the gallbladder leads to compression of the bile duct causing jaundice from cholecystitis (normally would need bile duct obstruction for jaundice so would expect stone to be there instead)
What urine and blood tests differentiate between pre-hepatic, hepatic and obstructive causes?
Urine: no bilirubin in pre-hepatic causes as unconjugated bilirubin is not water soluble
No urobilinogen in fully obstructive causes as bile isn’t secreted into intestine for conversion
Blood: unconjugated bilirubin (prehepatic), conjugated bilirubin (hepatic)
A patient has a raised bilirubin, how would you differentiate between causes?
Unconjugated= increased production, where liver can’t cope with amount (Gilbert’s or haemolysis)
Conjugated= metabolised by liver, then not filtered into bile ducts (obstruction of common bile duct or liver disease obstructing flow)
What are the difference causes that typically cause macronodular or micronodular cirrhosis?
Macronodular- alcoholism, drugs etc
Micronodular- generally metabolic ie Wilsons, haemachromatosis
