Jaundice and Chronic Liver Disease: Liver function and Liver Function Tests

Question 1

What is the synthetic functions of the Liver

Answer 1

Clotting factors
Gluconeogenesis, Glycogenolysis, Glycogenesis,
Albumin synthesis
Cholesterol synthesis, Lipoprotein
Triaglycerol synthesis
Produce hormones (angiotensinogen, insulin like growth factor)

Question 2

What is the detoxification functions of the liver

Answer 2

Urea production from ammonia

Detoxification of drugs

Bilirubin metabolism

Breakdown of insulin and hormones

Question 3

What is the immune functions of the liver

Answer 3

Combating infections

Clearing the blood of particles and infections, including bacteria

Neutralizing and destroying all drugs and toxins

Question 4

What is the storage function of the liver

Answer 4

Stores glycogen
Vitamin A, D, B12 and K
Copper
Iron

Question 5

What are the 8 Liver function tests

Answer 5

Bilirubin
Alkaline phospherase 
aminotransferase 
gamma GT 
Albumin 
Prothombin 
Creatine 
Platelet count

Question 6

How is bilirubin synthesised

Answer 6

Synthesied by heamm metabolism by RBC breakdown in the spleen

Question 7

What is the non conjugated from of bilirubin

Answer 7

Bound to albumin for transportation

Question 8

When does bilirubin become conjugated - soluble

Answer 8

In the Liver

Question 9

When does bilirubin become elevated

Answer 9

Pre-hepatic: Haemolysis
Hepatic: Parenchymal (liver) damage
Post hepatic: Obstructive

JAUNDICE

Question 10

What is amionotransferase (AST)

Answer 10

The enzyme present in hepatocytes

Question 11

What is more specific ALT or AST (alanine aminotransferase)

Answer 11

AST - shows alcohol involvement

Question 12

What does the ratio of ALT:AST indicate

Answer 12

Liver damage and if is due to alcohol (AST higher)

Question 13

Where is alkaline phosphatase (ALP) found

Answer 13

The enzyme is present in the bile ducts

as well as bone, placenta and intestine

Question 14

What does an elevation of alkaline phosphate indicate

Answer 14

Shows obstruction of liver infiltration

Also indicated problems in your gallbladder and bones

Question 15

What is the non specific liver enzyme that is tested for in liver function tests

Answer 15

Gamma GT

Question 16

What is is Gamma GT tested for in consideration with and why

Answer 16

alkaline phosphate (ALP) to see if the liver damage was due to alcohol

Question 17

What causes elevated Gamma GT

Answer 17

Alcohol use
NSAID drugs
Tumours

Question 18

Why is albumin an important test in liver function tests

Answer 18

To see Synthetic function of the liver

Question 19

What does Low levels albumin suggest in Liver function tests

Answer 19

Suggests a chronic liver disease as the synthesis of albumin is no longer occurring

Question 20

What can also cause low levels of albumin

Answer 20

Kidney disorder - protein lost in urine

Malnutrition - not enough protein in your diet

Question 21

What liver function test tells the degree of liver dysfunction and the recovery of the liver

Answer 21

Prothrombin time (INR test)

Measure how long it takes blood to clot - Bleeding disorder indicated liver disease

Question 22

What is the prothrombin time also used for in the diagnosis of liver disease

Answer 22

Used to calculate scores to decide stage of liver disease, who needs a liver transplant and who gets a liver transplant

Question 23

Why is the creatine test of importance in liver function tests

Answer 23

As asses kidney function, therefore determines the survival of liver disease, as liver dependant on kidney function

This means its a critical test inconsideration of liver transplant

Question 24

How does low platelets count occur in liver disease

Answer 24

Due to liver being an important source of thrombopoetin (releases hormone that stimulates platelet production)

and due to the occurrence of hypersplenism

Question 25

How does splenomegaly occur from Liver disease

Answer 25

Advanced liver disease - cirrhosis can cause portal hypertension which results in splenomegaly causing an over reactive spleen and low platelet count