wk 7 5 LFTs Flashcards

1
Q

other than ALT/AST what other enzymes studied in LFTs

A

GGT

Alkaline phosphatase

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2
Q

where else is alkaline phosphatase found

A

placenta

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3
Q

GGT indicates

A

alcholic liver disease

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4
Q

when are the transaminases released

A

in response to hepatocellular injury

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5
Q

where is ALT found in liver cells

A

near cytosol

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6
Q

biliary obstruction will coincid to how much ALT

A

> 1/2000 U/L (should revert back)

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7
Q

obstructive jaundice is seen as

A

less than 500 U/L (ALT)

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8
Q

half lives of ALT, AST and ALkaline phosphatase

A

…(27hr~)
…(17hr~)
1 week (slow rise)

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9
Q

what is bilirubin bound to

A

albumin

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10
Q

bilirubin is the breakdown of

A

Hb

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11
Q

liver is important for many clotting factors, which ones are fibrinogen/prothrombin

A

Factor I

Factor II

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12
Q

other than I and II, what other clotting factors produced

A
v
viii
ix
x
xii
xiii
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13
Q

what does PT measure

A

conversion of PT - thrombin, relfect clotting time

elevated may reflect of reduced synthetic functionality

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14
Q

other causes of prolongation of PTb

A

drugs
bile malabsorption (causes relative vit K deficiency)
consumptive /congenital coagulopathy

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15
Q

areas needed in history to cover for liver

A

drugs (OTC, herbal, controlled, prescription)
pruritus, jaundice, arthralgi weight loss, xanthema fever, anorexia
parenteral exposures (IV) blood transfusions, intranasal, drugs, tattoos sexual history
travel history - timings, zoos, unusual hobbies
alcohol exposure - specific
occupation
temporal variation - itchy at night, fatigue in morning (cholestatic jaundice)

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16
Q

questions for medications

A

timing? changed?

antibiotics/depressants, HMG Co-A nhibitors (statins), NSAIDS, anti-epiletics, anti-tuberculous, sulphonamides/sulphonylureas

17
Q

PT/INR increase alone indicates

A

prolonged jaundice/ vit k malabsorption

hepatocellular dysfunctiosn

18
Q

hepatocellular injury wiill see

A

AST/ALT > ALP

Bili N incr

19
Q

cholestasis will be indicated by

A

ALP > ALT/AST

Bili incr

20
Q

ratio of what in AST:ALT ratio is suggestive of Alcohol

A

normal < 1

>2 indicates alcohol

21
Q

other than ratio, what screens should be considered in acute hepatocellular injury

A

Hep A/HepB/HepC/HepE/HIV
Cytomegalovirus/ Epstein-barr Virus
Herpes Simplex Virus (pregnant/ immunocompromised)

22
Q

what conditions need to excluded for acute liver disease

A

coeliac - tTG (IgA), genotyping
muscle disorders (CK)
Adrenal insufficiency
Anorexia Nervosa (mixed form of LFT)

23
Q

rare causes of liver disease

A

autoimmune hepatitis (ASM antibody) (biopsy gold standard)
wilsons disease - caeruloplasmin
Hemochromatosis (ferritin > 500 - gene testing)
alpha 1 anti-trypsin (PiZZ - worse)

24
Q

hyperbilirubinaemia - unconjugated

A

incr bilirubin production

  • extra/intravascular haemolysis
  • extravasation of blood into tissues

impairec hepatic bilirubin uptake

  • heart failure
  • portosystemic shunts (TIPS)
  • drugs - rifampicin, probenecid

impaired bilirubin conjugation

  • GIlberts - low hyperbilirubinaemia, high LFT - send for genetics
  • CN Type II - same gene
  • Hyperthyroidism
  • Advanced liver disease
25
Q

hyperbilirubinaemia - conjugated

A

extrahepatic cholestasis (biliary obstruction)

  • cholelithiasis
  • PSC
  • cholangiocarcinoma
  • Head of Pancreas mass
  • acute/chronic pancreatitis

intrahepatic cholestasis

  • sepsis/hypoperfusion states
  • cirrhosis
  • TOtal perental nutriton (pronounced, may lead to liver failure, refeeding)
  • Infiltrative diseaases
  • acute hepatitis
  • drug - alkylated steroids, rifampicin, chlorpromerazine
26
Q

cholesterol high and LDL >5 indicates

A

might be genetic

27
Q

CMV /EBV is mostly supportive care, however the patient must be told to

A

avoid contact sports - may rupture spleen/liver