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Therapeutics > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

What are the symptoms of cirrhosis?

A 
Jaundice and pruritus 
nausea and vomiting 
Hepatomegaly 
Ascites
Dark urine and pale stools in cholestasis 
Spider nave in alcoholic liver disease
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2
Q

What are the causes of liver damage?

A 
Viral hepatitis
Alcohol abuse
Obesity (cirrhosis)
Cancer
Adverse drug reaction
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3
Q

What adverse drug reactions can cause liver damage?

A 
Halothane
Paracetemol overdose
Clavulanic acid in 'augmentin'- co-amoxiclav
Valporate
Amiodarone
Herbals
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4
Q

How is Bilirubin produced?

A

Mainly from breakdown of RBCs
Iron and globing are reused, biliverdin is formed from haem and reduced to bilirubin
Bilirubin is uncongugated and water insoluble
The liver conjugates bilirubin to make it water soluble and excreted as bile

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5
Q

When is bilirubin increased?

A

Biliary obstruction (cholestasis)
Hepatocellular damage
Haemolysis

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6
Q

What are aminotransferases (AST/ALT)?

A

Leak out from damaged cells
Markedly raised in hepatocellular damage
ALT a more specific marker of liver damage
Increases >2 fold greater than upper limits are often associated with biopsy proven liver disease

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7
Q

What’s alkaline phosphate?

A

Present in canalicular and sinusoidal membranes of liver
(Also other tissues e.g bone and placenta)
Markedly raised in cholestasis
Raised in infiltration of liver e.g markedly in metastasis

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8
Q

What are Gamma GTs?

A

Microsomal enzyme present in many tissues including the liver

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9
Q

What increases Gamma GTs?

A 
Induction:
Alcohol
Carbamazepine
Barbiturates
Phenytoin
Rifampicin 
Cholestasis
Cellular damage
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10
Q

What does albumin do?

A

Measures synthetic activity of liver
Indicate changes over a longer term
T1/2= 16-24 days

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11
Q

What is International Normalised Ratio (INR)?

A

Prothrombin time
Indicates synthetic activity (and coagulation)
As coagulation factors have a relatively short half life indicates both acute and chronic damage

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12
Q

Why are LFTs carried out?

A

Some diagnostic value
Poor predictor of drug metabolism
Monitor drug treatment

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13
Q

What drugs are monitored using LFTs?

A 
Statins
Fibrates
Amiodarone
Isotretinoin
Rifampicin
Glitazones
Valporate
Sulfasalazine
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14
Q

What are the LFT results for acute hepatitis?

A 
ALT + AST: Increased
ALP: Increased or normal
Bilirubin: Increased or normal
GGT: Increased or normal
Albumin: Normal 
INR: Increased or normal
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15
Q

What are the LFT results for cholestasis?

A 
ALP: Increased 
GGT: Increased 
Bilirubin: Increased 
ALT + AST: Normal or increased
Albumin: Normal 
INR: Normal or increased (reduced Vit K absorption)
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16
Q

What are the LFT results for chronic liver disease?

A 
GGT: Increased
Bilirubin: Increased 
Albumin: Decreased
INR: Increased
ALP, ALT+AST: Normal or increased
17
Q

What is jaundice?

A

Hyperbilirubinaemia resulting in yellow colouration of the skin and sclera of the eye
Leads to pruritus and nausea

18
Q

What’s prehepatic jaundice?

A

Water insoluble unconjugated bilirubin produced faster than liver can conjugate for excretion
Open due to haemolysis- haemolytic anaemias (spherocytosis)
Gilbert’s syndrome- reduced levels of UDP-glucuronosyl transferase which conjugates bilirubin

19
Q

What’s hepatocellular jaundice?

A

Transaminases leak out
Liver cannot convert insoluble bilirubin from the blood to water soluble bilirubin
Reduced bilirubin excretion (pale stools)

20
Q

What’s cholestasis?

A

Bile cannot flow from the liver to the duodenum

21
Q

What’s intrahepatic cholestasis?

A

Primary biliary cirrhosis: autoimmune damage to bile ducts
Hepatocellular damage
In pregnancy with unknown cause (3rd trimester)

22
Q

What’s extrahepatic cholestasis?

A

Gallstones

Ca head of pancreas

23
Q

What’s obstructive jaundice?

A

Cholestasis
GGT and ALP not excreted and are elevated
Liver can convert insoluble bilirubin in the liver to water soluble bilirubin
Cannot excrete bilirubin in the bile (pale stools)
Water soluble bilirubin excreted in the urine (dark urine)

24
Q

What are the complications of liver disease?

A 
Jaundice 
Ascites (accumulation of fluid in the peritoneal cavity)
Encephalopathy 
Impaired coagulation 
Gastric bleeding
Bleeding oesophageal varies
25
Q

What causes ascites?

A

Oedema secondary to hypoproteinaemia
Sodium retention due to secondary hyperaldosteronism
Portal hypertension

26
Q

What are the neuropsychiatric symptoms of encephalopathy?

A 
Changes in personality
Disorientation 
Confusion and drowsiness
Sensitivity to centrally acting drugs 
Gut flora produces nitrogenous waste products, including ammonia
27
Q

How do you treat encephalopathy?

A

Neomycin/metronidazole

Lactulose

28
Q

What can be used to treat gastric bleeding?

A

Ranitidine

29
Q

What can be used to treat bleeding oesophageal varices?

A

Beta blockers

Octreotide

Therapeutics (17 decks)

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