Sodium and LFTs

Question 1

What condition does AST being more than double ALT suggest?

Answer 1

Alcoholic liver disease

Question 2

What does raised ALP and GGT suggest?

Answer 2

Biliary/gall bladder pathology

Question 3

How is synthetic liver function assessed?

Answer 3

Clotting factors- prolonged PT time

Question 4

What liver function results would a known chronic alcoholic have?

Answer 4

Raised bilirubin Prolonged PT Hypoalbuminaemia

Question 5

The patient is Selma Bouvier, a 42 year old female. She has been a chronic heavy smoker since her teenage years. She is admitted to hospital confused, her observations and lab results are as follows: She has respiratory acidosis Na: 128 K: 4.4 Urea: 9 Creatinine: 109 Temp: 38.1°C HR: 109 bpm BP: 94/66 RR: 30 SaO2: 100% on 15L O2 What is the likely underlying diagnosis? Small cell lung cancer Pneumonia Heart failure Diarrhoeal illness AKI

Answer 5

b} Pneumonia High CURB 65 score Pneunomia can cause euvolaemic hyponatraemia due to SiADH- mechanism unknown

Question 6

What are the three types of hyponatraemia?

Answer 6

Euvolaemic

Hypovolaemic

Hypervolaemic

Question 7

What are the causes of hypovolaemic hyponatreamia?

Answer 7

Excessive water loss

Vomiting + diarrhoea

Question 8

What are the mechanisms that regulate sodium balance?

Answer 8

• ADH
• RAAS- Renin-angiotensin-aldosterone
• Natriuretic peptides- ANP/BNP

Question 9

How does ADH regulate sodium balance?

Question 10

How does the RAAS cause regulation of sodium balance?

Question 11

How do natriuretic peptides regulate sodium balance?