Flashcards in Biochemical investigation of liver disease Deck (67):
what are the major functions of the liver?
- carb metabolism
- fat, protein,hormone metabolism
-drugs and foreign compounds
What is damaged in hepatitis?
what is the characteristics of cirrhosis?
- liver shrinkage
- decreased hepatocellular function
- obstruction of bile flow
where is ALT present?
Mildly in skeletal muscle
where is AST present?
Hepatocytes, cardiac/skeletal muscle and erythrocytes
what is more liver specific out of ALT and AST?
what can cause a rise in alkaline phosphatase?
Cholestasis, 3rd trimester of pregnancy,meals
what is the albumin half life, why is this important?
in liver damage it won't drop as quickly as you expect
what is a useful marker for hepatocellular carcinoma?
what is alpha fetoprotein useful for?
A marker of hepatocellular carcinoma
what is low low levels of caeruloplasmin associated with?
what is high levels of ferritin associated with?
where does bilirubin become conjugated?
in liver by joining with albumin
what happens to conjugated bilirubin?
bilirubin --> urobilinogen --> excretion or enterohepatic circulation/ kidney
what can physiological process can cause a change in alkaline phosphatase?
what markers are important in inflammatory patterns?
what markers are important in cholestatic patterns?
GGT and bilirubin also
when do albumin concentrations tend to be decreased?
chronic liver disease
what are the first things to exclude when there is a raised ALT?
Alcohol intake,diabetes, increased triglycerides
If the ALT is raised but less than double the upper limit what is the recommendation?
repeat in 1-3 months unless they appear very ill
what are the first line tests for a raised ALT?
- AST to work out ratio
- hep B surface antigen
- Hep C antibody
- liver USS
what are the second line tests for a raised ALT?
- anti tissue transglutaminase antibodies
- alpha 1 antitrypsin
A raised ALT with a raised GGT is suggestive of?
A raised ALT showing thrombocytopenia on blood test is suggestive of?
A raised ALT investigated showing a raised AMA is suggestive of/
PBC (AMA m2 is specific)
A raised ALT investigated showing a raised ASM/ANA is suggestive of?
what is ALT with raised ferritin suggestive of?
what populations are more likely to have haemochromotosis?
Post menopausal women
Where in the cells is AST found?
what is half life of AST?
what is a AST:ALT ratio <1 suggestive of?
Majority of liver diseases will have this finding
what is a AST:ALT ratio >2 suggestive of?
An extrahepatic source
A raised AST:ALT ratio above 2 is suggestive of an extrahepatic source what are examples of this?
what is a AST:ALT ratio >4 suggestive of?
fulminant wilsons disease
A raised ALT with raised anti tissue transglutaminase antibodies suggests?
what is the most common finding on biopsy for non explained raised transaminases?
Non alcoholic steatohepatitis followed by non alcoholic fatty liver
what is more prevelant: non alcoholic fatty liver disease or alcoholic liver disease?
non alcoholic fatty liver disease
what is the most common cause of abnormal LFT's?
non alcoholic fatty liver disease
what are the stages of non alcohol fatty liver disease?
Healthy liver --> non alcohol fatty liver --> cirrhotic/ non alcohol steatohepatitis --> HCC
what is step 1 in the development of non alcoholic fatty liver disease?
Non alcoholic fatty liver --> cirrhotic liver/ non alcoholic steatohepatitis
what is step 2 in the development of non alcoholic fatty liver disease?
Cirrhotic liver/ non alcoholic steatohepatitis --> hepatocellular carcinoma
What are the major risk factors in non alcoholic fatty liver disease for fatty liver --> cirrhotic liver (step one)?
- arterial hypertension
What are the major risk factors in non alcoholic fatty liver disease for cirrhotic liver (step one) --> hepatocellular carcinoma (HCC)?
how does body weight change in NAFLD and alcoholic liver disease?
how does fasting plasma glucose change in NAFLD and alcoholic liver disease?
what is the reported daily alcoholic intake in alcoholic liver disease?
>20g in women and over 30g in men
how does AST change in NAFLD compared with alcholic liver disease?
Normal in NAFLD
alcoholic liver disease- increase
what is the AST:ALT ratio in non alcoholic fatty liver disease?
<0.8 Unless advanced
what is the AST:ALT ratio in alcoholic liver disease?
what is the management for NAFLD with an ALT <50?
Lifestyle advice to achieve weight loss
what is the management for NAFLD with an ALT of 50-150?
Lifestyle advice, weight loss, alcohol reduction, stop hepatotoxic drugs
what is gilberts disease?
A defect in the regulatory part of gene coding for bilirubin UPD-glucuronyl transferase leading to raised bilirubin
what is crigler najjar?
Ascence in bilirubin UDP glucuronyl transferase
what over the counter things can raise GGT?
st johns wart.
If there is a raised ALP how can you check the origin of the problem?
check GGT levels if normal bone in origin
if not normal; vit d/ pregnanc
what can cause ALP levels to be high in the population?
- black women
- old age
what tests can be done to check for fibrosis?
what tests can be done to check for alcohol?
what tests can be done for tumour markers?
What is P3NP often used for?
to monitor methotrexate treatment long term as it can cause liver fibrosis
what is the ELF test?
Meases three biomarkers
1. hyaluronic acid
3. tissue inhibitor of metalloproteinase 1
uses this to calculate a fibrosis score
what is a non invasive assesment for pancreatic exocrine insufficiency?
what causes a raised CEA?
what causes a raised AFPT?
what causes a raised CA125?
- conditions that cause peritoneal inflammation
what is hepatic elastography used to assess?
chronic liver disease