Biochemical investigation of liver disease Flashcards Preview

T IoD biochemistry > Biochemical investigation of liver disease > Flashcards

Flashcards in Biochemical investigation of liver disease Deck (67):
1

what are the major functions of the liver?

- carb metabolism
- fat, protein,hormone metabolism
-drugs and foreign compounds
- storage
- bilirubin

2

What is damaged in hepatitis?

hepatocytes

3

what is the characteristics of cirrhosis?

-increased fibrosis
- liver shrinkage
- decreased hepatocellular function
- obstruction of bile flow

4

where is ALT present?

Hepatocytes
Mildly in skeletal muscle

5

where is AST present?

Hepatocytes, cardiac/skeletal muscle and erythrocytes

6

what is more liver specific out of ALT and AST?

ALT

7

what can cause a rise in alkaline phosphatase?

Cholestasis, 3rd trimester of pregnancy,meals

8

what is the albumin half life, why is this important?

20 days
in liver damage it won't drop as quickly as you expect

9

what is a useful marker for hepatocellular carcinoma?

alpha fetoprotein

10

what is alpha fetoprotein useful for?

A marker of hepatocellular carcinoma

11

what is low low levels of caeruloplasmin associated with?

Wilsons disease

12

what is high levels of ferritin associated with?

iron overload

13

where does bilirubin become conjugated?

in liver by joining with albumin

14

what happens to conjugated bilirubin?

bilirubin --> urobilinogen --> excretion or enterohepatic circulation/ kidney

15

what can physiological process can cause a change in alkaline phosphatase?

Growth

16

what markers are important in inflammatory patterns?

ALT mainly

17

what markers are important in cholestatic patterns?

ALP mainly
GGT and bilirubin also

18

when do albumin concentrations tend to be decreased?

chronic liver disease

19

what are the first things to exclude when there is a raised ALT?

Alcohol intake,diabetes, increased triglycerides

20

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

21

what are the first line tests for a raised ALT?

- AST to work out ratio
- FBC
-Auto antibodies
- ferritin
- hep B surface antigen
- Hep C antibody
- liver USS

22

what are the second line tests for a raised ALT?

- anti tissue transglutaminase antibodies
- alpha 1 antitrypsin
- caeruloplasmin

23

A raised ALT with a raised GGT is suggestive of?

alcohol intake

24

A raised ALT showing thrombocytopenia on blood test is suggestive of?

hypersplenism
portal hypertension

25

A raised ALT investigated showing a raised AMA is suggestive of/

PBC (AMA m2 is specific)

26

A raised ALT investigated showing a raised ASM/ANA is suggestive of?

AIH

27

what is ALT with raised ferritin suggestive of?

Iron overload

28

what populations are more likely to have haemochromotosis?

Scottish men
Post menopausal women

29

Where in the cells is AST found?

20% cytosol
80% mitochondria

30

what is half life of AST?

12-22 hours

31

what is a AST:ALT ratio <1 suggestive of?

Majority of liver diseases will have this finding

32

what is a AST:ALT ratio >2 suggestive of?

An extrahepatic source

33

A raised AST:ALT ratio above 2 is suggestive of an extrahepatic source what are examples of this?

Alcohol hepatitis
ischaemia/ toxins
acute wilsons
lymphoma
cirrhosis

34

what is a AST:ALT ratio >4 suggestive of?

fulminant wilsons disease

35

A raised ALT with raised anti tissue transglutaminase antibodies suggests?

Coeliacs

36

what is the most common finding on biopsy for non explained raised transaminases?

Non alcoholic steatohepatitis followed by non alcoholic fatty liver

37

what is more prevelant: non alcoholic fatty liver disease or alcoholic liver disease?

non alcoholic fatty liver disease

38

what is the most common cause of abnormal LFT's?

non alcoholic fatty liver disease

39

what are the stages of non alcohol fatty liver disease?

Healthy liver --> non alcohol fatty liver --> cirrhotic/ non alcohol steatohepatitis --> HCC

40

what is step 1 in the development of non alcoholic fatty liver disease?

Non alcoholic fatty liver --> cirrhotic liver/ non alcoholic steatohepatitis

41

what is step 2 in the development of non alcoholic fatty liver disease?

Cirrhotic liver/ non alcoholic steatohepatitis --> hepatocellular carcinoma

42

What are the major risk factors in non alcoholic fatty liver disease for fatty liver --> cirrhotic liver (step one)?

- obesity
- arterial hypertension
- diabetes
- dyslipidaemia
- PNPLA3/TM6SF2
-polymorphisms

43

What are the major risk factors in non alcoholic fatty liver disease for cirrhotic liver (step one) --> hepatocellular carcinoma (HCC)?

obesity
diabetes
advanced fibrosis
PNPLAS3/TM6SF2
Age

44

how does body weight change in NAFLD and alcoholic liver disease?

NAFLD- increase
alcoholic- varies

45

how does fasting plasma glucose change in NAFLD and alcoholic liver disease?

NAFLD- increased
alcoholic- normal

46

what is the reported daily alcoholic intake in alcoholic liver disease?

>20g in women and over 30g in men

47

how does AST change in NAFLD compared with alcholic liver disease?

Normal in NAFLD
alcoholic liver disease- increase

48

what is the AST:ALT ratio in non alcoholic fatty liver disease?

<0.8 Unless advanced

49

what is the AST:ALT ratio in alcoholic liver disease?

>1.5

50

what is the management for NAFLD with an ALT <50?

Lifestyle advice to achieve weight loss
Reduce alcohol
Reassess

51

what is the management for NAFLD with an ALT of 50-150?

Lifestyle advice, weight loss, alcohol reduction, stop hepatotoxic drugs

52

what is gilberts disease?

A defect in the regulatory part of gene coding for bilirubin UPD-glucuronyl transferase leading to raised bilirubin

53

what is crigler najjar?

Ascence in bilirubin UDP glucuronyl transferase

54

what over the counter things can raise GGT?

Phenytoin
st johns wart.

55

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

56

what can cause ALP levels to be high in the population?

- black women
- old age
- hyperthyroidism
- pregnancy

57

what tests can be done to check for fibrosis?

P3NP
ELF

58

what tests can be done to check for alcohol?

CDT
Ethanol metabolites

59

what tests can be done for tumour markers?

- CA199
CEA
AFPT
CA125

60

What is P3NP often used for?

to monitor methotrexate treatment long term as it can cause liver fibrosis

61

what is the ELF test?

Meases three biomarkers
1. hyaluronic acid
2. P3NP
3. tissue inhibitor of metalloproteinase 1

uses this to calculate a fibrosis score

62

what is a non invasive assesment for pancreatic exocrine insufficiency?

faecal elastase

63

what causes a raised CEA?

colorectal cancer

64

what causes a raised AFPT?

Hepatocellular carcinoma

65

what causes a raised CA125?

ovarian cancer
- conditions that cause peritoneal inflammation

66

what is hepatic elastography used to assess?

chronic liver disease

67

what are some causes of iron overload?

haemochromotosis
alcohol