Hepatobiliary disease

Question 1

Liver synthesise

Answer 1

• Albumin
• prothrombin
• AST & ALT & gamma GT

Question 2

Function of liver

Answer 2

• Performs 500+ chemical processes
• Synthesise: fat, CHO, protein, clotting factors
• Stores: gly., Vit, minerals, nutrients
• Excrete: bile & bilirubin
• detoxify: toxins & drugs

Question 3

Describe the blood flow in & out of the liver via hepatic vein, Hepatic artery, portal vein

Answer 3

• HV: deox. blood & nutrients out of liver to <3
• HA: ox. blood from <3
• PV: deox. blood, nutrients & toxins from most organs to liver

Question 4

List the liver function tests

Answer 4

• Enzymes: ALP, ALT, AST, gamma GT

- Proteins: Alb, PT

Question 5

markers for hepatocellular damage (liver damage)

Answer 5

ALT, AST, ALP, gammaGT

Question 6

markers for determining liver excretory function

Answer 6

Bilirubin

Question 7

markers for determining liver synthesis function

Answer 7

Albumin, PTT, 5’ nucleotidase (instead of GGT), ammonia, LDH, glucose

Question 8

Ehrlich rxn measures _ by

Answer 8

D. bilirubin by reacting w/ Diazo agent => red/blue

Question 9

How are In.d bilirubin detected in the lab?

Answer 9

Ind. bilirubin + Diazo agent + ACCELERATOR => red/blue

Question 10

Types of hyperbilirubinemia (3)

Answer 10

1. Pre/intrahepatic: inc. breakdown of Hb = inc Ind. bilirubin
2. Extra/Hepatic: obstruction = partial cholestasis = damage to hepatocytes = inc. Ind + D. bilirubin
3. Complete obstructive jaundice / Posthepatic: Complete biliary obstruction = inc D. bilirubin

Question 11

bilirubin metabolism from formation of bilirubin (haemolytic jaundice)

Answer 11

1. excess haemolysis of RBC => heme => excess unconj./indirect bilirubin
2. Ind. bilirubin in blood -> liver via Alb
3. liver converts Ind. bilirubin to D w/ UDP-glucuronosyl-transferase
4. Hi [ ] of direct bilirubin -> intestine & converted by a bacteria => stercobilinogen
5. excess stercobilinogen
   => dark poo bc stercocilin
   => dark urine bc stercobilinogen

Question 12

Expected lab results of Hemolytic jaundice*

Answer 12

• AST, ALT, ALP, PT & Alb normal
• Hb dec
• inc Ind. bilirubin
• Dark colour poo & pee

Question 13

What happens when you have cholestasis (obstructive bilirubin)

Answer 13

1. excess haemolysis of RBC => heme => excess unconj./indirect bilirubin
2. Ind. bilirubin in blood -> liver via Alb
3. liver converts Ind. bilirubin to D w/ UDP-glucuronosyl-transferase
4. obstruction/cholestasis ≠> intestine = low stercobilinogen formed = pale poo
5. direct bilirubin reabsorbed back in blood excreted via urine (water-soluble) = v. yellow urine

Question 14

Expected lab results of intrahemolytic/hepatocellular jaundice (diagnosis)*

Answer 14

• inc AST & AST
• inc D. & Ind. bilirubin in blood
• pale poo
• urine dark brown (bc only exit for bilirubin)

Question 15

posthepatic/ obstructive jaundice*

Answer 15

• inc D. bilirubin
• ALP >3
• ALT & AST not inc. ~normal

Question 16

diagnose a patient w/ High GGT & High ALP

Answer 16

cholestasis

Question 17

ALP 3x higher than the upper limit =

Answer 17

(complete) obstructive jaundice

Question 18

diagnose a patient w/ High GGT (& normal ALP, AST, ALT)

Answer 18

Alcoholism & drugs

Question 19

diagnose a patient w/ High GGT, Hi ALT & Hi AST (& normal ALP)

Answer 19

Hepatocellular disease

Question 20

diagnose a patient w/ High ALP (& normal GGT)

Answer 20

Skeletal bone disease (occur in pregnant females)

Question 21

State where in&direct biliruben can appear whther in plasma or urine

Answer 21

In: plasma (bc insoluble in water)
Direct: plasma & urine (bc water soluble)

Question 22

Where can you find ALT, AST, ALP & GGT

Answer 22

• ALT: hepatocyte
• AST: hepatocyte, RBC, skeletal muscles
• ALP: bone, liver, placenta, kidney, intestines
• GGT: liver

Question 23

Define cholestasis. & marker for cholestasis

Answer 23

decrease in bile duct/f;low due to obstruction

marker inc. GGT, ALP (normal AST & ALT)

Question 24

Total Bilrubin (TBIL) RRange

Answer 24

0.2–1.2 mg/dL

Question 25

Direct Bilirubin (Conj. Bilirubin): RRange

Answer 25

0–0.4 mg/dL

Question 26

-----jaundice is very common in babies and neonates and may cause ----- damage (Kernicterus). If conc. ~200 µmol/L, then use ---- If conc. ~300 µmol/L, then use -------

Answer 26

a. haemolytic b. brain c. PHOTOTHERAPY to breakdown the molecules in the skin. d. blood exchange TRANSFUSION

Question 27

The marker that can differentiate b/w acute & chronic liver disease

Answer 27

- Alb - Acute: normal Alb lvls - Chronic: dec. Alb lvls

Question 28

Alpha Fetoprotein (AFP) is a tumor marker, which is synthesized by __ liver. However, it can be increased in ------ giving false positive.

Answer 28

embryonic liver | pregnant women

Question 29

An increased ------ is more sensitive and earlier indicator of reduced hepatic synthesis than __ (in hepatocellular disease).

Answer 29

PT than Alb

Question 30

-----is a more specific indicator of liver inflammation than ----, and, ----often follows ----.

Answer 30

ALT more specific than AST | AST follows ALT

Question 31

a) An AST:ALT result of >2:1 or >3:1 means | b) an AST:ALT result of > 1 or >2

Answer 31

a) alcoholic liver disease | b) acute hepatocellular disorders (viral hepatitis)

Question 32

Acute liver disease occurs due to one of the following

Answer 32

- Poisoning (e.g. w/ paracetamol) - Infection (e.g. Hepatitis A, B & C) - Inadequate perfusion / shock

Question 33

The stages of Hepatitis and liver damage are:

Answer 33

Fat accumulation – Fibrosis – Cirrhosis (chronic liver failure)

Question 34

Among the rare causes of cirrhosis are: Jaundice in (a) Wilson disease in (b) Hemochromatosis in (c)

Answer 34

a) Neonates b) Children c) Adults

Question 35

Clinical features of cirrhosis (chronic liver failure)

Answer 35

- Developing jaundice. - Encepholopathy (high ammonia are not removed from the plasma). - Ascites (low albumin). - Bleeding tendencies (low coagulation factors, PT).

Question 36

Patient with cirrhosis may suffer from a bad itch due to accumulation of ----------.

Answer 36

bile acids

Question 37

liver diagnosis usally done w/

Answer 37

liver biopsy

Question 38

If AST & ALT are ----, liver damage is more likely to be due to hepatocellular injury.

Answer 38

> 1000 U/L (*Note: 300 U/L non-specific) | and the AST:ALT ratio is >1 bu not >2

Question 39

------ enzyme is 10x-100x normal in acute hepatitis and it is ˂10x normal in obstructive jaundice .

Answer 39

ALT

Question 40

In case of obstructive jaundice, ALP is usually very high due to injury in the ---------attached to the liver.

Answer 40

Bile canaliculi