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Flashcards in Investigation of the Liver Deck (63):
1

Hepatocytes constitude what percentage of liver mass?

60%

2

Each hepatocyte is in contact with what other cells?

Sinusoid
Bile canaliculus
Neighbouring hepatocyte

3

Role of SER

Bilirubin conjugation
Drug detoxification

4

Carbohydrate metabolism of the liver

Glycogen storage and synthesis
Glycolysis and gluconeogenesis

5

Protein functions of the liver

Syynthesis and catabolism
Clotting factors
Amino acid metabolism
Urea synthesis

6

Lipid functions of the liver

Lipoprotein and cholesterol synthesis
Fatty acid metabolism
Bile acid synthesis

7

What is excreted by the liver

Bile acid and bilirubin

8

What does the liver do to drugs?

Detoxification and excretion
Inactivates steroids and excretes iron

9

What vitamins are stored in the liver

Vit A,D,E and B12
Iron

10

6 LFTs in routine liver panel

Alkaline phosphatase
ALT (alanine aminotransferase)
Bilirubin
Albumin
Total protein
GGT (gamma glutamyl transferase)

11

What would you test to determine the functional production of metabolites?

Urea, plasma proteins

12

What would you test to measure the clearance of endogenous substances?

Bilirubin
Ammonia
Hormones

13

What would you test to measure the clearance of exogenous substances?

Drugs, toxins

14

Measure of the integrity of the hepatocytes- released during damage

Aminotransferases

15

2 types of aminotransferases

Alamine/ALT
Asparate/AST

16

Which aminotransferase is more specific for the liver?

ALT

17

Where else, other than the liver, is AST found?

In the muscle and RBCs

18

Tumour markers for primary hepatocellular carcinoma (high levels found in children)

alpha fetoprotein

19

What are the 2 main results of biliary tract damage

Impaired excretory function (increased conjugated bilirubin)
Increased synthesis of enzymes by cells lining the bile canaliculi (ALP and yGT)

20

When do you get elevevated ALP (alkaline phosphatase)

Due to increased production by cells lining the bile canaliculi and overflow into blood

21

4 causes of elevated alkaline phosphatase

Cholestasis
Infiltrative diseases
Space-occupying lesions (tumours)
Cirrhosis

22

Sites of production of ALP

Liver, bone, intestine, placenta

23

How do you distinguish between ALP isoenzymes

Liver and bone ALP isoenzymes separated by electrophoresis

24

Enzyme that is elevated due to structural damage, and can support a liver source of raised ALF

Gamma glutamyltransferase (yGT)

25

When can gamma glutamyltransferase levels be induced?

Alcohol
Enzyme inducing agents e.g. anti-epileptics
Fatty liver e.g. alcohol, diabetes, obesity
Heart failure
Prostatic disease
Pancreatic disease
Kidney damagw

26

Novel biochemical markers of fibrosis

ELF score (PIIINP, TIMP-1, Hyaluronic acid)

27

Bilirubin is a measure of what?

Excretory capacity of the liver and free flow of bile

28

What 3 measurements of bilirubin can be taken?

Total
Unconjugated
Conjugated

29

What levels of bilirun defines jaundice

>40micromol/l

30

slide 21

ok

31

2 examples of pre-hepatic hyperbilirubinaemia

Haemolysis e.g. rhesus incompatibility
Ineffective erythropoiesis e.g. spherocytosis

32

4 post hepatic (obstructive) causes of jaundice

Gallstones
Bilicary stricutre
Cancer e.g. cholangiocarcinoma
Cholangitis

33

2 examples of inborn errors of bilirubin metabolism

Decreased activity of UDP glucoronyl transferase
Reduced ability to excrete bilirubin glucuronide

34

2 inborn errors related to decreased activity of UDP glucuronyl transferase

Gilbert's
Crigler Najjar

35

2 inborn errors related to reduced ability to excrete bilirubin glucuronide

Dubin-Johnson
ROTOR

36

AST/ALT elevated and normal ALP

90% hepatitis

37

AST/ALT normal and elevated ALP

90% obstructive jaundice

38

urine results in prehepatic jaundice

No urinary bilirubin

39

Urine results in post-hepatic obstruction

Dark urine and pale stools

40

Tests for viral hepititis

Serology (hep A-E, EBV, CMV, HIV)

41

Tests for chronic active and autoimmune hepatitis

Anti smooth msucle, anti liver/kidney, anti microsomal and anti nuclear antibodies

42

Test for primary biliary cirrhosis

Anti mitochondrial antibodies

43

Tests for hereditary haemachromatosis

ferritin, transferrin saturation, liver biopsy, genetic testing

44

Test for wilson's disease

Caeruloplasmin, urine copper, plasma copper, liver biopsy

45

Test for alpha antitrypsin deficiency

Alpha antitrypsin, genetic testing

46

Test for hepatocellular cancer

AFP

47

4 effects of oestrogen not being broken down in liver disease

Gynaecomastia
Spider naevi
Liver palms
Testicular atrophy

48

What percentage of subjects with abnormal LFTs have liver disease?

1%

49

5 signs/symptoms of liver disease

Pain
Itching
Jaundice
TATT
Bruising

50

Exocrine secretions come from which cells?

Ductal and acinar cells

51

What 2 exocrine secretions are secreted from the pancreas?

Bicarbonate
Digestive enzymes

52

Describe the pathology of acute pancreatitis

Acute necrotising liquefaction
Inflammatory

53

Causes of acute pancreatitis

Gallstones
Alcohol
Drugs
Hypertriglyceridaemia- increased demand on pancreas for digestive enzymes
Trauma,infections
Rare tumours, autoimmune

54

Symptoms of acute pancreatitis

Severe epigastric pain
Sudden onset
Radiating to the back

55

Potential biochemical features of acute pancreatitis

Uraemia
Hypoalbuminaemia
Hypocalcaemia
Hyperglycaemia
Metabolic acidosis
Abnormal LFTs

56

Diagnosis for acute pancreatitis

Amylast or lipase
Imaging
Clinical history

57

Pathology of chronic pancreatitis

Progressive loss of both islet cells and acinar tissues

58

Presentation of chronic pancreatitis

Abdominal pain
Malabsorption
Impaired glucose tolerance
Alcohol often an important factor

59

Do amylase/lipase values play a role in the diagnosis of chronic pancreatitis/

No

60

Diagnosis of chronic pancreatitis

Imaging
Pancreatic function tests for investigating insufficiency
Misc. Vit D, calcium, FBC, LFTs, glucose, lipids

61

2 types of pancreatic function tests

Direct (invasive) test
Indirect (non-invasive) test

62

Intubation to collect aspirates in the duodenum.
Secretin, CCK, Lundh Tests

Direct (invasive) tests

63

Pancreatic enzyme analysis in stools (Elastase)
Trypsinogen (IRT) measured in blood in CF screening
Pancreolauryl & NBT-PABA tests

Indirect (non invasive tests)