Jaundice and LFTs

Question 1

things that the liver makes

Answer 1

clotting factors
bile acids
glucose
albumin
cholesterol
TAG
angiotensin
IGF

Question 2

the liver neutralizes and destroys all ___

Answer 2

drugs and toxins

Question 3

things stored in liver

Answer 3

glycogen, vits A, B12, D and K, copper and iron

Question 4

8 LFTs

Answer 4

bilirubin
aminotransferases
alkaline phosphatase
gamma GT
albumin
prothrombin time
creatinine
platelet count

Question 5

relevance of bilirubin levels to liver function

Answer 5

bile pigment formed by liver from breakdown products of Hb. Elevated in liver damage

Question 6

what is haemolysis

Answer 6

breakdown of RBCs

Question 7

where is bilirubin made

Answer 7

the spleen

Question 8

how is the liver involved in bilirubin production

Answer 8

it conjugates it (solubises it)

Question 9

what condition is caused by raised bilirubin

Answer 9

jaundice

Question 10

how does liver damage cause elevated bilirubin

Answer 10

liver isn’t clearing bilirubin from blood effectively to excrete it

Question 11

how does haemolysis cause raised bilirubin

Answer 11

excess breakdown of Hb means more bilirubin made

Question 12

what state is bilirubin in before it reaches the liver

Answer 12

unconjugated - bound to albumin

Question 13

what is an aminotransferase

Answer 13

enzyme in hepatocytes: important for formation of amino acids from keto-acids

Question 14

what conditions are aminotransferases raised in

Answer 14

hepatocellular disease and viral hepatits

Question 15

alkaline phosphatase test

Answer 15

enzyme in bile ducts that is raised in obstruction of liver infiltratino

Question 16

gamma GT

Answer 16

enzyme often tested along with alkaline phosphatase to confirm the liver is the source

Question 17

why do gamma GT along with alkaline phosphatase

Answer 17

because alkaline phosphatase is present outside liver so doing gamma GT confirms the liver as the source

Question 18

what kind of people is alkaline phosphatase often raised in

Answer 18

pregnant women

Question 19

lifestyle causes of raised gamma GT

Answer 19

alcohol abuse and NSAIDs

Question 20

what result of albumin would be most concerning

Answer 20

low - indicates chronic liver disease

Question 21

what non liver condition can albumin be low in

Answer 21

kidney disease

Question 22

relevance of prothrombin time in liver

Answer 22

liver produces coagulation factors so the time it takes to make prothrombin into thrombin tells the degree of liver dysfunction

Question 23

when is prothrombin time used

Answer 23

to determine the stage of liver disease

Question 24

what vitamin is important for clotting and is stored by the liver

Answer 24

vitamin K

Question 25

what hepatovascular disease is platelet count an indirect marker of

Answer 25

portal hypertension

Question 26

what is jaundice

Answer 26

yellow skin and sclera caused by excess circulating bilirubin

Question 27

how can jaundice be distinguished from carotenemia

Answer 27

carotenemia has no yellowing of the sclera

Question 28

3 classifications of jaundice

Answer 28

pre-hepatic hepatic post-hepatic

Question 29

pre-hepatic jaundice has elevated conjugated/unconjugated bilirubin

Answer 29

unconjugated bilirubin

Question 30

organ of issue in haemolysis

Answer 30

spleen

Question 31

ways in which liver can raise bilirubin

Answer 31

defective uptake, conjugation and excretion

Question 32

3 hepatic causes of jaundice

Answer 32

intra-hepatic bile duct obstruction cholestasis hepatitis

Question 33

3 post-hepatic cause of jaundice

Answer 33

cholelithiasis gall bladder disease extra-hepatic duct obstruction

Question 34

stool findings of post-hepatic jaundice

Answer 34

pale, fatty stool from lack of bile (bilirubin) leaving liver

Question 35

urine in post-hepatic jaundice

Answer 35

dark coloured - excess bilirubin excretion

Question 36

why do you get gynaecomastia and spider naevi in liver disease

Answer 36

failure of the liver to break down oestrogen

Question 37

which type of jaundice cause would you find spider naevi and gynaecomastia in

Answer 37

hepatic

Question 38

in which type of jaundice is the urine pale ad what is this known as

Answer 38

pre-hepatic - acholuric jaundice

Question 39

pathology of pre-hepatic jaundice

Answer 39

excess breakdown of Hb

Question 40

why is urine pale in pre-hepatic jaundice

Answer 40

the excess bilirubin is unconjugated and water insoluble. It therefore is not excreted into urine

Question 41

if haemolysis jaundice is the excess breakdown of RBCs and Hb what other condition might it result in

Answer 41

anaemia

Question 42

what is asterixis

Answer 42

flapping tremor

Question 43

investigations in jaundice

Answer 43

LFTs ultrasound hep B and C serology

Question 44

what LFT is raised in viral hepatitis

Answer 44

aminotransferases

Question 45

what LFT is raised in alcohol abuse or cholestasis

Answer 45

gamma GT

Question 46

what is ERCP

Answer 46

endoscopic retrograde cholangioprancreatomoy

Question 47

when is ERCP commonly used therapeutically

Answer 47

to open up sphincter of Oddi, to remove stones or tumour

Question 48

imaging of biliary tree

Answer 48

percutaneous transhepatic cholangiogram (PTC) | endoscopic ultrasound