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Flashcards in liver and renal disease Deck (45):
1

functions of the kidnye

regulate vol of fluid in blood
electrolyte balance
acid-base balance
excretion of waste products
vit D metabolism
EPO

2

what electrolytes does the kidney control

sodium
potassium
chloride
calcium
magnesiom
phosphate

3

glomerular filtration rate

GFR
measreument of wast products in plasma
vol of fluid filteresd through all glomeruli per time unit

4

eGFR

estimated glomerular filtration rate
based on equation validated against gokd standard of renal clearance test

5

what waste products can be measured for the kidney

creatinine ( waste of muslce breakdown)
urea (breakdown of proteins and amino acids)

6

renal function releated tests

acid0ase balance
plasma phosphate
plasma calcium
urinary proteins

7

acid base balance relevance to kidneys

decreased excretion by the kidney
renal failure leads to metabolic acdosis, more H ions and more carbonic acid

8

relevance of urinary protein measurements in kiendye

glomeruli manage causes proteins to leake into tubules and these cannot reabsorp the protein back
as renal disease progresse, proteins get larger leading to proteinurina

9

low GFR

low renal function or failure

10

causes of acute renal failure

hypovolaemia due to blood loss dehydration/shock
acute glomerular inflamation
drugs
muscle breakdown
obstrution of renal flow

11

biochem changes due t actue renal failure

-low GFR
-rapid loss of urine vol
-accumulation of waste products, urea and creatinine
-accumulation of electrolytes, potassium and phosphate
- accumulation of acids, noHion excretion
- impairment of other renal function

12

causes of chronic renal failure

gradual decline of function over years
- diabetes
-hypertention
-disases affecting glomeruli

13

rhabdomylosis

breakdown of muscle
myoglobin leaked into blood
filtered by kidney but damages it leading to severe renal issues

14

what is type 2 renal failure

chronic
eGFR between 0-15
very bad, most dever

15

biochem changes in chronic renal failure

same as acute but slowly
-accumulation of wast products, urea and ceantnine
- accumulation of electrolytes
- no H ion excretion
- functions impaired
- low vit D production

16

why is creatinine a bad measure of renal function and failure

only starts rising and accumlating whne over 70% of function is lost

17

role of the kidney in electrolyte balance

sodium and water, balance coupled
kidney balances this using hormones
- adrenals: renin, angiotensin,aldosterone axis(Ha, H2O and K)
- pos pit ADH affects water balance

18

what is electrolyte imbalance (too little)

hyponatraemia
loss of Na and or excess water
low osmotic pressure
can lead to fluid moving to brain causing swelliing which is bad

19

too much electrolytes

hypernatramiae
loss of water, too much NA
water drawn out of brain cells leading to shrinkage which is bad

20

hyperkalaemia

higher plasma potassium
caused by:
- haemolysis, high intake, high rena absoption or chronic renal failure

21

why is hyperkalaemia important

can lead to arrythmias

22

hypokalamiae

low serum potasium levels
reduced renal absoption and low nintake of K
leads to arrythmias and muscle weakness

23

outline of bilirubin metabolism

Hb processed in spleen to haem then biibrin then to plasma when bound to albumin
this goe to liver
conjugated with glucoronicacid
now to small intestine
processed by bacteria
sterocolbilin made

24

liver functions

- bilirubin excretion
- gucose hoemostaisis
- cholesterol metabolism
- clotting factors production
- detoxification of drugs
- amino acid catbolism
- protein synthesis

25

liver function tests

ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
ALP (alkaline phosphatase)
Total bilirubin
Albumin
GGT (gamma glutamyl transpeptidase)

26

3 main liver function tests

bilirubin
albumin
prothombin time clotting

27

ALT and AST tests

alanine aminotransferase
aspartate aminotransferase

enzymes involved in tranfer of amino groups and metabolism
released into blood when hepatocytes damaged

28

ALP test

alkaline phosphatse test
enzymes found in blood whne pressure in billlary ducts increases

29

gamma glutamyl transpeptiade test

enzyme present in hepatocytes
enzyme blood lvels increase:
- when pressure inside ducts increaases
- sysnthesis induced by alchocol and drugs

30

albumin test

this protein is made in the liver and carriers things in the blood maintaining osmotic pressure
low albulin: sever liver disase

31

bilirubin test

product of RBC cycling
high levels indicate liver problem or hepatic block

32

use of prothombin time for liver test

measures clotting time
If liver isn't working well, less clotting factors being made therefore blood will take longer to clot

33

when is ammonia measured for liver function

in neonates only with severe ilness
in adults it doesnt correlate with liver disease so not helpful

34

main ctegories of liver disease

-Hepatitis: Inflammation/infection and hepatocyte damage
-Cholestasis: impairment of bile flow
-Mixed hepatitis /cholestasis
-Tumours and other infiltrative diseases
-Alcoholic liver disease

35

hepatitiscasues

-viral infection of liver
- epstein barr virus
- overdose of alchol or drugs
-autoimmune
- Ischaemia

36

what does hepatiis lead to

hepatocytes damages
- they relese enyes into blood leading to high levels which is bad
- ALt and AST HIGH
- serum bilirubin high
clotting may also be impaired

37

fulminant hepatitis

massive liver inflamation
- hypoglycamia, hypoalbinuaemia
sever clotting impairement
high ALT and AST
high ammonia

38

Cholestasis

impairment of blood flow
eg gall stones
bilirubin appears in urine and its brown but pale stools

39

functional tests for cholestasis

ALP very high
very high bilirubin

40

what is mixes hepatitis and cholestasis

damage of both herpatocytes and bile duct cells

- sepsis
- immunosuressant drugs
- autoimmune liver disease
aminotransferases and ALPmildly raised

41

effect of liver tumours or finction

usualy normlal functions untill very advanced tumour

42

what does chronic alchol intake do to the liver?

high GGT
large red cell vol, macrocytosis

43

what happens to someone with chonic
alchol liver disease after stopping intake

GGT goes back to normal in 3-4 weeks

44

consequences of chonic alchol liver diseae

- fatty liver
- acute hepatitis
- liver cirrhosis

45

when will GGT be raised

marker for alchol intake