Liver Disease and LFTs Flashcards
(28 cards)
Phenoxymethylpenicillin
When to use
Long term use due to the removal of spleen
Can be given for sickle cell disease
Jaundice: New born babies
Cause, management
Need to be assessed as liver is still not working thus there is an accumulation of bilirubin due to haemoglobin not being broken down
Low level of bilirubin - expose to light
High level of bilirubin - blood transfusion
Liver Function Tests (LFTs)
Bilirubin
Aminotransferases - ALT and AST
Alkalin phosphate (ALP) and Gamma glutamyl transferase (GGT)
Albumin
Prothrombin time
Bilirubin
Normal range. high bilirubin cause and consequences,
<17micromol/L - normal
High bilirubin - caused by haemolysis or hepatic mechanism failure by toxin or infection, gallstones causing cholestasis, Gilbert’s syndrome
Jaundice - consequences of these
Bilirubin: Cholestasis
Gallstones blocking the path of bile thus bile not metabolised
Itching - symptom, treat by antihistamine, skin emollients or colestyramine
ALT
Normal range, where it is localised, indication of what
5 - 40 U/L - normal
Main indication of acute liver disease
Localised in the liver - more specific
AST
Normal range, where it is present
10 - 40 U/L - normal
Present in heart, skeletal muscle, kidney, brain and liver
Aminotransferases: AST and ALT
Liver diseases associated with these
High enzymes - associated with acute liver damage e.g. acute viral hep or acute toxic injury
Small increases - obstructive jaundice and cirrhosis
2:1 AST:ALT ratio - alcoholic liver disease
Alkakine Phosphatase (ALP)
Normal range, main indicator, associated conditions with high levels
30 -300 U/L - normal
Main indicator of cholestasis - especially if GGT is also raised
High levels - also occur in the presence of cirrhosis or tumour and associated with pregnancy or Paget’s disease or osteomalacia
Can be found in the bone as well
High levels ALP but low levels GGT - associated with bone conditions
Gamma Glutamyl Transferase (GGT)
Normal range, associated conditions with high levels and other LFTs
<50 U/L - male
< 32 U/L - female
Enzyme inducer = high level
Found in liver and renal tubules
High level with no other LFT abnormalities - induction by alcohol or enzyme-inducing drugs e.g. phenytoin, carbamazepine
High GGT and ALP - cholestasis
GGT = Aminotransferases - acute hepatic changes
Albumin
Normal range, associated conditions with low levels
35 - 48g/L - normal
Low levels - liver is damaged
Good marker of severity of chronic liver disease e.g. cirrhosis
Hypoalbuminaemia - associated with ascites. Low albumin = low oncotic pressure resulting to accumulation of fluid
Low levels and no other LFT abnormalities - non-hepatic cause of low albumin
Ascites
What is it, causes and management
Excessive free fluid in the peritoneal cavity
Sodium and water retention - one cause. Low BP = RAAS system kicks in = Aldosterone causes retention thus give aldosterone antagonist
Portal hypotension - another cause. High fluid levels going up to GIT causing oesopahgus to bleed = give B-blockers (propanolol)
Ascites: Treatment
Bed rest
Low salt diet and fluid restriction (if required)
Spironolactone ± Furosemide
Spironolactone - S/E gynecomastia, swiitch to Amiloride
Large volume - drainage + albumin infused
Ascites: Monitoring
K+ levels
BP
Kidney function
Weight loss
Oesophageal varices: Management
Surgery - ligate
Terlipressin
Prothrombin Time (PT)
Indicator of, associated with
Indicator of hepatic synthetic function
High PT - associated with Vit. K deficiency - give Vit. K SC, if it doesn’t work, it doesn’t work
Others: Alfa-fetoprotein (AFP)
Normal range, associated conditions with high levels
Present in plasma
Synthesised by foetal liver
<20mcg/L - normal
High level - occurs in hepatocellular carcinoma, germinal tumours of the testis and ovary, neural tube effect
Others: Ammonia
Normal range, diagnosis and treatment of conditions
<40 micromol/L - normal
Diagnosis and treatment of hepatic encephalopathy and Reye’s syndrome
Hepatic Encephalopathy
What is it, management
Altered mental function due to liver impairment
Main neurotoxin - ammonia
Lactulose + Neomycin - management
Pabrinex - considered for emergency treatment
Pabrinex
Indication
Rapid therapy of severe depletion or malabsorption of Vit. B and C - particular in alcoholism
Thiamine
Indication
Given acutely and long term in alcoholic liver disease
Liver Disease Medicines that are not given: Impaired drug metabolism (RF)
Rifampicin
Fusidic acid
Liver Disease Medicines that are not given: Hypoalbuminaemia (PhPr)
Phenytoin
Prednisolone
Due to accumulation of drugs leading to toxicity
Liver Disease Medicines that are not given: Reduced clotting
Oral anticoagulants
