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Flashcards in Liver disease : case studies Deck (25):

What are liver function tests?

Blood tests that measure the levels of enzymes and other proteins from the liver.


What enzymes are examined in a blood test in order to see if the liver hepatocytes are functioning correctly?

AST and ALT (both transaminases - aspartate and alanine)


What enzymes are examined in a blood test in order to see if the bile is flowing correctly?

GGT and ALP (gamma-glutamyl transferase and alkaline phosphatase)


What would be a likely cause of elevated AST and ALT?

Inflammation of the hepatocytes (hepatitis) or a trauma/injury to the hepatocytes


What would be a likely cause of elevated GGT and ALP?

Blocking/obstruction of the bile ducts (cholestasis) caused by a tumour, gall stones (obstruction) or a fatty liver (slowing down of flow)


What are the two main patterns of abnormal liver tests?

Hepatocellular and cholestatic


How is hep C spread and what is the most common risk factor?

Spread via blood and greatest risk factor is injecting drug use.


Is there a vaccine for hepC?

no only hep A and B


What is the name of the drug that used to be very common for treating hepC that caused flu like symptoms? How was it administered?

Interferon via a subcutaneous injection.

Interferon is a cytokine that is naturally produced in the body which helps the immune system to fight off viral infection. Eg when you have the flu your body automatically produces more.


What is melaena and what causes it?

Melaena is the production of dark sticky faeces containing blood. This is as a result of bleeding in the GI tract often as a result of a bleeding varices vein.

The black colour is produced as a result of haemoglobin being altered by digestive bacteria and chemicals in the gut.


What is the treatment of a burst varices vein the oesophagus?

Using an endoscopy they try to stick a rubber band around the vein or inject it with adrenaline (often dosent work).


What is the new treatment only proposed in the last few years and what problems of interferon does it overcome?

Group of drugs called direct acting antiviral agents.

- little symptoms
- taken as tablets over short duration (not injections for up to a year)
- cure rates > 90%


What is portal hypertension?

High pressure in the portal vein (difficult for blood to pass through the liver and then into the heart)


How does the body react or compensate for portal hypertension?

It forms collaterals (alternate vessels to the portal vein that enlarge in order to try bypass as much blood as possible from the portal vein - an alternate root to the heart)

These are called varices and are commonly found in the oesophagus and stomach. (most commonly the gastro-oesophageal junction)


If varcices burst does blood leak or splurt out?

Splurt out - they are under very high pressure!


What are the various causes of portal hypertension? (pre hepatic, intra-hepatic and post hepatic)

Pre hepatic = portal vein thrombosis (clot)
Intra-hepatic = cirrhosis, hepatitis, tumour etc
Post hepatic = hepatic vein thrombosis and right sided heart failure


Whats the similarity and differences between fibrosis of the liver and cirrhosis?

Both are caused by excessive alcohol exposure.

Fibrosis is caused by repeated or prolonged inflammation but is potentially reversible if the liver not exposed to alcohol or toxin and given time to regenerate.

Cirrhosis occurs when the scarring is no longer reversible.


What is hepatic encephalopathy?

A complication or a result of cirrhosis where there is loss of brain function due to build up of toxins in the blood eg ammonia.

It is an indication of advanced cirrhosis


Do people with hepC commonly get rid of the virus?

No they are often unable to fight it and about 85% of people will move on to develop chronic infection which can lead to things like cirrhosis.


What are some of the signs of hepatic encephalopathy?

Signs of nervous system changes may include:

Shaking of the hands ("flapping") when trying to hold arms in front of the body and lift the hands

Problems with thinking and doing mental tasks

Signs of liver disease, such as yellow skin and eyes (jaundice) and fluid collection in the abdomen (ascites)

Musty odor to the breath and urine


What toxin is most responsible for HE?



What is the available treatment of HE?

The mechanism of treatment is not entirely known but it is thought to decrease the ammonia generation by bacteria, converts it to a non absorbable molecule and increases the bowell transit time.


What is ascites and what are the two main causes?

Build up of fluid in the peritoneum which causes abdo distension. The two main causes are:

Portal hypertension - fluid pushed out of circulation into peritoneum

low oncotic pressure in portal vein - low protein levels due to low serum albumin means that the vein is less able to hold onto fluid


What is the most common cause of portal hypertension and what else can portal hypertension present as?


varices, ascites, hepatic encephalopathy, splenomegaly


What is Budd-chiari syndrome?

A relatively uncommon condition where the hepatic veins (from which blood flows out of the liver) is blocked by a clot. (acute thrombosis of the hepatic vein).

This is presented with symptoms that occur rapidly and the cause of the clot is most of the time unknown!

Usually presents as acute congestion of the liver causing hepatocellular damage and sever rapid upper abdo pain.

Portal hypertension occurs with rapid ascites.

Mild jaundice.