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Liver Function Tests Flashcards

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1
Q

What does the liver produce ?

A

Clotting factors
Albumin
Lipids
Hormones

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2
Q

What does the liver convert ammonia into ?

A

Urea

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3
Q

What vitamins and minerals does the liver store ?

A

Iron
Copper
B12
A, D, E and K

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4
Q

What is bilirubin a measure for ?

A

High levels of Bilirubin shows a dysfunctioning liver or blockage in the system.

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5
Q

What do aminotransferases show ?

A

They are enzymes present in hepatocytes, ALT and AST, if there levels are high then it shows there is liver damage.

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6
Q

What does a high (2 or more) AST/ALT ratio indicate ?

A

ALT is specific for the liver but if the AST/ALT ratio is high shows alcoholic liver damage.

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7
Q

What does high levels of alkaline phosphate indicate ?

A

Indicates a blockage or inflammation in the bile ducts

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8
Q

Where is alkaline phosphate also found ? (2)

A

Bones

Intestines

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9
Q

What does Gamma GT show ?

A

It’s a liver enzyme who’s levels increase with alcoholic liver damage. Can be used to confirm source of ALP.

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10
Q

Apart from alcohol what can also raise levels of Gamma GT ?

A

NSAID’s

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11
Q

What do albumin levels shows ?

A

They are important in testing liver function, used to calculate the levels of liver disease.

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12
Q

Why are creatine levels tested ?

A

Shows kidney function and is used to determine overall survival from liver disease.

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13
Q

Why is platelet count important ?

A

Platelets are low in patients with liver disease as Thrombopoietin levels are low. It is an indirect indication of portal hypertension.

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14
Q

Why is Thrombopoietin important ?

A

Its a hormone needed for platelet production

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15
Q

What are the signs of portal hypertension/liver disease ?

A
  • Jaundice
  • Varices
  • Ascites
  • Hepatic encephalopathy
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16
Q

At what level is jaundice detectable in plasma ?

A

34 micromol/L

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17
Q

What are the 3 classifications of jaundice ?

A

Pre-hepatic
Hepatic
Post-hepatic

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18
Q

At what stage does bilirubin become conjugated ?

A

Hepatic stage

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19
Q

What 2 things may cause pre-hepatic jaundice ?

A

Haemolysis

Impaired transport

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20
Q

What other signs would the patient have in pre-hepatic jaundice ?

A

Splenomegaly
Anemia
Chest pain
Fatigue

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21
Q

What 3 things may cause hepatic jaundice ?

A

Defective conjugation
Defective uptake
Defective excretion

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22
Q

How might a patient present with hepatic jaundice ?

A

Ascites
Variceal bleeding
Hepatic encephalopathy
Gynaecomastia

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23
Q

What may cause post-hepatic jaundice ?

A

Defective transport of bilirubin in the bile ducts

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24
Q

How might post hepatic jaundice present ?

A

Pale stools
Dark urine
Abdominal pain

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25
What investigations should be done in a patient with jaundice ?
Copper, ferritin, Hep B and C Ultrasound of the abdomen MRCP/ERCP
26
What is PTC used for ?
Percutaneous Transhepatic Cholangiogram Used when ERCP isn't possible due to an obstruction or previous surgery. Dye is injected into the bile duct and x-rays are taken. Can also be used to stent or unblock bile ducts.
27
What is EUS ?
Endoscopic Ultrasound | Done using a probe, biopsy may be taken. Used for looking at pancreatic masses and staging tumours .
28
Define chronic liver disease
Liver disease that persists beyond 6 months
29
What should all patients with new onset ascites have ?
A paracentesis
30
What is measured via paracentesis ?
Protein and albumin levels Cell count SAAG gradient (Serum ascites albumin gradient)
31
What does a SAAG gradient >1.1g/dl mean ?
Portal hypertension related e.g. heart failure or cirrhosis
32
What does a SAAG gradient <1.1g/dl mean ?
Non portal hypertension related e.g. infections and pancreatitis
33
Define transudative
Fluid is pushed through capillaries due to high pressure, proteins stay in vessel e.g. albumin
34
Define exudative
Fluid moves between cells due to inflammation, albumin also leaks out
35
What are the treatment options for ascitic patients ? (3)
TIPS procedure Large volume paracentesis Liver transplantation
36
How is bleeding from varices controlled ?
- A, B, C - Wide bore cannula and IV fluids - Blood transfusion - Emergency endoscopy - Band ligation, clipping - Give Terlipressin to control bleeding - May need a Sengtaken Blakemore tube for uncontrolled bleeding
37
Define Hepatic Encephalopathy
Confusion due to liver disease
38
How is Hepatic Encephalopathy graded ?
From 1-4
39
How is Hepatic Encephalopathy treated ?
- Need to treat underlying cause - Laxative if constipated - Antibiotics if infected
40
Patients who have Hepatocellular carcinoma usually have what other clinical disease ?
Hep B or C with cirrhosis
41
How is Hepatocellular carcinoma diagnosed ?
USS, CT, AFP
42
What is the treatment for Hepatoceullar carcinoma ? (4)
Transplantation Hepatic resection Chemotherapy (TACE) Radio-frequency ablation
43
Which Hep viruses are enteral ?
A and E
44
Which Hep viruses are paraenteral ?
B, C and D
45
Which Hep versus have a self-limiting course ?
A and E
46
Which Hep versus have a chronic course ?
B, C and D
47
How is Hep A and E transmitted ?
Faecal oral route, sexual contact and via blood products
48
How is Hep A and E diagnosed ?
Via IgM antibodies
49
How is Hep A and E treated ?
Symptomatic medication
50
Is there an immunisation for Hep A ?
Yes it is given to lab workers, travellers and IVDU's
51
How is Hep B and D transmitted ?
Sexual contact and blood products
52
How is Hep B and D diagnosed ?
Blood tests for surface antigen (HBSAg), Hep D antibodies, USS for liver damage
53
How is Hep B and D treated ? (2)
Antivirals | Pegylated interferon
54
How is Hep C transmitted ?
Sexual contact and blood products
55
How is Hep C diagnosed ?
Blood test for antibodies and PCR | USS
56
How is Hep C treated ?
Antivirals
57
What are the 3 stages of NAFLD ?
Steatosis Steatohepatitis Cirrhosis
58
How do you investigate NAFLD ?
Liver biopsy (PTC) USS Bloods
59
How is NAFLD scored ?
> 3 high risk
60
Name 3 autoimmune liver diseases ?
PBC PSC Autoimmune hepatitis
61
What is elevated and what is positive when investigating PBC ?
IgM elevated | AMA positive
62
How do you treat PBC ?
UDCA
63
What is found positive in PSC ?
pANCA
64
How is PSC diagnosed ?
MRCP
65
How is PBC diagnosed ?
If AMA negative do a Liver biopsy
66
What is elevated in autoimmune hepatitis ?
IgG
67
How is autoimmune hepatitis diagnosed ?
Elevated enzymes - ANA, SNA and LKM1 | Liver biopsy
68
How to decide priority in cirrhosis for transplantation ?
Child Pugh score UKELD score MELD score
69
Define orthotopic
Occurs in the usual place e.g. liver transplantation is orthotropic
70
What medication is needed after liver transplantation ? (3)
Antibiotics Anti-fungals Steroids
71
Which Hep strains can cause serious liver damage if they get severe enough ?
A, B and E
72
What part of haemoglobin forms bilirubin ?
The haem part when it is broken down in the spleen
73
Describe the enterohepatic circulation from the breakdown of haemoglobin
Haemoglobin is broken down in the spleen into haem and globin. Haem then becomes bilirubin. Bilirubin is taken up by hepatocytes from circulation and conjugates and excreted into the biliary system. Once in the biliary system it makes it way into the intestine where it is taken up via reabsorption.
74
Define cholestasis
Accumulation of bile within hepatocytes or bile canaliculi
75
Is PBC more common in males or females ?
Females
76
What is seen in the blood in PBC ?
AMA and elevated ALP
77
Describe what happens to the bile ducts in PBC ?
Granulation of the bile ducts progressing to cirrhosis due to autoimmune disease
78
Describe what happens to the bile ducts in PSC ?
Chronic inflammation and fibrosis of the bile ducts. Progresses to cirrhosis
79
What bowel disease is PSC associated with ?
IBD
80
Which cancer is PSC associated with ?
Cholangiocarcinoma
81
Liver tumour mets what are the common primary sites ? (4)
Breast Lung Melanoma Colon
82
What does chronic cholecystitis lead to ?
Fibrosis and inflammation of the gallbladder
83
What can cause bile duct obstruction ?
Tumours ExternaL compression Gallstones Strictures
84
What might bile duct obstruction lead to ?
Cirrhosis Ascending Cholangitis Pancreatitis
85
Define Cholesterolosis
Buildup of cholesteryl esters and they stick to the wall of the gallbladder forming polyps
86
What are the two different types of gallstones ?
Cholesterol and pigment
87
What are the risk factors for gallstones ?
Pregnancy Over 40 Female Obesity
88
How do gallstones present ?
``` Colicky pain spreads to shoulders Loss of appetite Itchy skin Diarrhoea Fever N/V ```
89
What are gallstones in the bile duct known as ?
Choledocholithiasis
90
What may gallstone in the bile ducts lead to ?
Pancreatitis or ascending Cholangitis
91
How do you investigate gallstones ?
LFT's USS (dilated ducts ) MRCP
92
What is the gold standard treatment ?
Laproscopic cholecystectomy
93
What types of tumours are most ampullary types ?
Adenocarcinoma or adenomas
94
What type are cancers of the gallbladder ?
Cholangiocarcinomas

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