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Clinical Biomedicine > W2: Liver > Flashcards

W2: Liver Flashcards

1
Q

hepatic portal vein role

A

to take nutrients absorbed from small intestine to liver to be processed

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2
Q

what are rbcs broken down into + by what

A

heme + globin
by macrophages

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3
Q

heme broken down into

A

bilirubin + iron

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4
Q

how is bilirubin transported by the liver + why

A

bound to albumin - to incr its solubility

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5
Q

what makes urine yellow + faeces brown

A

urine converted to urobilin
faeces converted into stercobilinogen

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6
Q

7 liver functions

A
  • Catabolism + excretion of bilirubin
  • Mainten. of glucose homeostasis
  • Metabolism of cholesterol + triacylglycerols
  • Prod of some clotting factors
  • Detoxification of drugs
  • Catabolism of ‘amino’ (NH2) groups of AAs to urea
  • Protein syn: albumin & globulins (except immunoglobulins)
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7
Q

3 tests for liver damage + how its indicated

A

indicated by high levels of:

  • ALT (alanine aminotransferase)
  • AST (aspartate aminotransferase)
  • ALP (alkaline phosphatase)

bc when damaged they leak out into blood

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8
Q

3 liver function tests

A
  • Total bilirubin
  • Albumin
  • GGT (gamma glutamyl transpeptidase)
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9
Q

3 strictly liver function tests

A
  • Bilirubin
  • Albumin
  • Prothrombin time (clotting test)
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10
Q

what are ALT + AST + when are they abundant

A

Enzymes involved in the transfer of amino groups. Important in AA metabolism.
Correct name = aminotransferases
ALT & AST abundant in hepatocytes
AST also abundant in skeletal muscle cells + rbcs
Released into bloodstream when hepatocytes are damaged

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11
Q

ALP: found where, function, isoenzymes found in which organs, enzyme blood levels incr when

A
  • enzyme found in hepatocyte mems close to bilary ducts
  • function not fully understood
  • isoenzymes in; liver, bone, intestines, placenta
    -incr when pressure inside bilary ducts incr
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12
Q

GGT: found where, function, enzyme blood levels inc rwhen

A
  • enzyme found in hepatocyte mems close to bilary ducts
  • transfers gamma-glutamyl groups btwn peptides
  • when pressure inside bilary duct incr
    OR
  • when enzyme syn induced by: alc/ some antiepileptic drugs
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13
Q

albumin: synth where, carrier of, function,

A
  • liver
  • proteins, peps, drugs in blood
  • maintains oncotic pressure in blood vessels
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14
Q

high or low conc of serum albumin in severe liver disease

A

low

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15
Q

low albumin suggests…

A

patient has disease but not specific enough to identify which
further testing needed

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16
Q

bilirubin: conjugated in liver with, excreted in,

A
  • glucuronic acid
  • bile
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17
Q

lab measures ___ bilirubin (adults)
normal values unconjugated vs conjugated

A
  • total
    uncon: 98%
    con: 2%
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18
Q

prothrombin time

A
  • clotting test: assesses clotting factors syn by liver
  • gives an international normalised ratio (INR)
  • prolonged clotting time in moderate/severe liver disease
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19
Q

ammonia: measured + not measured in

A
  • only in neonates w severe illness, irritability, low consciousness level
    -Not measured in adults w liver disease as levels do not correlate w severity of disease
20
Q

glucose high or low in severe liver disease

A

low

21
Q

main categories of liver disease

A
  • hepatitis
  • cholestasis
    -mixed hep + chole
  • tumours + other infiltrative diseases
  • alcohol liver disease
22
Q

what does hepatitis + cholestasis mean

A

hep = inflamm of liver
cholestasis = bile flow impairment

23
Q

infectious types of hepatitis

A

A, B, C
acute or chronic

other viruses - Epstein Barr virus causing glandular fever 9mild hep)

24
Q

2 drugs/ toxins that can cause hep

A

alc
para overdose

25
Q

2 other causes of hep

A

autoimmune
ischaemic - secondary to acute shock (causes rapid drop to BP)

26
Q

ALT & AST usually x 20-50 ULN indictates

A
  • acute hepatitis types A, B, C,
  • secondary to severe ischaemia
  • severe paracetamol overdose/ other overdoses
27
Q

ALT & AST x 2 -10 ULN indicates

A
  • glandular fever, autoimmune hepatitis & chronic hepatitis
28
Q

other abnormalities

A

incr serum ALP 2 x ULN
incr serum bilirubin (depends on severity)
Usually 3-4 x ULN
In severe cases, jaundice appears (usually bilirubin > 4-5 x ULN)
Both unconjugated and conjugated

29
Q

other abnormalities (2)

A

Bilirubin appears in urine (brown colour). Not normally present
Clotting may be impaired. incr INR (depends on severity)

30
Q

effects of massive hep (fulminant)

A
  • Hypoglycaemia
  • Hypoalbuminaemia
  • Severe clotting impairment
  • V high bilirubin
  • Extremely high ALT & AST
  • V high ammonia -> altered level of consciousness
31
Q

what is urgently given to prevent liver damage after paracetamol overdose

A

N-acetylcysteine

32
Q

where can cholestasis occur

A

anywhere from liver canaliculus to duodenum

33
Q

2 types of obstruction + examples

A

partial or complete
gall stones
extra-hepatic cancer causing obstruction (pancreas) which
presses on bile duct so bile can’t be removed from liver

(cholestasis can be caused by other diseases affecting billary tree)

34
Q

how is cholestasis detected?

A

cholestatic pattern
- incr back-pressure on cells of canaliculi + then hepatocytes
- big incr ALP (depends on severity)
Twice ULN – 20 x ULN
- ALT & AST slightly raised (but can be 3-4 x ULN)
- big incr bilirubin 5 – 15 x ULN, 95% conjugated
- bilirubin appears in urine (brown colour) not normally present

35
Q

how is complete obstruction cholestasis detected

A

stool is pale as bile pigments don’t reach gut

36
Q

what is mixed hepatitis/ cholestasis

A

damage to both hepatocytes + cells of bile duct

37
Q

causes of mixed hep/chole

A

During sepsis
Drugs - immunosuppressants
Autoimmune liver disease
Any hepatic/ cholestatic disorder already mentioned

38
Q

effect of mixed H+C on aminotransferases + ALP

A

mildly-moderately raised

39
Q

indicator of autoimmune hep

A
  • incr antinuclear antibodies (Abs that bind to nucleus of own cells)
  • incr smooth muscle antibodies
40
Q

types of liver tumours

A
  • Benign or malignant
  • Single or multiple nodules/masses. Usually infiltrative
  • Primary or secondary (metastases from tumour in different part of body)
41
Q

in liver function test there’s big incr in which enzyme to detect advanced liver cancer

A

ALP

42
Q

what’s raised in hepatocarcinoma

A

alpha-feto-protein (AFP) as this is prod by tumour in liver of foetus

43
Q

effects of chronic alc intake on GGT + red cell vol

A
  • incr GGT due to incr enzyme syn
  • incr red cell vol (macrocytosis)
44
Q

how long for GGT to go back to normal if individual stops alc intake

A

3-4 weeks

45
Q

disadvs of GGT testing

A
  • not sensitive
  • not specific as levels of GGT can be incr in most types of liver disease
46
Q

Other consequences of chronic alcohol intake

A
  • Fatty liver: deposition of fat in liver, associated w raised serum triaylglycerols -> (not damaging but can lead to) inflamm of liver, fibrosis of liver -> liver cancer
  • Raised plasma urate
  • Acute hepatitis (acute alcohol intake)
  • Liver cirrhosis (fibrosis of the liver) in heavy drinkers. Can progress to malignancy.
47
Q

why does MCV take longer to normalise

A

bc rbc half life = 120days

Clinical Biomedicine (23 decks)

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