Week 10: Liver Biochemistry Flashcards by C L

What are the general symptoms for acute liver disease? (3)

Mild
Self-limiting
Progressive to chronic.

How well did you know this?

Not at all

Perfectly

What are the general features that indicate chronic liver disease? (1)

Structural changes = affects liver function

How well did you know this?

Not at all

Perfectly

What are the initial symptoms of liver disease? (3)

Non-specific
Easily Fatigued
Nausea

How well did you know this?

Not at all

Perfectly

What are the common symptoms of liver disease? (2)

Appetite/Weight loss

How well did you know this?

Not at all

Perfectly

What is the difference between compensated and decompensated liver disease? (1)

Compensated: Liver function maintained after liver damage.

Decompensated: Liver function compromised after liver damage.

How well did you know this?

Not at all

Perfectly

What are the symptoms of decompensated liver disease? (6)

Arms/Legs muscle loss
Abdomen + lower body swelling
Ab. Pain
Pruritus
Bruising
Gums/Nose Bleeding

How well did you know this?

Not at all

Perfectly

What are the signs of liver disease? (9)

Jaundice
Palmar Erythema
Finger Clubbing
Spider Naevi
Ascites (ab. swelling)
Dilated Ab. blood vessels
Varices
Neurological changes
Hepatic Flap
Xanthelasmas

How well did you know this?

Not at all

Perfectly

What are the causes of liver disease? (7)

Alcohol
Viral infections (Hep. A-E)
Fatty Liver
Malignancy (HCC)
Immune Disease (Autoimmune Hepatitis)
Inherited + Metabolic Disorders (Wilson, a1-antitrypsin deficiency)
Drugs + Toxins

How well did you know this?

Not at all

Perfectly

Give e.g. of drugs that can cause liver disease. (4)

Paracetamol
Phenytoin
Oral Contraceptives
Methotrexate

How well did you know this?

Not at all

Perfectly

What is the reference range for albumin?

34-45g/L

How well did you know this?

Not at all

Perfectly

Where in the body is albumin made? (1)

Made in the liver.

How well did you know this?

Not at all

Perfectly

What is the half-life of Albumin? (1)

Half-life = 20 days.

How well did you know this?

Not at all

Perfectly

What is the general level of albumin in acute liver disease? (1)

Normal

How well did you know this?

Not at all

Perfectly

Explain the importance of Albumin. (1)

Useful guide to severity of chronic liver disease.

How well did you know this?

Not at all

Perfectly

What causes is considered when albumin levels are low? (1)

Extrahepatic

How well did you know this?

Not at all

Perfectly

What are the symptoms of hypoalbuminemia? (5)

Oedema
Appetite changes
Muscle breakdown
Dry Skin
Ab. weight gain

How well did you know this?

Not at all

Perfectly

What are the potential causes of hypoalbuminemia? (4)

Heart Failure
Diabetes
Vitamin deficiency
Severe burns

How well did you know this?

Not at all

Perfectly

What are the general features for ALT? (4)

A.K.A. Alanine Transferase
Released from hepatocytes when damaged.
Cytosol enzyme
Liver specific than AST
Also indicates drug-induced reaction.

How well did you know this?

Not at all

Perfectly

What is the reference range for ALT? (1)

0-40 IU/L

How well did you know this?

Not at all

Perfectly

What is the reference range for AST?

0-40 IU/L

How well did you know this?

Not at all

Perfectly

What are the general features for AST?

A.K.A. Aspartate Transferase
Released from hepatocytes when damaged.

How well did you know this?

Not at all

Perfectly

Which part of the body can you find AST? (6)

Heart
Pancreas
Kidney
Lung
Muscle
RBC

How well did you know this?

Not at all

Perfectly

What is the AST:ALT ratio for hepatocellular injury? (2)

AST < ALT
Chronic liver disease

How well did you know this?

Not at all

Perfectly

What is the AST:ALT ratio for established cirrhosis? (4)

AST > ALT
2:1 or greater
Alcoholic Liver Disease
Esp. if GGT = increased.

How well did you know this?

Not at all

Perfectly

What is GGT? (6)

A.K.A. Gamma-Glutamyl Transpeptidase Enzyme Released in all types of liver dysfunction Indicator for alcohol abuse Enzyme inducing drugs

Where in the body is GGT found? (6)

Hepatocytes Biliary Epithelial Cells Kidneys Pancreas Intestine Prostate

What is the reference range for GGT? (1)

0-50IU/L

What is ALP? (3)

Alkaline Phosphatase Isoenzyme

Where is ALP produced? (1)

Hepatocytes

What disease state causes an increase in ALP levels?

Cholestatic disease

What does an isolated rise in ALP not indicate?

Liver dysfunction

What is Bilirubin? (4)

Breakdown RBC product Transported to liver, attached to albumin. Billirubin is conjugated in the liver. Excreted via bile.

What is the reference range for Bilirubin? (1)

5-21umol/L

What factors can increase bilirubin levels? (4)

Liver damage resulting to jaundice. Biliary tract obstruction Haemolysis

What is prothrombin? (2)

Made in the liver Vit. K dependent

What is the range of prothrombin time? (1)

12-16 seconds

What is prothrombin time? (3)

Time taken for clot to form. Marker of synthetic function. Excludes vit. K deficiency.

Outline the complications associated with liver disease. (5)

Portal hypertension Ascites Encephalopathy Bleeding Varices Spontaneous Bacterial Peritonitis (SBP)

What is portal hypertension? (3)

Increase pressure in portal venous system. Collateral veins develop. Contributes to ascites + encephalopathy.

What are the treatment options for portal hypertension? (2)

Carvedilol Propanolol

What is ascites?

Swollen abdomenW

What factors cause ascites? (4)

Fluid acccumulation Low serum albumin Portal hypertension Decrease in aldosterone metabolism

What are the treatment options for ascites?

Low sodium diet Mobilise fluid excess: - Diuretics - Paracentesis

What are the possible causes of encephalopathy? (3)

Occurs with significant liver dysfunction. Altered BBB permeability (ammonia) Altered mental state Asterixis

What is the main treatment aim for encephalopathy? (1)

Reduce ammonia in circulatory system.

What are the treatment options for encephalopathy? (2)

Lactulose Antibiotics (Rifaximin)

What are the treatment aims for bleeding varices? (3)

Stop/delay blood loss Treat hypovolaemic shock Prevent recurrent bleeding.

What are the preventative measures for bleeding (bleeding varices)? (2)

Propranolol + endoscopic ligation Carvedilol

What are treatment options for bleeding varices? (3)

Vasopressin or Terlipressin Somatostatin or Octreotide Balloon Tamponade

What do you need to consider for using PPIs? (1)

Complications can arise in cirrhosis - Use with caution

What is spontaeneous bacterial peritonitis? (3)

Complication of cirrhosis. Acute bacterial infection of ascitic fluid. Mortality (40-70%)

What are the treatment options for acute SBP? (1)

IV antibiotics

What are the treatment options for prophylactic SBP? (2)

For high risk patients Quinolones (use with caution)

What is pruritus? (1)

Bile salt deposition within the circulation.

What are the treatment options for pruritus? (5)

Depends on severity: - Moisturising and cooling agents - Ursodeoxycholic acid - Antihistamines - Anion exchange resins

Explain the importance of CIWA-Ar for managing alcohol withdrawal.

CIWA-Ar - scoring system. Monitors alcohol withdrawal and guides need for pharmacological therapy i.e. BZPs.

What is the treatment aims for alcohol withdrawal? (4)

Reduces: - Mortality - Withdrawal symptoms duration - Seizures - Delirium Tremens

What are the potential cause of muscle cramps? (2)

Diuretics Vit. D deficiency

What is the treatment for muscle cramps? (1)

Quinine Sulphate

What are the common side effects for Quinine Sulphate when used for muscle cramps? (2)

Thrombocytopenia (low platelet count) Cardiotoxicity

What do you need to consider when treating pain for patients with liver disease? (5)

Don't use NSAIDs Opioids: Morphine, Oxycodone, Fentanyl Paracetamol

What factors do you need to consider for hepatic blood flow? (2)

Reduced Increase in systemic bioavailabilty of oral drugs undergoing 1st pass metabolism

What main factor do you need to consider for portosystemic shunting?

60% blood supply diverted

What factors do you need to consider for reduced hepatic cell mass? (2)

Severe disease = 30% capacity Drugs extensively metabolised in liver.

What factors do you need to consider for reduction in protein binding? (3)

Lower serum albumin Highly protein drugs Drug free conc. = increased.

Give e.g. of drugs that can exacerbate liver complications. (4)

Opioids Benzodiazepines Diuretics NSAIDs

Give e.g. of drugs that can induce liver disease.

Statin NSAIDs Penicillins (Can present in weeks/months after medication is started/stopped)

High GGT, bilirubin and ALP means that the patient will have cholestasis. – True – False

True

High ALT and AST means that the patient has hepatotoxicity. (T/F?)

False

Which of these drugs WILL cause liver impairment? Digoxin Rifampicin Statins

Statins