what is a normal level of bilirubin/
3 to 20
clinically evident level of bilirubin?
> 50
what are old RBC broken down into?
Haem is broken down into?
at this stage bilirubin is soluble in water?
globin and haem
iron and bilirubin
insoluble in water (unconjugated bilirubin)
unconjugated bilirubin is taken up by?
how is bilirubin conjugated?
what is conjugated bilirubin excreted as?
liver
with glucoronic acid
bile
bile is broken down by gut bacteria to yield?
where are they excreted/absorbed?
urobilinogen and stercobilinogen
stercobilinogen = excreted as faeces
urobilinogen = reabsorbed by liver and excreted by kidneys
Functions of liver?
1) protein synthesis?
2) carbohydrate metabolism?
3) lipid metabolism?
1) clotting factors
albumin
Immunoglobins
2) glycogen storage and gluconeogenesis
3) bile formation
cholesterol synthesis
LIVER FAILURE
- what happens with albumin synthesis|?
low albumin
oedema/ascites
due to reduced colloid oncotic pressure so water moves into peripheral tissue
LIVER FAILURE
- what happens to clotting factor synthesis?
- what is INR?
- how is it affected in this time?
- bleeding and bruising
- Patient’s PT/normal PT
- raised INR in liver disease
if patient develops very severe hypoglycaemia?
suggests very severe liver impairment
LIVER FAILURE
- what happens to lipid metabolism?
- steatorrhoea
- as a result of failure of bile reaching GI tract
LFTs
-This is more specific to liver and suggests liver pathology if raised.
- Not specific to liver, present in placenta, intestine + most importantly bone.
- Enzyme that is induced by drugs (anti-epileptics classically) + alcohol so it can be a good indicator of alcohol intake
is the best measure of hepatic synthetic function in patients with liver disease.
in patient with liver disease is a very poor prognostic sign.?
- ALT
- ALP
- gGT
- albumin and prothrombin time (PT)
- low albumin and high PT
if someone had hepatic/cholestatic jaundice - what would their LFT’s look like with regards to:
- ALT
- ALP
- bilirubin
HEPATIC
- ^^^^ALT/AST
- mild rise in ALP
- mild rise in bilirubin
CHOLESTATIC
- ^^^ ALP + gGT
- with or without rise in ALT/AST
- High bilirubin
pre-hepatic jaundice?
Faeces Urine Bilirubin Conjugated? ALT/AST ALP Examples
faeces: DARK
urine: normal
bilirubin: normal/high
conjugated?: unconjugated
ALT/AST: normal
ALP : normal
Examples: haemolysis (DIC, malaria) - more bilirubin that can be conjugated + excreted
hepatic jaundice?
Faeces Urine Bilirubin Conjugated? ALT/AST ALP Examples
faeces: pale
urine: dark
bilirubin: high
conjugated: unconjugated
ALT/AST: VERY HIGH
ALP: high
Examples:
Acute Hepatitis
Alcohol
Cirrhosis
post-hepatic jaundice?
Faeces Urine Bilirubin Conjugated? ALT/AST ALP Examples
faeces pale urine: dark bilirubin: very high conjugated: mixed ALT/AST: high ALP: VERY HIGH Examples: cholestasis or biliary obstruction
Drug induced jaundice?
- pre
- hepatic?
- post?
pre-hepatic: antimalarials
hepatic: paracetamol overdose, statins,
post: steroids, sulfonylureas
causes of obstructive jaundice?
- most common?
- if it is within liver - raised igM
- ## if in hilum of liver?
- gallstones
- primary biliary cirrhosis
- cholangiocarcinoma
what questions would you ask for hepatitis??
tattoos? body piercings? IVDU? blood transfusions? sexual activity? travel? alcohol?
in urine you find that bilirubin is absent - what type of jaundice?
- pre-hepatic
in urine you find that urobilinogen is absent - what type of jaundice?
hepatic or post hepatic
in FBC what would you look for if suspecting haemolysis?
haptoglobins
-
Presenting Complaints16
-
Dysphagia10
-
Nausea and Vomiting5
-
Dyspepsia and Peptic Ulcer Disease15
-
GORD8
-
Hiatus Hernia5
-
Upper GI Bleeding12
-
Diarrhoea13
-
Constipation6
-
IBD - UC and Crohn's32
-
Coeliac's Disease8
-
IBS2
-
Chronic Pancreatitis5
-
Carcinomas of Pancreas8
-
Jaundice21
-
GI Questions9
-
Liver Failure9
-
Liver Cirrhosis8
-
Alcoholism3
-
NAFLD4
-
HCC5
-
Primary biliary cholangitis6
-
primary sclerosing cholangitis7
-
A1AT Deficiency4
