Liver damage

Question 1

What is the function of SER, RER & lysosomes in the liver?

Answer 1

• SER=bilirubin conjugation, drug detoxification
• RER=protein, lipid, enzyme synthesis
• L=intracellular scavengers (copper,ferritin)

Question 2

What are LFTs?

Answer 2

• Bilirubin
• Albumin
• Alkaline phosphotase
• ALT
• Total protein
• GGT

Question 3

What specific things are being tested for with:

• urea
• albumin
• Cholesterol
• Prothrombin

Answer 3

• U&P=clotting factors, aa metabolism, urea synthesis, vit K
• A=synthesis & catabolism
• C=synthesis& lipoproteins

Question 4

What test can be used for suspected hepatocyte damage?

Answer 4

• Aminotransferase
• ALT, AST- intracellular only released in damage
• ALT more specific for liver
• AST found in muscles, RBC
• α-fetoprotein in hepatocellular carcinoma

Question 5

What test can be used for suspected biliary tract damage?

Answer 5

• Impaired excretory function=inc conjugated bilirubin
• ALP= elevated due to inc production (cirrhosis, tumours, infiltrative disease, cholestasis)
• γGT=elevated due to structural damage (alcohol, HF, kidney damage, prostatic&pancreatic disease)

Question 6

What are biochemical markers of fibrosis?

Answer 6

-ELF score: hyaluronic acid, PIIINP, TIMP-1

Question 7

What bilirubin levels cause jaundice?

Answer 7

• Serum level >40-50
• Unconjugated= pre & hepatic
• Conjugated=hepatic & post

Question 8

What are causes of pre & post hepatic jaundice

Answer 8

• Hyperbilirubinaemia
• Pre=haemlysis (rhesus incompatibility), ineffective erythropoiesis (spherocytosis)
• Post=gallstones, cholangitis, cancer, biliary stricture

Question 9

What are causes of conjugated/unconjugated jaundice?

Answer 9

• C=impaired excretion, inherited (Dubin-Johnson, rotor), intrahepatic obstruction
• U=Microsomal, inherited (Gilberts), pre-microsomal

Question 10

What are inborn errors of bilirubin metabolism?

Answer 10

• Dec activity of UDP transferase= Gilbert’s/Crigler

- Red ability to excrete bilirubin glucuronide= ROTOR, Dubin-Johnson

Question 11

What blood results would be obtained from someone with:

• Hepatitis
• Obstructive jaundice

Answer 11

• H= AST/ALT elevated, normal ALP

- U=AST/ALT normal, ALP elevated

Question 12

What test results can be found from the urine of someone with jaundice?

Answer 12

• Prehepatic= no urinary bilirubin

- Posthepatic=dark urine & pale stools

Question 13

What test can be carried out on the liver for suspected:

• Hepatocellular cancer
• Primary Biliary Cirrhosis
• Wilson’s disease

Answer 13

-HC=AFP
PBC=Anti mitochondrial antibodies
-Urine/plasma copper, liver biopsy, Caeruloplasmin

Question 14

What are the systemic effects of liver disease?

Answer 14

• Oestrogen: gynaecomastia, spider naevi, liver palms, testicular atrophy
• Pigmentation
• Bruising
• Ascites
• Encephalopathy
• Osteomalacia/porosis
• Clubbing

Question 15

What are the functions of the pancreas?

Answer 15

• Exocrine: Bicarb, digestive enzymes

- Endocrine: Insulin, glucagon, pancreatic polypeptide

Question 16

What disorders of the pancreas are there?

Answer 16

• Acute Pancreatitis
• Chronic Pancreatitis
• Pancreatic Insufficiency
• Cystic Fibrosis
• Carcinoma of the Pancreas

Question 17

What are causes of acute pancreatitis?

Answer 17

• Gallstones
• Alcohol
• Drugs
• Hypertiglyceridaemia
• Traumainfectious
• Rare tumours, autoimmune, Scorpion Toxins

Question 18

What are potential biochemical features of acute pancreatitis?

Answer 18

• Uraemia
• Hypoalbuminaemia
• Hypocalcaemia
• Hyperglycaemia
• Metabolic acidosis
• Abnormal LFTs

Question 19

What is the presentation of chronic pancreatitis?

Answer 19

• Abdominal pain
• Malabsorption
• Impaired glucose tolerance
• Alcohol

Question 20

Name some pancreatic function tests?

Answer 20

• Direct= Secretin, CCK, intubation for aspirates, Lundh test
• Indirect= elastase in stools, trypsinogen in blood, Pancrealauryl, PABA test