Liver Disorders and Functions Quiz

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Questions and Answers

What is Gamma-Glutamyl Transpeptidase (GGT) predominantly associated with?

Cholestasis (correct)

Pancreatic function

Cardiovascular diseases

Lung function

Which of the following is NOT a common cause of acute liver disease?

Chronic alcoholism (correct)

Infective hepatitis

Inadequate perfusion

Paracetamol overdose

How might acute liver disease progress?

Always lead to cirrhosis

Only resolve

Resolve, progress to acute hepatic failure, or lead to chronic damage (correct)

Always lead to kidney failure

Which condition is characterized by irreversible scarring of the liver?

Cirrhosis Signup and view all the answers

What is the gold standard for diagnosing cirrhosis?

Liver biopsy Signup and view all the answers

Which of the following laboratory tests is NOT recommended when platelet counts are low?

Liver biopsy Signup and view all the answers

Which of the following liver diseases is a chronic autoimmune disease?

Primary biliary cirrhosis Signup and view all the answers

Which of the following is a marker that indicates liver pathology and is sensitive to liver injury?

Gamma-Glutamyl Transpeptidase (GGT) Signup and view all the answers

What is alanine aminotransferase (ALT) primarily used to assess?

Hepatocyte integrity Signup and view all the answers

Elevated indirect bilirubin levels are commonly associated with which condition?

Hemolysis Signup and view all the answers

Elevation of alkaline phosphatase (ALP) in blood can indicate all of the following except:

Acute liver damage Signup and view all the answers

Which condition is marked by an excess of bilirubin greater than 50 µmol/L?

Jaundice Signup and view all the answers

What does increased prothrombin time (PT) indicate?

Poor hepatic synthesis function Signup and view all the answers

Which liver function test marker is often used to assess the extent of liver damage in conditions such as Wilson Disease?

Bilirubin Signup and view all the answers

What is the primary consequence of untreated hereditary hemochromatosis?

Cirrhosis and liver cancer Signup and view all the answers

What is the clinical significance of hypoalbuminemia?

Observed in advanced chronic liver disease Signup and view all the answers

Elevated direct bilirubin levels may indicate which of the following conditions?

Biliary obstruction Signup and view all the answers

Which of the following laboratory results is indicative of severe copper accumulation in Wilson Disease?

Elevated AST, ALT, GGT Signup and view all the answers

What is a key feature of aspartate aminotransferase (AST) compared to ALT?

Less relevant in liver assessment Signup and view all the answers

Which clinical symptom is most commonly associated with chronic liver disease in hereditary hemochromatosis?

Joint pain Signup and view all the answers

Which panel component is associated with cholestasis?

Alkaline phosphatase (ALP) Signup and view all the answers

What characteristic finding is associated with Wilson Disease and can be observed in the eyes?

Kayser-Fleischer rings Signup and view all the answers

What is a common cause of acute jaundice in adults?

Paracetamol poisoning Signup and view all the answers

Which of the following is a primary function of the liver related to protein metabolism?

Synthesis of plasma proteins Signup and view all the answers

What substance is produced by the liver during the breakdown of amino acids?

Urea Signup and view all the answers

Which of the following best describes the role of glucagon in liver metabolism?

Promotes glycogenolysis Signup and view all the answers

Which function of the liver is primarily responsible for the detoxification of harmful substances?

Excretion of ammonia Signup and view all the answers

Which clinical marker is most directly associated with liver damage and can indicate jaundice?

Conjugated bilirubin Signup and view all the answers

What is a common indicator of acute liver disease in laboratory tests?

Elevated ammonia levels Signup and view all the answers

In the context of chronic liver disease, what does the term 'cirrhosis' refer to?

Scarring of liver tissue Signup and view all the answers

What type of blood vessel supplies oxygen-rich blood to the liver?

Hepatic artery Signup and view all the answers

Which of the following substances is NOT a result of normal liver bile production?

Glucose Signup and view all the answers

Which metabolic process associated with carbohydrates occurs primarily in the liver?

Gluconeogenesis Signup and view all the answers

What is a common symptom of acute hepatitis?

Jaundice Signup and view all the answers

Which test is used in the acute hepatitis panel to detect hepatitis A?

Anti-HAV IgM Signup and view all the answers

What is a significant characteristic of hepatitis C infection?

High percentage of cases are asymptomatic Signup and view all the answers

What is the incubation period for hepatitis B?

60 to 90 days Signup and view all the answers

Which laboratory test is a non-specific marker for liver function?

ALT Signup and view all the answers

What is a potential long-term complication for individuals with chronic hepatitis C?

Hepatocellular carcinoma Signup and view all the answers

Which type of hepatitis is primarily transmitted via the fecal-oral route?

Hepatitis A Signup and view all the answers

Which of the following is NOT a typical symptom of hepatitis?

Chronic pain syndrome Signup and view all the answers

What does the presence of Hepatitis B surface antigen (HBsAg) indicate?

Acute infection Signup and view all the answers

In terms of liver pathology, what does the presence of elevated bilirubin indicate?

Potential liver dysfunction Signup and view all the answers

Study Notes

Liver Disorders

The liver is a vital organ with four lobes and hepatic lobules.
Its primary blood sources are the hepatic artery and hepatic portal vein.
Bile is collected by bile canaliculi and transported via the common hepatic duct.

Functions of Liver

Metabolism of carbs, lipids, and proteins, including breakdown of red blood cells (reticuloendothelial system).
Detoxification of endogenous and exogenous compounds.
Bilirubin metabolism.
Protein synthesis (e.g., albumin, acute-phase proteins, coagulation factors).
Storage of substances.

Liver and Carbohydrate Metabolism

Carbohydrate metabolism is linked to blood glucose levels.
Glucose levels are regulated by the liver, influenced by insulin, glycogen, glycogenolysis, and gluconeogenesis.

Liver and Lipid Metabolism

Lipids are water-insoluble and transported as lipoproteins.
The liver produces lipoproteins, metabolizes fatty acids (acetyl-CoA) and triglycerides (for energy), and converts carbohydrates and proteins into fats.
Cholesterol is converted to bile, a continuous process involving water, bile salts, bilirubin, fatty acids, and cholesterol.

Liver and Protein Metabolism

The liver produces plasma proteins and clotting factors.
It deaminates amino acids, converting them to ammonia (a byproduct).
The liver forms waste products (e.g., urea) from ammonia.

Liver and Bilirubin Metabolism

Bilirubin results from hemoglobin degradation.
Unconjugated bilirubin is converted to conjugated bilirubin using glucuronic acid.
High levels of unconjugated bilirubin cause cell damage, jaundice, and brain toxicity.
Total bilirubin is the sum of unconjugated and conjugated bilirubin.

Liver Tests (LFTs)

Common LFT panels include Alanine aminotransferase (ALT), measuring hepatocyte integrity; Bilirubin; Alkaline phosphatase (ALP), abundant in bile canaliculi; and Albumin.

Aminotransferases

Alanine aminotransferase (ALT) is a sensitive, non-specific marker of acute hepatocyte damage (hepatitis, toxic injury).
Aspartate aminotransferase (AST) is produced by hepatocytes, skeletal muscles, kidney, brain, and heart, less specific for liver assessment.

Bilirubin

Bilirubin is derived from heme (hemoglobin).
Unconjugated bilirubin is excreted into bile, and conjugated bilirubin is degraded by intestinal bacteria to stercobilinogen.
Small amounts of stercobilinogen are excreted in urine as urobilinogen.
Elevated total bilirubin may indicate liver disease, hemolysis, or biliary obstruction.
Elevated indirect bilirubin may point to hemolysis or liver dysfunction.
Elevated direct bilirubin suggests liver disease or biliary obstruction.

Jaundice

Jaundice is caused by excess bilirubin (>50 µmol/L).
Its three main causes are hemolysis (pre-hepatic), failure of liver conjugation (hepatic), and biliary obstruction (post-hepatic).
Increased indirect bilirubin in newborns may pose a risk of brain damage, necessitating phototherapy.

Alkaline Phosphatase (ALP)

ALP is present in blood, derived from liver, bone, intestine, and placenta.
Increased ALP in blood often signifies increased synthesis by cells lining bile canaliculi, cholestasis, or infiltrative liver diseases (like cirrhosis).

Plasma Proteins (Albumin)

Albumin is produced by the liver with a 20-day biological half-life in plasma.
Low albumin (hypoalbuminemia) can indicate advanced chronic liver disease or severe acute liver damage.

Prothrombin Time (PT)

PT measures blood clotting time in seconds.
It reflects hepatic synthesis function.
Prothrombin, a liver-produced clotting protein, is activated by an enzymatic cascade.
Its short half-life (60-72 hrs) makes PT a sensitive indicator of hepatic synthesis.
Normal PT suggests adequate blood-clotting protein levels.

Gamma-Glutamyl Transpeptidase (GGT)

GGT is a very sensitive marker of liver pathology, found in hepatocytes' endoplasmic reticulum.
GGT is involved in detoxification and is widely distributed.
Alcohol ingestion and drugs like phenytoin can increase GGT levels.
GGT elevation is specifically associated with cholestasis.
Increased GGT with normal ALT may suggest a non-liver-related cause for GGT elevation.

Acute Liver Disease

Common causes include poisoning (paracetamol overdose, plant/fungal toxins), infections (hepatitis A, B, and C), and inadequate liver perfusion (blood loss).

Acute Liver Disease - Outcome

Acute liver disease can resolve, progress to acute hepatic failure (medical emergency, potentially leading to chronic hepatic injury, increased blood ammonia), or lead to chronic hepatic damage.

Chronic Liver Disease

Chronic liver damage involves gradual progression, leading to long-term liver injury.
Conditions include alcoholic liver disease, chronic active hepatitis, primary biliary cirrhosis, and nonalcoholic fatty liver disease.

Cirrhosis

Cirrhosis is the final stage of chronic liver damage with irreversible scarring, impaired function, and often associated with alcoholism.
It may eventually progress to liver failure.
Cirrhosis typically involves irreversible scarring and loss of liver function.

Diagnosis of Cirrhosis and Liver Failure

Early cirrhosis may have no significant biochemical indicators.
Late stages often present with jaundice, encephalopathy, ascites, and potentially bleeding, concluding eventually in terminal liver failure.
Liver biopsy is the gold standard for diagnosis but not recommended with low platelet count or clotting factor issues.

Gilbert Syndrome

Gilbert syndrome is a hereditary, autosomal recessive liver disease, characterized by a reduced activity of glucuronyl transferase.
Affected individuals have decreased conjugation of bilirubin, resulting in high levels of unconjugated bilirubin.

Crigler-Najjar Syndrome

Crigler-Najjar syndrome is a rare, autosomal recessive condition with no or severely reduced glucuronyl transferase activity leading to profound, life-threatening unconjugated bilirubinemia.
Type I is typically life-threatening.
Type II is treatable with phototherapy.

Dubin-Johnson Syndrome

Dubin-Johnson syndrome is an autosomal recessive inherited disease characterized by a defect in bilirubin transport from the hepatocytes to the bile, resulting in conjugated bilirubinemia.
This defect leads to the accumulation of bilirubin in the liver, causing dark pigmentation.
Signs include jaundice, upper abdominal pain, anorexia, nausea, and vomiting, appearing generally in early adulthood.

Hepatitis

Hepatitis is an inflammation of the liver with various causes, including viruses (A, B, C, D, and E), bacteria, toxic chemicals, drugs, and alcohol.
Acute hepatitis typically resolves within six months, while chronic hepatitis lasts beyond six months.

Hepatitis A (HAV)

HAV is a single-stranded RNA virus transmitted via the fecal-oral route.
Individuals infected with HAV experience an incubation period before developing symptoms, which involve jaundice and feces that are a clay color.

Hepatitis B (HBV)

HBV is a double-stranded DNA virus, transmitted through contact with blood, semen, or vaginal fluids.
Incubation typically lasts 60-90 days.
Signs include anorexia, vomiting, abdominal pain, dark urine, and jaundice.
Some individuals progress to chronic liver disease.

Hepatitis C (HCV)

HCV is a single-stranded RNA virus, transmitted through blood transfusions or contaminated needles.
Symptoms may not appear for 2-26 weeks.
Up to 70% of individuals lack initial symptoms.
Most individuals with HCV progress to chronic conditions.

Laboratory Diagnosis of Viral Hepatitis

Non-specific blood tests (bilirubin, liver enzymes: ALT, AST, ALP, and GGT) and specific blood tests to target viral antigens and antibodies (Anti-HAV IgM, HAV IgG, HBsAg, Anti-HBs, Anti-HBc, Anti-HBc IgM, Anti-HCV) determine and differentiate the type of hepatitis and its severity.

Hereditary Hemochromatosis

Hereditary hemochromatosis is an autosomal recessive disease characterized by excessive iron absorption and accumulation in various organs.
The disease can be asymptomatic early on but eventually leads to significant organ damage (liver, heart, pancreas, joints).
Symptoms can mimic other conditions, delaying diagnosis, which often requires genetic and blood tests to determine the presence of excess iron and its impact.

Wilson Disease

Wilson disease is a genetic disorder where copper cannot be properly metabolized/excreted in bile.
Copper accumulates in various organs (liver, brain, eyes, and kidneys) leading to progressive dysfunction.
Serum copper levels are low, and ceruloplasmin (a copper-binding protein) is reduced.
Increased urinary copper, along with elevated AST, ALT, GGT, and bilirubin, are key indicators.

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Description

Test your knowledge on liver disorders, its essential functions, and metabolism processes. This quiz covers vital aspects such as carbohydrate and lipid metabolism, detoxification methods, and the liver's role in protein synthesis. Perfect for students and healthcare professionals alike!