Liver Disease

Question 1

Tests of hepatocellular damage

Answer 1

AST 10-30

ALT 11-45

BR C<0.2, T<1.2

Question 2

Tests of biliary tract disease

Answer 2

Alk Phos 30-130

GGT (F<24, M<38)

BR C<0.2, T<1.2

Question 3

Tests of etiology

Answer 3

-Hepatitis virus antigens/antibodies
-Alpha fetoprotein
-Immunoglobulins
-Iron, trans, ferritin (hemochromatosis)
-Copper, Cerulo (Wilson’s)

Question 4

Jaundice is usually detectable when the serum total bilirubin ___

Answer 4

exceeds 2 – 3 mg/dL

Question 5

Bilirubin is ____

Answer 5

very light senstive
-stable for months when frozen and protected from light

Question 6

____ increases bilirubin in blood slightly in the normal person and more markedly in Gilbert’s disease

Answer 6

Fasting

-decreases with sunbathing and is slightly lower in women than in men

Question 7

Elevations of the unconjugated bilirubin without significant elevations of the conjugated are seen in:

Answer 7

-Hemolytic
-Gilbert’s
-Crigler-Najjar
-Liver immaturity
-Cirrhosis

G HICC

Question 8

Elevations of the conjugated plus unconjugated bilirubin are seen in:

Answer 8

-Hepatitis
-Cirrhosis
-Posthepatic obs
-Dubin Johnson
-Rotor’s
-Cholestasis drug induced

CC HROD

Question 9

Rotor’s vs DJS

Answer 9

DJS
-liver pigmentation, GB not visualized

Rotor’s
-no liver pigmentation, GB visualized

Question 10

Bilirubinuria

Answer 10

Bilirubinuria is seen in: HROD
a. Biliary obstruction
b. Hepatocellular damage
c. Dubin-Johnson syndrome
d. Rotor’s syndrome

Question 11

Plasma total protein concentrations in liver disease often are near ___ because a decrease of albumin is offset by an increase of globulins

Answer 11

normal

Question 12

A ____ of the prothrombin time (PT) is an indicator of hepatic dysfunction as the synthesis of the coagulation factors is impaired in hepatocellular disease

Answer 12

Prolongation
-severe: PTT also prolonged

Question 13

____ blood ammonia is seen in severe liver disease and in actual or impending hepatic coma

Answer 13

Elevated
due to:
-Reduced removal of ammonia and shunting
-Blood ammonia levels show some correlation with the deepness of coma

Question 14

Most sensitive indicators of hepatic cell injury =

Answer 14

AST, ALT
-sensitive, not specific

Question 15

ALT elevated, but not AST

Answer 15

-Mild hepatic disease
-Recovery hepatitis phase

(ALT elevations persist longer than AST)

ALT is more sensitive

Question 16

The general rule applies that the ____ the alkaline phosphatase, the ____ the chances for post-hepatic obstruction

Answer 16

higher, greater

*If the elevation is less than three times normal, consider hepatocellular disease

*If greater than three times the upper reference limit, consider post-hepatic obstruction

Question 17

The alkaline phosphatases show differential heat stability

Answer 17

bone < intestine < liver < placenta < Regan enzyme (most heat stable)

BILP

Question 18

GGT

Answer 18

-differentiating bone and liver sources of alkaline phosphatase (no GGT in bone)

-sensitive indicator of alcohol-induced liver disease and of recent alcohol ingestion

Question 19

Detection of HAV IgG without HAV IgM

Answer 19

implies resolved infection or past immunization

Question 20

Detection of IgG against Hb surface antigen (HBsAb)

Answer 20

implies recovery (or successful immunization) and lifelong protection from infection

Question 21

IgG antibodies against HB core antigen (HBcAb)

Answer 21

imply infection with HB at some point