Liver enzymes

Question 1

Male with RUQ pain, AST2300, ALT3400, Bilirubin11, AP(N76)

-What is diagnosis? WHY

Answer 1

AST/ALT- are&raquo_space;»1000 ==> viral hepatitis, ischemic liver injury, toxin, or drug damage

fecal oral== HepA!!!!!!!!!!!!

Question 2

F with RUQ pain, WBC25000, AST145, ALT150, AP300.

-What is diagnosis? WHY

Answer 2

-Acute cholestasis?

Question 3

M with RUQ pain, AST600,ALT300, AK is normal.

-What is diagnosis? WHY

Answer 3

Alcoholism - liver disease - AST is 2x as high as ALT

check INR and bilirubin - may need tx to prevent acute hep failure or GI bleed

Question 4

AST - What is it?

Answer 4

Aspartate aminotransferase - enzyme that is released by necrotic, inflamed hepatic tissue AND other tissue such as kidney, heart, skeletal muscle and brain.

Not specific to LIVER!

Question 5

ALT - what is it?

Answer 5

Alanine aminotransferase - enzyme that IS specific to liver and is released secondary to necrosis or inflammation

Question 6

AK - what is it?

Answer 6

Alkaline phosphatase - enzyme found in hepatic canicular membrane (also bones, intestines, and placenta)

**–> inc levels with biliary tract obstruction or cholestasis of liver

Question 7

5-NT - what is it?

Answer 7

5-nucleotidase - enzyme involved in the hydrolysis of a 5-ribonucleotide to a ribonucleoside

**–> VERY speicifc for liver and can be used to confirm that other enzymes are elevated due to liver damage/dysfunction

Question 8

GGT - what is it?

Answer 8

gamma-glutamyl transpeptidase - involved in the transfer of amino acids and in glutathione metabolism

**—> very specific for liver - can help confirm diagnosis of liver disease

Question 9

If AP/GGT/5NT are all elevated then?

Answer 9

These are all located near the same area == Cholestasis -hepatic disease - stones, tumor, PBC, PSC

Usually only if these are more elevated than ALT/AST

Question 10

Bilirubin - direct-

Answer 10

• breakdown product of porphyrin ring of heme containing proteins
• conjugated=hepatic of biliary tract disease - biliary tree may be blocks or when hepatic injury prevents excretion of bilirubin

Question 11

Bilirubin - indirect

Answer 11

-breakdown product of porphyrin ring of heme containing proteins

• unconjugated - high levels reflect hemolytic process
• could be found high in congenital diseases such as Gilberts and Crigler Najjar

Question 12

True synthetic function test of liver?

Answer 12

• albumin - exclusively made by hepatocytes –> t1/2 is 15-20days
• PT/INR and PTT - all factors except 8 are made exclusively by hepatocytes –> t1/2 of 7 is 6hrs and INR is single best test to ID the acute measure of liver function**

Question 13

Single best test to determine liver synthetic fucntion?

Answer 13

Factor 7 - INR**

Question 14

HepA-
genetic info?
transmission?
vaccine?

Answer 14

• ssRNA
• fecal oral
• YES Vaccine

Question 15

HepB-
genetic info?
transmission?
disease?
vaccine?

Answer 15

• dsDNA
• blood-borne pathogen - close contact
• Acute and chronic disease
• YES Vaccine

Question 16

HepC-
genetic info?
transmission?
disease?
vaccine?

Answer 16

• ssRNA
• blood borne pathogen - close contact
• acute and chronic disease
• NO vaccine

Question 17

HepE
genetic info?
transmission?
special case with this one?
vaccine?

Answer 17

• ssRNA
• fecal oral / Waterborne
• High mortality in pregnant women
• NO Vaccine

Question 18

Tylenol OD:
How much?
Tx?

Answer 18

• > 12g or 24 pills/whatever

- give N-acetylcysteine - powerful antioxidant and cellular detox agent

Question 19

Autoimmune hep:

• Type1?
• Type2?

Answer 19

• 1 have ANA and ASMA

- 2 have ALKM

Question 20

autoimmune hep;

• prevalent sex?
• presentation?
• Tx?

Answer 20

(CHRONIC HEP)

• WOMEN in 30s -40s
• asymptomatic to fulminant liver failure
• steroids and immunosuppresants

Question 21

Non-alcoholic fatty liver disease

• associated with?
• progression?
• Tx?

Answer 21

• metabolic syndrome - obese, abn lipids, HTN, glucose intolerance
• cirrhosis and end stage liver
• Weight loss, glucose control, insulin sensitizing agents

Question 22

hemochromatosis

-classic presentation/symptoms:

Answer 22

CLASSIC=CHF; Diabetes; bronze skin

Also arthritis of 2nd and 3rd MCPs

Question 23

hemochromatosis

• what is it?
• inheritance?
• tx?

Answer 23

• iron overload disorder
• auto recessive - Chromosome 6
• 10% of whites are heterozygotes!
• phlebotomy

Question 24

Wilsons disease

• what is the problem?
• when is presentation?
• What are symtpoms or presentation?

Answer 24

-Copper overload disorder
-TEENAGE YEARS
-pt may have kayser fleischer rings (brown on outside rim of iris
DECREASED CERULOPLASMIN

Question 25

Ratio of AST to ALT is 2:1 —> what is disease?

Answer 25

Alcohol liver damage!

AST higher ST for scotch and tonic!

Question 26

Ratio of AST to ALT is 1.15:1 –> what is disease?

Answer 26

non alcoholic fatty liver

Question 27

AST and ALT levels&raquo_space;» 1000 –> what is disease?

Answer 27

Viral hep

Question 28

Primary Biliary Cirrhosis (PBC)

• which ducts?
• who affected?
• what is presentation?
• serum marker?

Answer 28

• intrahepatic (SMALL) ducts
• middle aged women
• pruritus** among others
• Anti-mitochondrial Ig***

Question 29

Primary Sclerosis Cholangitis

• which ducts?
• diagnosis?

Answer 29

• intra and extra hepatic (LARGE) biliary tree

- use ERCP/MRCP (CHAIN OF LAKES)