Liver EnZ Tests

Question 1

Any condition in which the flow of bile from the liver is inhibited
or blocked

Answer 1

Cholestasis

Question 2

Causes of Extrahepatic cholestasis (occurs outside the liver)

Answer 2

Strictures (narrowing of bile duct)
Stones in common bile duct
Pancreatitis
Primary sclerosing cholangitis (inflammation & scarring of bile duct)
Cysts
Tumors (bile duct; nearby tumors which exert pressure on bile duct

Question 3

Causes of Intrahepatic cholestasis (occurs inside the liver)

Answer 3

Alcoholic liver disease
Primary biliary cirrhosis
Viral hepatitis

Question 4

Medications responsible for cholestasis

Answer 4

Antibiotics (e.g., penicillins)
Anaboic steroids
Birth control pills

Question 5

ALP (alkaline phosphatase), 5’NT and GGT are all test for what and located where?

Answer 5

cholestasis adn are on teh cell membrane; associated with biliary type disease

Question 6

AST & ALT catabolize “glucogenic” amino acids such as

Answer 6

aspartate and alanine

Question 7

AST Aspartate aminotransferase
= SGOT, serum glutamic oxaloacetic transaminase
Two isoforms:
GOT1 =________ form
GOT2 =________ form

Answer 7

cytoplasmic

mitochondrial

Question 8

Both isoforms of GOT require________ as a cofactor
Broad tissue distribution: liver, cardiac muscle, skeletal
muscle, kidney, brain, pancreas, lung, leukocytes,
erythrocytes (liver highest, erythrocytes lowest)

Answer 8

pyridoxal phosphate (PLP)

Question 9

~80% of AST activity in human liver is due to ________ form

Answer 9

GOT2 mitochondrial

Question 10

AST (SGOT) take L-aspartic acid and ketoglutaric acid to:

Answer 10

L-glutamic acid and oxaloacetic acid

Question 11

ALT Alanine aminotransferase
= SGPT, serum glutamic pyruvic transaminase
Present only in the_____
Requires ________ as a cofactor
Tissue distribution: found predominantly in the_____

Answer 11

cytoplasm

pyridoxal phosphate (PLP)

liver

Question 12

Aminotransferases ALT/SGPT takes alanine and alpha-ketaglutaric acid to:

Answer 12

to L-glutamic and pyruvic acid

Question 13

AST & ALT are not exclusively expressed in the liver.
However,_____ is predominantly expressed in liver. Therefore,
is a more specific test of acute hepatocellular damage

Answer 13

ALT

Question 14

Elevated AST & ALT are NOT specific for_______
They are also found in patients with severe cardiac and skeletal
muscle damage.____ is more often increased in patients with
myocardial infarction

Answer 14

hepatobiliary disorders.

AST

Question 15

Liver Cell Necrosis
ALT > AST____ hepatitis
AST > ALT____ hepatitis

Answer 15

viral

alcoholic

Question 16

Membrane-bound metalloenzyme which catalyzes the
hydrolysis of phosphomonoesters at an alkaline pH

Answer 16

ALP Alkaline phosphatase

Question 17

Elevated serum ALP observed in disorders of _____
characterized by increased_____ activity, and as
normally occurs during growth and pregnancy

Answer 17

bone

osteoblastic

Question 18

Involved in purine catabolism. Catalyzes hydrolysis of
nucleotides such as adenosine 5’-phosphate in which the
phosphate is attached to the 5 position of the pentose ring

Answer 18

5’NT 5’-Nucleotidase

Question 19

5’NT 5’-Nucleotidase: Broad tissue distribution: liver, intestines, brain, heart, blood
vessels, pancreas.
In liver, enzyme is associated primarily with

Answer 19

canalicular
and sinusoidal plasma membranes.

Question 20

In contrast to alkaline phosphatase, ________is not
elevated in bone disease or during pregnancy.

Answer 20

5’-nucleotidase

Question 21

Catalyzes the transfer of the γ-glutamyl group from γ-glutamylcontaining
peptides such as glutathione to other peptides, amino
acids, or water.

Answer 21

GGT γ-Glutamyl Transpeptidase

Question 22

When is GGT levels elevated?

Answer 22

GGT is frequently elevated in diseases of liver, biliary tract, and pancreas.
Certain medications (barbiturates, anticonvulsant drugs) and alcohol abuse (i.e.,
increases hepatic microsomal GGT) can cause elevated serum GGT levels

Question 23

Unlike alkaline phosphatase,___ is NOT elevated in bone disease.

Answer 23

GGT

Question 24

TRANSAMINASES:
ALT (SGPT) & AST (SGOT)
• Both located in the_____
–____ in cytoplasm + mitochondria
–____ in cytoplasm
• Elevation usually indicates hepatocyte (liver
cell) injury

Answer 24

hepatocytes

AST

ALT

Question 25

• An enzyme on the surface of the liver cells that is adjacent
to the bile canaliculi
• Usually elevated with biliary obstruction or cholestatic
process
• Present in
– Liver
– Bone
– Intestine
– Placenta

Answer 25

Alkaline Phosphate

Question 26

If Alk Phos is elevated, what other levels can you check to be sure of hepatic origin?

Answer 26

Isoenzymes
– 5̕ -nucleotidase
– GGT

Question 27

• The product of red blood cell breakdown
• First produced as water-insoluble
(unconjugated/indirect)

Answer 27

Bilirubin

Question 28

Liver cells conjugate indirect bilurubin through
the action of ________ and
make it water soluble (conjugated/direct)
allowing it to be secreted in bile

Answer 28

UDP-glucuronyltransferase

Question 29

Increased direct (conjugated) bilirubin resluts in:

Answer 29

– Liver injury
– Bile duct problems
– Rare metabolic problems

Question 30

• Increased indirect (unconjugated) bilirubin results in

Answer 30

– Hemolysis
– Gilbert’s

Question 31

• Both are good indicators of liver synthetic function
• Both can be affected by poor oral intake and severe infections

Answer 31

ALBUMIN AND INR

Question 32

• Replacement of vitamin K corrects the INR if due to _______ but not if due to
________
• Proteinuria and GI loss can decrease_______levels

Answer 32

nutritional causes

hepatic dysfunction

albumin

Question 33

• Hepatocellular: (ALT/AST) list of diseases

Answer 33

– alcohol
– viral hepatitis
– autoimmune hepatitis
– hemochromatosis
– Wilson’s Disease
– fatty liver
– alpha-1 antitrypsin
deficiency
– medications

Question 34

List of • Cholestatic/Obstructive:
(alkaline phosphatase)

Answer 34

– stones
– primary biliary cirrhosis
(PBC)
– primary sclerosing
cholangitis (PSC)
– medications

Question 35

Infiltrative liver disease:

• Space occupying lesion
• __________elevation
• Occasional bilirubin elevation
• Examples: tumors, amyloid, sarcoid

Answer 35

Alkaline phosphatase

Question 36

Why is Bilirubin frequently not helpful in determining type of injury

Answer 36

– Can become elevated due to hepatic as well as nonhepatic causes
– Can become elevated in hepatocellular, cholestatic as well as infiltrative disease

Question 37

• ALT > 500 =

Answer 37

Hepatitis A, Hepatitis B,
autoimmune hepatitis, medications, ischemia
(shock liver), rarely stone passage

Question 38

• Alcoholic liver disease rarely has transaminases

Answer 38

>300

Question 39

• AST:ALT > 2:1 is suggestive of

Answer 39

alcoholic liver disease

Question 40

• ALT 614
• AST 567
• ALK PHOS 145
• TOTAL BILI 10.3
• DIRECT BILI 7.6
• INR 1.2

Answer 40

Pt has hepatocellular injury with normal alk phos

the elevated TOTAL bili means they are jaundice

the INR is normal thus they are compensated