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Flashcards in 4 - Jaundice & LFTs Deck (46)
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1

Elevated ALT - Cause

I don't fucking know. That shit just happens sometimes

2

15% of patients with Chronic Liver disease (HCV or NAFLD)

Have NORMAL liver tests despite having histologic damage

3

New Recommendations for the cut off for aminotransferases

Men - 31
Women - 30

4

Dangerzone - Hepatocytes

Well-differentiated
80% of cytoplasmic mass
Have the ability to replicate in injury
Secrete bile acids
Take up digested material
Synthesize albumin
Metabolize and detoxify exogenous compounds

5

Dangerzone - Biliary Tree

Bile is secreted by hepatocytes
Cholestasis is caused by alterations in microfilaments surrounding bile canaliculus
Alterations can be induced by toxins, infection or obstruction
Obstruction may be intrahepatic or extrahepatic

6

Liver Functions

Measure of SYNTHETIC activity, not inflammation!!!!!!

7

"True" liver function tests measure

Protein synthesis (albumin, coag factors)
Nutrient Metabolism (Gluconeogenesis - the last thing to go)
Biotransformation (bilirubin glucoronidation)
Immune Defense
Bile Acid Synthesis

8

Synthetic Function Tests

PT - Production of coag factors
Most have half-lives between 6 - 96 hours and prolonged within a day with hepatic synthetic dysfunction

Albumin - Produced in hepatocytes half life is 20 days but not specific can be abnormal because of the other factors that can lower, including poor nutrition,

9

Bilirubin Test

Can be a marker of impaired synthetic function

10

Labs - Bilirubin

Breakdown product of heme cells released from senescent red blood cells and from hemoprotein in the liver
Natural compound circulates with albumin and is taken up by liver and secreted in the bile

If bile secretion is impaired, conjugated bilirubin may leak into plasma and cause jaundice

11

Alkaline Phosphatase

A family of isoenzymes that catalyze the hydrolysis of phosphatase esters

Found in liver, bone, intestine, placenta, kidney, leukocytes

In liver associated with sinusoidal and canalicular membranes

Obstruction to bile flow causes an increase in AP secondary to the induction of AP synthesis

12

Aminotransferases (AST, ALT)

Naturally found in the serum at low levels

AST is also found in cardiac muscle, skeletal muscle, kidney, pancrease, lungs, leukocytes

Both enzymes are released in the blood in increasing amounts when the hepatocyte membraen is damaged

Correlated in injury byt not to chance of recovery

13

INR of 2

Bad

14

γGlutamyl Transpeptidase (GGT)

Catalyzes transfer of glutamyl groups of peptides suc has glutathione to other amino acids

Found in liver, kidney, seminal vesciles, liver, spleen, heart, brain, not bone

VERY SENSITIVE, limited specificity

15

AST - Location

Mitochondria and cytosol of hepatocytes, heart and muscle

16

ALT - Location

Cytosol of hepatocytes

17

Alk Phos

Microvilli of the bile canaliculi, bone, placenta

18

Hepatocellular Pattern

AST +++
ALT +++
Alk Phos +
TB +
GGT +

19

Cholestatic Pattern

AST +
ALT +
Alk Phos +++
TB +++
GGT +

20

Infiltrative Pattern

AST +
ALT +
Alk Phos +++
TB +
GGT +

21

Ultrasound - Use

Biliary Obstruction, Masses, Vasculature
$

Biliary Tree:
Rule out obstruction
Evaluate for presence of stones

Vasculature:
Evaluate flow, rule out obstruction
Screen for thrombus
Screen for stricture

22

CT or MRI/MRCP - Use

HCC, Mets
$$

3D imaging
Demonstrates morphology of the liver
Evaluate for size, position
Evaluate for bleeding
Evaluate for tumors, both benign of malignant

Will not evaluate for liver function and is not sensitive enough to detect fibrosis of the liver
Rarely reveals exact etiology of disease

23

ERCP - Use

Evaluate and Treat Biliary Obstruction
$$$$

Endoscopic cannulation of the ampulla with injection of contrast into the biliary tree
Diagnosis and therapy

24

EUS

Endoscopy using ultrasound technology to locate masses, lymph nodes, evaluate bile ducts

25

Liver biopsy

Provides diagnostic and prognostic information
Performed if expected benefit exceeds risk of procedure
Complications requiring hospitalization (1.4 - 4%)
Severe hemorrhage, pneumo, peritonitis (.1 - .3%)
Mortality rate of 9/100,000

26

Disease Identification - Hepatocellular Disease

History, Serology, Virology, Biopsy

Viral Hepatitis
(A, B, C, D, E, EBV, CMV)
Drug Induced Liver Disease
(Acetaminophen, INH)
Autoimmune Hepatitis

27

Disease Identification - Cholestatic Disease

Imaging

Obstruction of Biliary Tree
(Gallstones, Pancreatic Mass, Ampullary Mass)
Drug Induced Liver Injury
(Augmentin)

28

Disease Identification - Infiltrative DIsease

Imaging, Biopsy

Sacroid, Tuberculosis, Fungal Infections, Lymphoma

29

Painless Jaundice
Double Duct Sign

Know what that means I was scanning my shit

30

Elevated Unconjugated Bilirubin

Kids with something

Conditions overwhelming the system:
Sickle Cell Patients
ABO Mismatch blood transfusions --> Massive hemolysis