Liver tests

Question 1

what are the sources of AST?

Answer 1

LIVER, SKELETAL MUSCLE, brain, RBCs, heart

Question 2

what are the sources of ALT?

Answer 2

LIVER, kidney

Question 3

which transaminase is less specific?

Answer 3

AST

Question 4

when is AST released?

Answer 4

damaged hepatocytes

Question 5

what is the classic ratio of AST to ALT?

Answer 5

2-to-1

Question 6

what should always be considered for elevated AST : ALT ratios? what enzyme do you check for this?

Answer 6

rhabdomyolysis

creatine kinase

Question 7

when does direct bilirubin build up?

Answer 7

biliary drainage is inadequate

Question 8

what is the equation for indirect bilirubin?

Answer 8

total bili - direct bili

Question 9

what are the sources of alkaline phosphatase?

Answer 9

liver, bone, placenta

Question 10

when is alkaline phosphatase elevated?

Answer 10

stretch or inflammation of biliary tree
metastatic prostate cancer
paget disease

Question 11

what test is used to determine alkaline phosphatase?

Answer 11

gamma glutamyl transferase (GGT)

Question 12

if GGT is elevated what does that indicate? if it is not elevated?

Answer 12

alkaline phosphatase is from the liver

from the bone

Question 13

alcoholic hepatitis is associated with a phenomenally high level of what compound?

Answer 13

bilirubin

Question 14

what is the source of ammonia?

Answer 14

bacteria in large intestine

protein metabolism

Question 15

high ammonia levels can result in what condition?

Answer 15

hepatic encephalopathy

Question 16

what are the important antibodies for liver tests?

Answer 16

antinuclear antibody (ANA)
antimitochondrial antibody (AMA)
antismooth muscle antibody (ASMA)
anti liver-kidney-microsomal antibody (LKM)

Question 17

ammonia is usually converted to what compound in the liver?

Answer 17

urea

Question 18

total protein-albumin should be below what level? if higher, what conditions should be considered?

Answer 18

3.5

protein gap
autoimmune disease
cancer

Question 19

what are the clinical features of primary biliary cirrhosis? what is the treatment?

Answer 19

disproportionate increase in alkaline phosphatase
positive antimitochondrial antibody

ursdiol

Question 20

what is the result of primary biliary cirrhosis?

Answer 20

destruction of INTRA hepatic bile ducts
typically middle aged females
associated with Sjogren, Reynaud

Question 21

what are the clinical features of primary sclerosing cholangitis? what is the treatment?

Answer 21

disproportionate increase in alkaline phosphatase
“beads on a string” bile ducts
onion skinning of bile ducts

liver transplant

Question 22

what is the result of primary sclerosing cholangitis?

Answer 22

destruction of INTRA and EXTRA hepatic bile ducts
more common in males
associated with ulcerative colitis

Question 23

which antibodies are seen in autoimmune hepatitis?

Answer 23

antinuclear antibody

antismooth muscle antibody

Question 24

what is the most sensitive test for iron levels?

Answer 24

serum ferritin