6/5/25 Liver Labs

Question 1

What is the largest organ in the body?

Answer 1

Liver

Question 2

What are the functions of the liver?

Answer 2

Store and filter blood
Metabolize carbs, proteins, fats, hormones, and chemicals
Formation of bile
Store vitamins and iron
Formation of coag factors

Question 3

The elevation of what liver tests are markers for necrosis?

Answer 3

ALT, AST

Question 4

The elevation of what liver tests are markers for cholestasis?

Answer 4

ALP, GGT

Question 5

Where is ALT found in hepatocytes?

Answer 5

In the cytoplasm

Question 6

Where is AST found in hepatocytes?

Answer 6

Small amount in cytoplasm, large amount in mitochondria

Question 7

What AST and ALT levels would be expected in hepatitis or drug toxicity?

Answer 7

Large increase in ALT, less of an increase in AST (only cell wall is destroyed, so only small amount of AST goes into the intravascular space)

Question 8

What AST and ALT levels would be expected in alcoholism?

Answer 8

Large increase in AST, less of an increase in ALT (Mitochondrial wall and cell wall both destroyed, so lot of AST released)

Question 9

In what organ are concentrations of AST and ALT the highest?

Answer 9

Liver

Question 10

What is hemochromatosis?

Answer 10

Disorder that results in high iron

Question 11

What is Wilson’s disease?

Answer 11

Disorder that results in high copper

Question 12

Which is more specific to the liver: AST or ALT?

Answer 12

ALT

Question 13

What is considered mild AST and ALT elevation?

Answer 13

2-3x the upper limit of normal

Question 14

What is considered moderate AST and ALT elevation?

Answer 14

3-20x the upper limit of normal

Question 15

What is considered marked AST and ALT elevation?

Answer 15

> 20x upper limit of normal

Question 16

What are causes of marked liver enzyme elevation?

Answer 16

Acute viral hepatitis, ischemic liver injury, toxin-induced hepatitis

Question 17

What is cholestasis?

Answer 17

The lack of bile flow due to blocked bile ducts. Formation of bile and drainage from the liver is impaired.

Question 18

What liver enzymes are elevated in cholestasis?

Answer 18

AP and GGT

Question 19

Would you expect an elevation of AP and GGT in a blockage closer to the sphincter of oddi or further away up in the liver?

Answer 19

Close to the sphincter of oddi

Question 20

What protein can bilirubin bind to?

Answer 20

Albumin

Question 21

Where does bilirubin become conjugated?

Answer 21

Liver

Question 22

What form of bilirubin is water soluble?

Answer 22

Conjugated (direct) bilirubin

Question 23

What form of bilirubin is water insoluble?

Answer 23

Unconjugated (indirect) bilirubin

Question 24

If there is a bile duct blockage/obstruction, what type of bilirubin would you expect to be increased?

Answer 24

Conjugated

Question 25

Jaundice is noticeable at what bilirubin concentration?

Answer 25

>3 mg/dL

Question 26

How much bilirubin do we typically excrete in one day?

Answer 26

250-300 mg

Question 27

Where on the body is jaundice noticable?

Answer 27

Sclera of eyes, skin, roof of mouth, palms of hands

Question 28

If total bili is elevated (direct+indirect), what test should be orderd?

Answer 28

Fractionated bili (indirect)

Question 29

What would cause an increase in unconjugated (direct) bilirubin?

Answer 29

Hemolysis Gilbert's

Question 30

Why do females have an increase in ALP during menopause?

Answer 30

ALP is found in the liver and bone. When women are menopausal, they start losing bone density so ALP is released into the blood.

Question 31

What is GGT?

Answer 31

A membrane bound enzyme found in the PCT, liver, pancreas, and intestine

Question 32

What is more sensitive in liver obstruction: AP or GGT?

Answer 32

GGT (predictive of 32% of liver disease)

Question 33

What can cause GGT elevations?

Answer 33

Cholestasis Biliary obstruction Alcohol ingestion Diabetes Drugs

Question 34

What 3 tests are the hepatic function tests?

Answer 34

Albumin PT Bilirubin

Question 35

What organ synthesizes albumin?

Answer 35

Liver

Question 36

What causes low albumin?

Answer 36

Cirrhosis (liver failure) Alcohol Malnutrition Cancer Sepsis Burns Nephrotic syndrome Malabsorption

Question 37

All clotting factors except for __ are made in the liver.

Answer 37

VIII (8)

Question 38

True or False: Normal liver function tests mean the liver is normal

Answer 38

False

Question 39

What do liver function tests actually test?

Answer 39

Hepatocyte integrity or biliary excretory ability