Liver Studies

Question 1

which test is used to identify hepatocellular disease?

Answer 1

ALT (found in cytosol of liver)

Question 2

what does ALT stand for?

Answer 2

alanine aminotransferase

Question 3

what are the normal ALT values?

Answer 3

4-36 IU/L

Question 4

what are the interfering drugs for ALT?

Answer 4

PAMS PODP

phenothiazine, acetaminophen, methotrexate, statins, procainamide, OCP, dilatin, propoxyphene

Question 5

myositis, pancreatitis, MI, infections mono and shock would produce what level of ALT/

Answer 5

mildly elevated

Question 6

cirrhosis, cholestasis, hepatic tumor, hepatotoxic drug, obstructive jaundice, severe burns and muscle trauma would produce what level of ALT?

Answer 6

moderately elevate

Question 7

hepatitis, hepatic necrosis and hepatic ischemia would produce what level of ALT/

Answer 7

significantly elevated

Question 8

what does AST stand for?

Answer 8

aspartate aminotransferase (found in liver, heart, skeletal muscle, kidney, pancreas and RBC)

Question 9

what are normal AST values?

Answer 9

0-35

Question 10

how will AST levels change with injury?

Answer 10

elevates at 8hrs
peaks at 24-26 hrs
normal at 3-7 days

Question 11

what drugs interfere with AST levels?

Answer 11

SAVE CODOIC

salicylates, antihypertensive, verapamil, E-mycin, cholinergics, OCP, digoxin, opiates, INH, coumadin

Question 12

acute renal dz, beriberi, DKA, pregnancy would cause what levels of AST?

Answer 12

low

Question 13

liver dz would cause what level of AST/

Answer 13

elevated

Question 14

where is alkaline phosphatase found?

Answer 14

liver, bone, biliary tract

intestine, kidney, placenta, leukocytes

Question 15

what are normal ALP levels?

Answer 15

30-120

Question 16

what is ALP1 isoenzyme specific for?

Answer 16

liver origin

Question 17

what is ALP2 isoenzyme specific for?

Answer 17

bone origin

Question 18

hypophosphatemia, malnutrition, milk-alkali syndrome, pernicious anemia and scurvy would cause what level of ALP?

Answer 18

decreased

Question 19

liver dz, normal pregnancy, normal bone growth, bone tumors, fractures, paget dz, and others would cause what levels of ALP?

Answer 19

increased

Question 20

which drugs interfere with ALP levels?

Answer 20

too many

Question 21

what is GGT?

Answer 21

gamma-glutamyl transpetidase

Question 22

where is GGT found?

Answer 22

biliary tract, liver

kidney, spleen, heart, intestine, brain, prostate

Question 23

what are normal GGT values?

Answer 23

8-38

very high in newborns

Question 24

which is the most sensitive indicator of liver dz?

Answer 24

GGT level

-indicates heavy and chronic EtOH use

Question 25

late pregnancy, clofibrate, OCP, will do what to GGT levels?

Answer 25

lower

Question 26

EtOH, dilantin, liver dz, MI, pancreatic dz and phenobarbital will do what to GGT levels?

Answer 26

elevate

Question 27

what is 5' NT?

Answer 27

5' nucleotidase

Question 28

where is 5' NT found?

Answer 28

hepatocyte plamsa membrane

Question 29

what is normal 5'NT value?

Answer 29

0-1.6

Question 30

how is 5'NT used?

Answer 30

supports dx of obstructive hepatobiliary dz in pts with increased ALP

Question 31

liver dz will do what to 5'NT levels?

Answer 31

increase

Question 32

where is albumin formed?

Answer 32

inside the liver

Question 33

what is the main function of albumin?

Answer 33

maintains colloidal osmotic pressure and transports drugs, hormones and enzymes

Question 34

what are normal albumin levels?

Answer 34

3.5-5

Question 35

dehydration will do what to albumin?

Answer 35

increase

Question 36

inflammation, cirrhosis and nephrotic syndrome will do what to albumin?

Answer 36

decrease

Question 37

what is normal PT value?

Answer 37

11-12.5 seconds

Question 38

what is the best indicator of prognosis in acute liver dz?

Answer 38

PT

Question 39

what top tube will you collect PT?

Answer 39

blue top

Question 40

what is serum ammonia?

Answer 40

byproduct of protein metabolism, converted to urea

Question 41

what is normal serum level?

Answer 41

10-80

Question 42

what is the main interfering factor for serum ammonia?

Answer 42

smoking

Question 43

what are normal bilirubin levels?

Answer 43

.3-1 total

Question 44

how is bilirubin used?

Answer 44

assess liver function, hemolytic anemia and jaundice in newborns

Question 45

which meds will increase bilirubin?

Answer 45

``` allopurinol anabolic steroids antimalarials cholinergics sulfonamides methotrexate ```

Question 46

what does the liver make?

Answer 46

``` glucagon lipoproteins cholesterol proteins of all kinds bile salts ```

Question 47

what does the liver store?

Answer 47

glucagon triglycerides vitamins A, D, E, K, B12, Cu and Fe

Question 48

what is a Kupffer cell?

Answer 48

macrophage of liver

Question 49

what tests are used to dx hepatocellular injury?

Answer 49

ALT, AST, bilirubin

Question 50

what test are used to dx cholestasis?

Answer 50

bilirubin, ALP, GGT

Question 51

what tests are used to assess liver function?

Answer 51

albumin, PT, ammonia, platelets

Question 52

what is the de Ritis ratio?

Answer 52

AST/ALT ratio

Question 53

when would de Ritis ratio be greater than 2?

Answer 53

alcohol related liver dz

Question 54

what doaminotransferase levels greater than 1000 indicate?

Answer 54

necrosis

Question 55

what do ALP levels greater than 4times normal indicate?

Answer 55

ductal injury

Question 56

are isolated elevated GGT levels a good test?

Answer 56

no

Question 57

when coupled with ALP, which test works well to suggest liver dz?

Answer 57

GGT

Question 58

normal GGT with elevated ALP suggests what?

Answer 58

bone dz

Question 59

increased unconjugated bilirubin, normal serum conj bili increased gut conj bili increased urine urobiligen would indicate

Answer 59

pre-hepatic jaundice

Question 60

increased unconjugated serum bili increased conj serum bili decreased conj bili in stool, urine would indicate

Answer 60

intrahepatic jaundice

Question 61

normal unconjugated serum bili increased conj serum bili decreased conj bili in gut would indicate

Answer 61

post hepatic jaundice

Question 62

when is bilirubin in urine normal?

Answer 62

never

Question 63

what causes prehepatic jaundice?

Answer 63

excess hemolysis

Question 64

what causes intrahepataic jaundice?

Answer 64

damage to liver causes it to be unable to process bilirubin

Question 65

what causes posthepatic jaundice?

Answer 65

biliary system becomes inflammed or obstructed and bilirubin does not move into the digestive system