Metabolic and Autoimmune Liver Disease

Question 1

4 liver enzymes to test

Answer 1

ALT
AST
ALP (alkaline phosphatase)
Gamma GT

Question 2

4 liver function tests

Answer 2

Albumin
INR
Bilirubin
Glucose

Question 3

Lab clues for cirrhosis

Answer 3

AST > ALT 1.5-2 because AST is found in many more extrahepatic tissues than ALT
Elevated Igs (decreased kupffer cell mass, increased liver vascular shunting)
Leukopenia and thrombocytopenia (from splenomegaly)

Question 4

Will ALP and GGT be up or down in cholestasis

Answer 4

Both up

Question 5

Lab findings in alcoholic liver disease

Answer 5

AST > ALT (alcohol suppresses ALT)
GGT markedly raised (induced by alcohol)
IgA increased (induced by fat in liver)
Ferritin increased (induced by steatosis, alcohol, and inflammation)

Question 6

Non alcoholic fatty liver disease

Answer 6

DM, high TG and obesity are main risk factors
Visceral fat is the problem
Can also be genetic predispositions
Tx with weight reduction

Question 7

Primary biliary cholangitis

Answer 7

Chronic progressive cholestatic liver disease
More in females
Destruction of the small-to-medium sized intrahepatic bile ducts
Treatment slows disease and may prevent/delay need for transplant

Question 8

Treatment for PBC

Answer 8

1st line: ursodeoxycholic acid

2nd line: Obeticholic acid and/or fibrates

Question 9

Autoimmune hepatitis

Answer 9

Unresolving inflammatory disease of the liver
Unknown cause
Can present as fulminant, acute or chronic
Mainly women
IgG, ANA, and ASMA most common
Treat with immunosuppression

Question 10

Primary sclerosing cholangitis

Answer 10

Chronic, cholestatic liver disease
Characterized by inflammation and fibrosis of intra and extrahepatic bile ducts leading to the formation of bile duct strictures
Eventually develops into cirrhosis, portal hypertension and hepatic decompensation
Needs regular screening for malignancies

Question 11

Main lab tests to look at for hemochromotosis

Answer 11

Raised ferritin (in the thousands)
Transferrin saturation of > 45% in females and > 50% in males

Question 12

Wilson’s disease

Answer 12

Uncommon autosomal recessive disease
Excessive Cu deposition in organs
Acute or chronic disease
Frequently associated with neuropsychiatric syndromes
Chelation therapy and maintainence with Zn