Flashcards in EXAM #1: LIVER ENZYMES Deck (41):
What is the common term to refer to a elevation in the liver transaminases, AST and ALT?
Which of the transaminases is LESS specific?
What is AST?
What are the primary sources of AST?
When is AST released?
Liver and skeletal muscle damage
What is ALT?
What is the primary source of ALT?
Elevated ALT indicates damage to what organ?
What is the ratio of AST and ALT in alcohol use?
What is an alternative etiology to AST and ALT elevations?
How do you evaluate for Rhabdomyolysis?
What markers indicate cholestatic injury?
When is there a build-up of direct bilirubin?
If biliary drainage is inadequate
When is there a build-up of Indirect bilirubin?
Liver failing to process as quickly as RBCs are lysing
What is the source of Total Bilirubin?
Breakdown of Hemoglobin
What are the major sources of Alkaline Phosphatase?
What causes an elevation of Alkaline Phosphatase?
1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester of pregnancy
What are two examples of classic diseases that will cause an increase in Alkaline Phosphatase related to bone abnormalities?
- Metastatic prostate cancer
- Paget Disease
What cardiac related disease can cause an increase in Alkaline Phosphatase?
How do you test for the specific etiology of an elevated ALP?
Gamma Glutamyl Transferase (GGT)
Is a GGT part of a normal CMP?
What does an elevated GGT tell you?
GGT elevation indicates ALP is increased from liver disease
What does a GGT that is NOT elevated tell you?
ALP elevation is from bony etiology
What are three indications that liver synthetic function is normal?
What is Alcoholic Hepatitis?
Acute inflammation of the liver (due to alcohol consumption)
What lab test is associated with Alcoholic Hepatitis?
Extremely high bilirubin
What is the source of ammonia in the body?
What is ammonia converted to? Where?
Urea in the liver
What causes an elevated ammonia?
Severe liver disease
What is hyperammonia associated with?
****This is a big predictor of mortality*****
What is ANA?
What is AMA?
What is ASMA?
Antismooth muscle antibody
What is LKM?
Anti liver-kidney microsomal antibody
What are the two major labs associated with Primary Biliary Cirrhosis?
1) Disproprotionate increase in alkaline phosphatase (APL)
1) Positive AMA (antimitochondiral antibody)
What patient population in Primary Biliary Cirrhosis associated with?
Middle aged females
What is Primary Sclerosing Cholangitis?
Inflammation and obliterative fibrosis of the bile ducts
What is Primary Sclerosing Cholangitis associated with?
What are the red flags for Primary Sclerosing Cholangitis?
1) Disproportionate increase in APL
2) "Beads on a string" in bile ducts
3) Onion skinning of bile ducts on biopsy
What antibodies are associated with Autoimmune Hepatitis?