LFT, Serologies, Cardiac

Question 1

Bilirubin is a product of what?

Answer 1

breakdown of heme portion of RBC (porphyrin ring)

Question 2

Indirect bilirubin travels to the liver bound to what protein?

Answer 2

albumin

Question 3

Indirect bilirubin is turned into direct bilirubin in what organ?

Answer 3

liver

Question 4

How is bilirubin excreted from the body?

Answer 4

as urobilinogen in the feces and urine

Question 5

What are the 4 causes of hepatitis?

Answer 5

• Viruses
• Iron/copper overload
• Genetic disorders/enzyme deficiencies
• Drugs/toxins/alcohol

Question 6

What are the 4 traditional liver function tests? (LFTs)

Answer 6

• ALT
• AST
• Alkaline Phos
• GGT

Question 7

Traditional LFTs are markers for what?

Answer 7

liver damage

Question 8

What are the 4 synthetic liver function tests?

Answer 8

• Total protein and serum albumin
• Prothrombin time (PT/INR)
• Partial thromboplastin time (PTT)
• Total bilirubin

Question 9

Synthetic LFTs are markers for what?

Answer 9

measure of liver function

Question 10

What are the 3 factors NOT produced in the liver?

Answer 10

-III, IV, VIII

Question 11

What do the 5 Lactic dehydrogenase (LDH) isoenzymes correlate to?

Answer 11

• LD1 = heart
• LD2 = reticuloendothelial system
• LD3 = lungs and pancreas, lymphocyte, platelet, other tissues
• LD4 = kidney, placenta, pancreas
• LD5 = liver and skeletal muscle (prostate)

Question 12

Where is ALT found and when are they released?

Answer 12

• found in hepatocytes

- released when cells are hurt or destroyed

Question 13

What is the ratio of AST:ALT in alcoholics?

Answer 13

2 or 3:1

Question 14

Where is alkaline phos found? (4)

Answer 14

• liver (esp. biliary tract)
• bones
• intestines
• placenta

Question 15

What causes alkaline phos to increase?

Answer 15

obstruction or infiltrative diseases

Question 16

1. What is the hepatocelluar pattern for AST, ALT, ALKP?

2. What is the cholestasis pattern for AST, ALT, ALKP?

Answer 16

1. Increased AST/ALT compared to ALKP

2. Increase in ALKP compared to AST/ALT

Question 17

What are the 7 hepatocellular injuries to be aware of?

Answer 17

• viral hepatitis
• alcohol
• drugs
• environmental toxins
• autoimmune hepatitis
• Wilson Disease
• Ischemia

Question 18

What are the 5 cholestatic injuries to be aware of?

Answer 18

• biliary cirrhosis
• sclerosing cholangitis
• cholangiocarcinoma
• pancreatic cancer
• choledocholithiasis

Question 19

1. What should you expect for LFTs in chronic hepatitis?
2. What should you expect for LFTs in cirrhosis?
3. What should you expect for LFTs in HCC or ESLD?

Answer 19

1. sudden elevation in LFTs
2. LFTs begin to drop
3. LFTs will be low

Question 20

What are the 4 viral hepatitis?

Answer 20

• Hepatitis
• Cytomegalovirus
• HSV
• West nile virus

Question 21

1. Which of the Hepatitis B studies, when elevated, indicates infection?
2. Which of the Hep B studies, when elevated, indicates immunity?

Answer 21

1. Anti-HBc

2. Anti-HBs

Question 22

What are the 3 main values you should test for HBV?

Answer 22

• HBsAg (HB surface antigen)
• Anti-HBs (HB surface antibody)
• Anti-HBc (HB core antibody)

Question 23

Which of the hepatitis virus is the most common cause of a liver transplant?

Answer 23

Hep C

Question 24

What are the 2 pancreatic enzymes and, when elevated, what do they indicate?

Answer 24

• Amylase, Lipase

- Acute pancreatitis

Question 25

What value is a sensitive and reliable indicator of tissue hypoxia?

Answer 25

Lactic acid

Question 26

What 4 conditions may cause an elevation in lactic acid?

Answer 26

- shock - vascular occlusion - ischemic bowel - sepsis (and indicates prognosis)

Question 27

What tubes should be used for a lactic acid test?

Answer 27

-iced gray or red tube

Question 28

What are the 4 cardiac markers?

Answer 28

- Troponin - CK-MB - Myoglobin - LDH

Question 29

Which of the 4 cardiac markers is best for measuring if a re-infarct has occured?

Answer 29

CK-MB

Question 30

How quickly does CK rise, peak and fall?

Answer 30

- Rises 3-6 hours after infarction - Peaks 12-24 hours - Returns to normal 12-48 hours

Question 31

How quickly does troponin rise, peak and fall?

Answer 31

- Rises 2-3 hours after infarction - Peaks 10-24 hours - Returns to normal in 10 days

Question 32

What is the normal range for Troponin I?

Answer 32

0.0 to 0.04 ng/ml

Question 33

What 2 values for hscTn indicate an MI?

Answer 33

- change of > 4 ng/L | - level is greater than 99th percentile

Question 34

What 3 things are necessary for an AMI diagnosis?

Answer 34

- Symptoms - EKG Changes - Elevated cardiac enzymes

Question 35

1. At what 3 points should cardiac enzymes be measured? | 2. At what 2 times should hscTn be measured?

Answer 35

1. 0, 6, and 12 hours | 2. 0 and 2 hours

Question 36

What is the cause of HAV and what is the prognosis?

Answer 36

- Food, water borne (fecal-oral contamination) | - self limited 99% spontaneous recovery

Question 37

What is the primary cause of HBV and what is the prognosis?

Answer 37

- sexual transmission | - 90-95% self limited over 6 months but can be chronic

Question 38

What is the primary cause of HCV and what is the prognosis?

Answer 38

- blood borne | - 20% self clearing 80% chronicity

Question 39

Which Hepatitis virus can lead to hepatocellular carcinoma?

Answer 39

HCV

Question 40

What is the testing procedure for HCV?

Answer 40

1. HCV Ab | 2. If it comes back positive then confirm with HCV PCR RNA

Question 41

Which of the cardiac markers would be the FIRST to increase in an AMI?

Answer 41

Myoglobin