LFTs Flashcards by Jessica H

Elevations typical of inflammation/hepatocellar damage

ALT
AST
may see GGT

(bilirubin, bilirubin direct, bilirubin indirect- only see if inflammation is severe)

How well did you know this?

Not at all

Perfectly

Elevations typical of cholestasis

Bilirubin
Bilirubin direct
Alkaline Phosphatase
may see GGT

How well did you know this?

Not at all

Perfectly

If GGT and ALP are elevated..

Source is likely liver

How well did you know this?

Not at all

Perfectly

Pattern indicative of reduced liver function

low albumin
low total protein

(may order separately:
PT- prolonged/high)

How well did you know this?

Not at all

Perfectly

Which is worse?
Very high ALT & AST with nl albumin & PT/INR

Normal ALT & AST w. slightly low albumin & minimally high PT/INR?

Normal ALT & AST w. slightly low albumin & minimally high PT/INR

This means that the liver is not functioning!
No direct relationship between severity of liver disease & transaminase levels

How well did you know this?

Not at all

Perfectly

Liver inflammation/hepatocellular damage=

high ALT & AST

How well did you know this?

Not at all

Perfectly

Cholestasis=

high All phos & high Direct Bilirubin

How well did you know this?

Not at all

Perfectly

Reduced liver function=

High PT/INR, low albumin

How well did you know this?

Not at all

Perfectly

Common cause of cholestasis?

Sx?

Choledocholithiasis

pain- biliary colic
jaundice
clay-colored stools (light colored)
cola colored urine

How well did you know this?

Not at all

Perfectly

Isolated elevation in Indirect (unconjugated) bilirubin is often due to?

Gilbert syndrome

How well did you know this?

Not at all

Perfectly

Alkaline phosphate is derived from..?

liver & bone

How well did you know this?

Not at all

Perfectly

If only Alk phos is elevated, must get _____?

If elevated/not elevated, suggests..?

GGT

elevated= liver source
not elevated= bone source

How well did you know this?

Not at all

Perfectly

Common cause of reduced liver function= ?

Cirrhosis

How well did you know this?

Not at all

Perfectly

Explain why cirrhosis causes reduced liver function

Results from chronic liver disease ->
causes chronic inflammation/hepatocellular damage ->
scarring (fibrosis) - scarred liver does not function like healthy liver

How well did you know this?

Not at all

Perfectly

Signs and sx of cirrhosis

fatigue
portal HTN
ascites
jaundice
easily bruising/bleeding

How well did you know this?

Not at all

Perfectly

Can patients with nl ALT & AST levels have significant liver disease? Explain

Yes

Occurs in setting of chronic disease- like cirrhosis

How well did you know this?

Not at all

Perfectly

Is ALT or AST more specific to the liver?

ALT

How well did you know this?

Not at all

Perfectly

Risk factors for liver damage and disease

fam hx
EtOH
obesity
DM
hyperlipidemia
meds/supplements
autoimmune dz

Hepatitis risk factors
-IVDU
-high-risk sexual behavior
foreign travel
-hx of transfusions
-tattoos

How well did you know this?

Not at all

Perfectly

What is the easiest way to determine if a medication is causing elevation of ALT & AST?

Stop it and see if the lab value returns to nl

How well did you know this?

Not at all

Perfectly

DDx for elevated transaminases (AST & ALT)

hepatitis
alcoholic liver dz
fatty liver disease
meds
hemochromatosis

(celiac, hypothyroidism = uncommon)

How well did you know this?

Not at all

Perfectly

When to worry about elevated ALT & AST vs not

modest elevations are common- often asymptomatic

Worry if:
other liver tests abnormal
clinical signs and sx of disease
>3-5 fold elevation of any level
persistently abnormal for >6 months

How well did you know this?

Not at all

Perfectly

DDx for mildly elevated AST & ALT

-Fatty liver (hepatic steatosis)- assoc. with obesity, type 2 DM, HLD
EtOH related

How well did you know this?

Not at all

Perfectly

DDx for elevated AST

Alcoholic hepatitis
common bile duct obstruction
cholangitis

How well did you know this?

Not at all

Perfectly

DDx for ALT/AST elevation with:

AST:ALT ratio of >1

Study These Flashcards

EtOH liver disease (especially if GGT >2x normal)

DDx for ALT/AST elevation with: | AST:ALT ratio of < 1 (ALT higher)

acute or chronic viral hepatitis | NASH (nonalcoholic steatohepatitis)

DDx for ALT/AST elevation with: | associated increased Alk Phos

Cholestatic disease (choledocholithiasis)

NASH = ?

fatty infiltration + associated inflammation

Prevalence of NAFLD (non alcoholic fatty liver disease)/NASH in population

11% (accounting for 75% of chronic liver dz)

Risk factors for NAFLD/NASH

obesity hypertriglyceridemia insulin resistance & DM Meds (estrogens, corticosteroids)

What labs would be elevated in pt with NAFLD/NASH?

ALT or ALT & AST

What is the usual initial imaging test you do to diagnose NAFLD/NASH? why?

Ultrasound | increased echogenicity can detect steatosis

General approach to management of NAFLD/NASH

weight loss in obese pts Hep A & B vaccinations avoid alcohol treatment of risk factors of cardiovascular dz

What is Hereditary Hemochromatosis? | And what population is it mostly seen in?

Hereditary disorder of iron metabolism -autosomal recessive Caucasians

Classic triad in Hereditary Hemochromatosis

cirrhosis DM bronze skin pigmentation

What are the steps to diagnosing Hereditary Hemochromatosis?

1. Elevated ALT & AST, or 1st degree relative 2. check serum transferrin saturation 3. If TS <45= normal, no further eval 4. If TS > 45 - check genotype

If not identified, hereditary hemochromatosis can lead to?

cirrhosis leading to a hepatocellular carcinoma

What is the most common pt to be diagnosed with autoimmune hepatitis? Age/gender

40s-50s | female

What is Wilsons disease?

very rare hereditary disorder of cellular copper transport | -autosomal recessive

What is a notable physical feature of patients with Wilsons disease?

Kayser-Fleischer rings (in about 1/2 pts with dz)

Other than elevated ALT/AST, what other lab abnormality would you see in a pt with Wilson disease?

Low ceruloplasim (the major copper-carrying protein)

Approach to an asymptomatic pt with mildly elevated ALT/AST

Step 1 Check for risk factors for hepatitis, liver damage, & conditions assoc. with NAFLD/NASH Step 2 Consider other causes of elevated ALT/AST (celiac, hypothyroidism, adrenal insufficiency) Step 3 Consider screening for rare liver conditions (autoimmune hepatitis, Wison disease) Step 4 Ultimately may need specialty consult- GI or Hepatologist

Describe Hep A infection | what kind of hep, chronic/not, route

- causes "infectious/ endemic hepatitis" - does not lead to chronic disease - spread fecal-oral route

What are the main sx of Hep A?

fever and jaundice (looks like hepatitis)

Management of Hep A

supportive care | post-exposure prophylaxis (vaccine)

Prevention of Hep A

- Hygiene- hand washing - vaccinate children between 12-23 months - vaccinate those who are at risk of complications from HAV (traveling, MSM, drug users, w/ chronic liver disease, contacts of people w/ HAV)

What will labs show in pt with Hep A?

Elevated ALT & AST | Can also see elevated bilirubin

When testing for Hep A, what is an good marker of acute or recent infection?

IgM anti-HAV antibodies

Describe Hep B | transmission, chronic/not?

Transmitted by blood, sexual contact, parenteral contact Leading cause of cirrhosis and hepatocellular carcinoma worldwide

Hep B- Acute vs chronic sx

Acute: varies Chronic: usually asymptomatic until late disease

Prevention of Hep B

- Avoid high risk behaviors | - Vaccination (infants, children, MSM, IVDU, people with HIV)

What labs would you see n acute vs chronic Hep B?

Acute: Elevated ALT/AST (in the hundreds or thousands) Chronic: Elevated ALT/AST (mildly elevated)

What is Hep B surface antigen (ABsAg) and when is it highest?

Protein on surface of the virus During incubation-beginning of acute phase (Infective phase)

What is Hep B surface antibody (anti-HBs) appear and what does it indicate?

- appears during recovery - usually indicates recent infection or immunity - also in vaccinated person

When does Total Hep B core antibody appear and what does it indicate?

At onset of sx in acute phase and persists for life Indicates previous or ongoing infection of HBV in undefined time frame

What does IgM antibody to Hep B core antigen (IgM anti-HBc) indicate?

acute or recent infection with HBV (less than 6 months)

If someone has anti-HBs + does not have anti-HBc, what does that indicate?

Immunity from vaccination

What is Hep C the leading cause of?

leading cause of liver transplants in the U.S.

How is Hep C transmitted?

- IVDU (most common) - received donated blood - needle-stick injuries - birth (HVC-infected mother) Can also be spread infrequently through: sex sharing personal items (toothbrush/razors)

Explain the process of testing for HCV

1. HCV antibody 2. If +, check for HCV RNA 3. If HCV RNA is +, pt has HCV. If HVC RNA not preset- infection might have cleared or HCV antibody was false + (Because Hep C does not provide immunity to re-infection!)

LFTs Flashcards

(59 cards)