Liver Disease Flashcards
(113 cards)
1
Q
List the common liver function tests
A
Aspartate Aminotransferase (AST, SGOT) Alanine Aminotransferase (ALT, SGPT) Alkaline Phosphatase (ALP) Total Bilirubin Albumin *not on LFT panel but still used: Gamma Glutamyl Transpeptidase PT
2
Q
Where is aspartate aminotransferase (AST) enzyme made?
A
RBC's Liver Heart Muscle tissue Pancreas Kidney
3
Q
Normal values of AST are
A
Low
4
Q
Abnormal Values of AST are
A
high
5
Q
What does an increased AST indicate?
A
damage to tissue (not very specific)
Amount of AST in blood is directly related to extent of tissue damage (time = tissue)
6
Q
What test can AST be done along with to determine whether the liver or another organ has been damaged?
A
ALT
7
Q
Where is alanine aminotransferase (ALT) enzyme made?
A
Mainly in the liver, but also in small amounts in kidneys, heart, muscles pancreas
8
Q
Normal values of ALT are?
A
Low
9
Q
Abnormal values of ALT are?
A
High
10
Q
What can elevated ALT levels indicate?
A
liver disease (more convincing when associated with elevated AST)
11
Q
Where is Alkaline Phosphatase (ALP) enzyme made?
A
Liver Bone intestines kidneys placenta of preg
12
Q
What body part makes the most ALP?
A
liver (more than other organs/bones)
13
Q
What conditions can cause elevated ALP?
A
rapid bone growth (during puberty) bone disease hyperparathyroidism vit D deficiency Damaged liver cells
14
Q
What is the function of gamma glutamyl transpeptidase in the body?
A
transport molecule that helps liver metabolize drugs/toxins
15
Q
Where is glutamyl transpeptidase found in the body?
A
concentrated in the liver Also found in GB Spleen pancreas kidney NOT IN THE BONES
16
Q
What other lab test is helpful to use along with GGT to diagnose liver disease?
A
ALP
Not found in bones, so helps r/o bones as cause of elevated lab.
17
Q
What does a total bilirubin measure?
A
amount of bilirubin in the blood
18
Q
What is bilirubin a by-product of?
A
RBC’s are broken down daily-bilirubin is produced as a result. The liver then breaks down the bilirubin and it is excreted in the feces.
19
Q
What 2 forms of bilirubin exist?
A
direct (conjugated) bilirubin
indirect (unconjugated) bilirubin
20
Q
Elevated levels of indirect (unconjugated) bilirubin are a sign of____?
A
hemolysis or failure of liver uptake
21
Q
Elevated levels of direct (conjugated) bilirubin are a sing of ___?
A
Impaired secretion of liver
22
Q
Which of the 2 forms of bilirubin is measured directly in the blood?
A
direct (conjugated)
23
Q
Where is Albumin produced?
A
liver
24
Q
What is the fxn. of albumin?
A
moves bilirubin calcium hormones medications through the blood Keeps fluid in the blood from leaking into capillaries
25
What is albumin used to test for?
kidney and liver dz
26
greatly decreased values of Albumin are indicative of?
Liver/kidney dz
27
decreased values of albumin are indicative of?
```
Absorption problem
post surgery
malnutrition
low protein diet
crohns etc.
```
28
Increased levels of albumin are indicative of?
dehydration and high protein diet
29
What will occur to Prothrombin time in the setting of chronic liver dz?
increase
30
Define Steatosis
fatty infiltration of the liver
31
Define steatohepatitis
fatty infiltrate PLUS inflammation
32
Define cirrhosis
Chronic degenerative dz in which cells are damaged and replaced by scar tissue
33
functions of the liver
```
Conjugates bilirubin
produces bile
produces many proteins
processes ETOH, some meds/toxins
Regulates lipids
Converts glycogen into glucose and vice versa
Excretes some wastes
storage unit
```
34
Definition of Alcoholic liver dz?
Acute or chronic inflammation and parenchymal necrosis of the liver induced by ETOH
35
Which of the discussed liver diseases is reversible?
Alcoholic liver dz
| Non alchoholic fatty liver disease
36
Which type of liver dz is the most common precursor of cirrhosis in the US?
Alchoholic liver dz
37
What are the three pathologic stages of alcoholic liver dz?
Fatty liver-reversible
Alcoholic hepatitis-reversible
Cirrhosis-irreversible
38
Fatty liver =
steatosis
| asymptomatic
39
Alcoholic hepatitis =
Steatohepatitis
| Asymptomatic-symptomatic
40
_______ as the first histological response in response to any hepatotoxic stimuli (ETOH in ALD)
fat accumulation (steatosis)
41
What is the deficiency found in ALD in the liver?
alcohol dehydrogenase deficiency
42
What is the hallmark of the shift from steatosis to steatohepatitis in ALD?
Hepatocyte injury
43
RF for ALD?
```
Alcohol intake (duhhhhh)
Females more than males
Concurrent viral Hep C
Genetics
Fattly liver/obesity
```
44
ETOH threshold for females for developing liver dz?
Chronic use exceeding 30-40g/day (3/4 beers a day)
45
ETOH threshold for males for developing liver dz?
Chronic use exceeding 80g/day (6/7 beers a day)
46
sx of early (fatty liver) ALD?
```
Asymptomatic
Hepatomegally
RUQ tenderness occasionally
Nausea
Jaundice - very rare
```
47
sx of advanced steatohepatitis in ALD?
```
Asymptomatic in some
Fever
SPIDER NEVI
jaundice
abd tenderness/acute and.
encephalopathy
portal hypertension (ascites, esophageal varicies)
```
48
Lab finding for ALD early?
Modest increase in GGTP, AST, ALT
Hypertriglyceridemia
hypercholesterolemia
hyperbilirubinemia
49
Lab finding for ALD advanced?
```
SEVERE INCREASE in GGTP, AST, ALT, (AST greater than ALT (ratio greater than 1))
Hyperbilirubinemia
ALK PHOS HIGH**
HYPOALBUMINEMIA**
INCREASED PT**
```
50
Imaging for ALD?
US detects fatty infiltration
51
T/F US can distinguish between fibrosis and inflammation in ALD?
FALSE
52
What test is used as gold standard for ALD to confirm diagnosis and guide therapy?
Liver Bx
53
How can you differentiate ALD from NASH?
Not on Bx (can't tell difference).
| Have to get a good HX from pt.
54
General tx for ALD?
Abstain from ETOH
Nutrition (particularly in malnourished/anorexic pt's)
Psych.
55
Pharm Tx for ALD?
Methylprednisolone reduces short term mortality
| Pentoxyfylline (for severe)
56
Most important prognosis for pt's with ALD?
continued ETOH use
57
What is the MC chronic liver dz in the US?
Nonalchoholic fatty liver disease (NAFLD)
58
Why is there an increase in the US in NAFLD?
rise in childhood obesity
59
MC causes of NAFLD?
```
Obesity (MC)
DM
Hypertriglyceridemia
Meds (steroids)
Cushings syndrome/hypothyroidism
PCOS
OSA
Metabolic syndrome
```
60
RF for progressive NAFLD?
Older age
obesity
DM
61
SX of NAFLD?
Mostly asymptomatic
RIQ discomfort
Hepatomegaly (75% of pt's)
Progression of chronic liver dz is common
62
Labs for NAFLD?
may be normal or mildly elevated AST/ALT alk pos.
| Ratio of AST:ALT is almost always greater than 1
63
Imaging for NAFLD?
may be seen on CT, US MRI but won't distinguish between stages
64
Diagnostic test of choice for NAFLD?
Liver Bx
65
lifestyle tx for NAFLD
Wt loss
dietary fat restriction
exercise
66
Pharm options that are being studied for use in NAFLD?
TZD's
Vit. E
Metformin (but causes wt gain)
Pentoxyfylline
67
Surgical options for NAFLD?
Gastric bypass
68
What percentage of pt's with NAFLD progress to NASH?
25%
69
define NASH?
Nonalcoholic steatohepatitis
70
NASH histologically presents exactly like ____?
Alcoholic hepatitis
71
What distinguishes NASH from ALD?
lack of Hx of chronic excessive ETOH use
72
Common sx of NASH?
fatigue
wt loss
weakness
73
What confirms diagnosis of NASH?
Liver bx
74
What are the 2 most common causes of Cirrhosis in the US?
Alcohol and Hep C are 2 MC causes of Cirrhosis in the US
75
Describe three stages of Cirrhosis?
Compensated-no complications
Compensated with varices
Decompensated-with complications
76
Complications of Cirrhosis
```
Portal hypertension (ascites, spontaneous bacterial perionitis, variceal bleeding)
Hepatorenal syndrome
hepatic encephalopathy
Hepatopulmonary HTN
malnutrition
coagulopathy
bone dz
Hematologic abnormalities
```
77
sx of cirrhosis
```
weakness
fatigue
anorexia
wt loss
stigmata of liver dz (see complications)
```
78
Standout symptoms of cirrhosis?
```
Gynecomastia
Caput medusa (dilated abd vessels)
Asterixis (dorsiflexion of palms)
spider angiomas (trunk/upper arms)
Dupuytren's contracture (can't straighten finger)
Palmar erythema (spares palmar region)
ascites
esophageal varices
```
79
Labs that are abnormal in cirrhosis?
```
(can be normal/abnormal depended on stage)
macrocytic anemia
WBC low or high (if infxn.)
thrombocytopenia
prolonged PT
Elevated AST/ALT and ALP
Bili elevated
Albumin decreased
GGTP increased
Serum sodium decreased
Vit D level low
```
80
Gold standard for diagnosis of cirrhosis?
Liver BX
81
When is a liver Bx not needed?
if clinical, lab, and radiologic data strongly suggests cirrhosis already
82
Imaging for Cirrhosis?
Doppler US (liver size, nodules, ascites, patency)
CT/MRI
EGD
83
General Tx for cirrhosis?
Tx cause (ETOH, Hep C, Hep B)
proper diet
psych counseling
vaccine UTD
84
Tx for cirrhosis (meds)
NONE!
85
What is TX aimed at for Cirrhosis?
Complications
| Prevention of progression
86
What is the MC complication of cirrhosis?
Ascites and edema
87
tx for ascites?
restrict Na consumption
diuresis (spironolactone first, add loop)
Paracentesis
TIPS
88
Tx of Variceal hemorrhage
Vasoconstricting agents
Balloon tamponade
TIPS/band ligation
Prophylaxis-routine screening for all pt's with cirrhosis
89
define hepatorenal syndrome?
Development of renal failure in pt's with advanced liver dz.
90
Progressive increase in _____ occurs during hepatorenal syndrome?
Creatinine
91
Why does hepatic encephalopathy occur?
buildup of toxins in the body , neurotoxins are not removed by live and end up in the brain.
92
Sx of hepatic encephalopathy?
```
mental status change
hypersomnia
personality change
asterixis
brain swelling
high emonia
```
93
tx of hepatic encephalopathy?
Hydration with IV fluid
electrolyte correction
Lactulose (removes GI nitrogenous product)
Mannitol (decreases brain swelling)
Rifaxim or metronidazole plus neomycin If pt doesn't tolerate lactulose
zinc supplementation
94
Signs of hepatopulmonary syndrome with cirrhosis?
dyspnea and drop in O2 sat that is worse when UPRIGHT. (weird)
95
define portopulmonary HTN
presence of pulm htn. in pt's with portal htn.
96
how is portopulmonary HTN diagnosed?
echo and cardiac cath.
97
Tx of malnutrition 2nd to cirrhosis?
sietary supplementation
98
How common in coagulopathy in cirrhosis?
VERY- universal in all pt's with cirrhosis
99
tx of coagulopathy in Cirrhosis?
Vit K (if Vit K is diminished)
If synthesis of clotting factors d/t mass in liver
Vit K will NOT correct problem. Tx requires FFP if active bleeding or before surgery
100
Tx for bone disease 2nd to cirrhosis?
Bisphosphonates
101
What is the ultimate tx of decompensated cirrhosis?
Liver transplant
102
Define hemochromatosis
inherited disorder of iron metabolism.
| results in progressive increase in iron deposition which can cause cirrhosis
103
What labs can be used to evaluate for Hemochromatosis?
Elevated fasting transferrin sat and elevated ferritin level
| genetic testing, liver bx
104
Tx of hemochromatosis?
regular phlebotomy
105
Define Wilson's disease?
Autosomal recessive d/o of copper homeostasis w/ failure to excrete excess copper leading to liver damage
106
What groups are generally affected by Wilson's disease?
young adults and adolescents
107
What group is usually effected by Wilson's disease?
young adults and adolescents.
108
Important PE finding of Wilson's disease?
Kayser-Fleisher corneal rings (ring of copper around the eye).
109
How is Wilson's disease diagnosed?
Low serum ceruloplasmin concentration and increased hepatic copper on LIVER BX.
110
Tx of Wilson's disease?
Copper-chelating agents indefinitely (penicillamine)
111
define alpha-1 antitrypsin deficiency
autosomal recessive d/o that causes abnormal folding of the alpha 1 antitrypsin protein leading to failure of the liver (also effects pulm system-emphysema)
112
Diagnosis of Alpha-1 antitrypsin is done by doing___?
phenotype testing and alpha 1 antitrypsin levels
113
tx of alpha-1 antitrypsin deficiency?
Liver transplant is curative.
