Liver enzymes Flashcards
(29 cards)
Male with RUQ pain, AST2300, ALT3400, Bilirubin11, AP(N76)
-What is diagnosis? WHY
AST/ALT- are»_space;»1000 ==> viral hepatitis, ischemic liver injury, toxin, or drug damage
fecal oral== HepA!!!!!!!!!!!!
F with RUQ pain, WBC25000, AST145, ALT150, AP300.
-What is diagnosis? WHY
-Acute cholestasis?
M with RUQ pain, AST600,ALT300, AK is normal.
-What is diagnosis? WHY
Alcoholism - liver disease - AST is 2x as high as ALT
check INR and bilirubin - may need tx to prevent acute hep failure or GI bleed
AST - What is it?
Aspartate aminotransferase - enzyme that is released by necrotic, inflamed hepatic tissue AND other tissue such as kidney, heart, skeletal muscle and brain.
Not specific to LIVER!
ALT - what is it?
Alanine aminotransferase - enzyme that IS specific to liver and is released secondary to necrosis or inflammation
AK - what is it?
Alkaline phosphatase - enzyme found in hepatic canicular membrane (also bones, intestines, and placenta)
**–> inc levels with biliary tract obstruction or cholestasis of liver
5-NT - what is it?
5-nucleotidase - enzyme involved in the hydrolysis of a 5-ribonucleotide to a ribonucleoside
**–> VERY speicifc for liver and can be used to confirm that other enzymes are elevated due to liver damage/dysfunction
GGT - what is it?
gamma-glutamyl transpeptidase - involved in the transfer of amino acids and in glutathione metabolism
**—> very specific for liver - can help confirm diagnosis of liver disease
If AP/GGT/5NT are all elevated then?
These are all located near the same area == Cholestasis -hepatic disease - stones, tumor, PBC, PSC
Usually only if these are more elevated than ALT/AST
Bilirubin - direct-
- breakdown product of porphyrin ring of heme containing proteins
- conjugated=hepatic of biliary tract disease - biliary tree may be blocks or when hepatic injury prevents excretion of bilirubin
Bilirubin - indirect
-breakdown product of porphyrin ring of heme containing proteins
- unconjugated - high levels reflect hemolytic process
- could be found high in congenital diseases such as Gilberts and Crigler Najjar
True synthetic function test of liver?
- albumin - exclusively made by hepatocytes –> t1/2 is 15-20days
- PT/INR and PTT - all factors except 8 are made exclusively by hepatocytes –> t1/2 of 7 is 6hrs and INR is single best test to ID the acute measure of liver function**
Single best test to determine liver synthetic fucntion?
Factor 7 - INR**
HepA-
genetic info?
transmission?
vaccine?
- ssRNA
- fecal oral
- YES Vaccine
HepB- genetic info? transmission? disease? vaccine?
- dsDNA
- blood-borne pathogen - close contact
- Acute and chronic disease
- YES Vaccine
HepC- genetic info? transmission? disease? vaccine?
- ssRNA
- blood borne pathogen - close contact
- acute and chronic disease
- NO vaccine
HepE genetic info? transmission? special case with this one? vaccine?
- ssRNA
- fecal oral / Waterborne
- High mortality in pregnant women
- NO Vaccine
Tylenol OD:
How much?
Tx?
- > 12g or 24 pills/whatever
- give N-acetylcysteine - powerful antioxidant and cellular detox agent
Autoimmune hep:
- Type1?
- Type2?
- 1 have ANA and ASMA
- 2 have ALKM
autoimmune hep;
- prevalent sex?
- presentation?
- Tx?
(CHRONIC HEP)
- WOMEN in 30s -40s
- asymptomatic to fulminant liver failure
- steroids and immunosuppresants
Non-alcoholic fatty liver disease
- associated with?
- progression?
- Tx?
- metabolic syndrome - obese, abn lipids, HTN, glucose intolerance
- cirrhosis and end stage liver
- Weight loss, glucose control, insulin sensitizing agents
hemochromatosis
-classic presentation/symptoms:
CLASSIC=CHF; Diabetes; bronze skin
Also arthritis of 2nd and 3rd MCPs
hemochromatosis
- what is it?
- inheritance?
- tx?
- iron overload disorder
- auto recessive - Chromosome 6
- 10% of whites are heterozygotes!
- phlebotomy
Wilsons disease
- what is the problem?
- when is presentation?
- What are symtpoms or presentation?
-Copper overload disorder
-TEENAGE YEARS
-pt may have kayser fleischer rings (brown on outside rim of iris
DECREASED CERULOPLASMIN
