Liver Enzymes

Question 1

What enzyme is specific to the liver?

Answer 1

Alk phosphatase

Question 2

What enzyme is measured in LFTs, but can also come from muscles?

Answer 2

AST

Question 3

What are the three AST-predominant elevation causes?

Answer 3

Alcoholic-related liver injury

Steatosis
Cirrhosis

Question 4

What are examples of severe ALT and AST elevations? (5)

Answer 4

Acute viral hepatitis
Meds
Wilson’s disease
Acute Budd-Chiari syndrome

Question 5

What are the sources of AST?

Answer 5

Liver and skeletal muscle

Question 6

What are the sources of alk phos?

Answer 6

Liver, bone, placenta

Question 7

What are the sources of ALT?

Answer 7

Liver kidneys (much more liver specific than AST)

Question 8

What is the classic ratio of AST:ALT?

Answer 8

2:1

Question 9

If there is an elevation in AST or ALT, you should consider what? How?

Answer 9

rhabdomyolysis

Check creatine kinase

Question 10

Direct bilirubin is elevated in what?

Answer 10

blockage

Question 11

Indirect bili is elevated in what?

Answer 11

Liver failure or hemolysis

Question 12

What does total bili measure?

Answer 12

Breakdown of Hb

Question 13

What is the equation to total bili?

Answer 13

D bili + I bili

Question 14

What is Gilbert’s syndrome?

Answer 14

Defect in glucuronide transferase that only becomes apparent during times of stress

Question 15

What is the cause of neonatal jaundice?

Answer 15

fetal Hb lyse and liver cannot keep up.

Question 16

What is the test for hemolysis?

Answer 16

Coomb’s test

Question 17

What are retics like in hemolysis?

Answer 17

Elevated

Question 18

What is Crigler-Najjar syndrome? What is the major complication with this? How is it inherited?

Answer 18

Deficiency in UDP-glucuronosyltransferase. The disorder results in a form of nonhemolytic jaundice, which results in high levels of unconjugated bilirubin and often leads to brain damage in infants. The disorder is inherited in an autosomal recessive manner.

Question 19

You see a pt with AST» ALT. What lab should you check next? What are you assessing for?

Answer 19

CK

Rhabdomyolysis

Question 20

What is the enzyme that is lacking in Crigler-Najjar syndrome?

Answer 20

UDP-glucuronosyltransferase

Question 21

What is Dubin-Johnson syndrome? SSx?

Answer 21

Inability to transport bilirubin out of the liver, but liver is otherwise fine. Results in elevated direct bilirubin, without any increase in AST or ALT

This is benign

Question 22

When is alk phos elevated?

Answer 22

inflammation of the biliary tree

Question 23

What are the two bone diseases that cause elevated alk phos?

Answer 23

Metastatic prostate CA

Paget’s disease

Question 24

Back pain with elevated alk phos?

Answer 24

Prostate CA mets

Question 25

If your alk phos is high, what is the next test to order to distinguish if it comes from bone or the liver? How can this be used to determine what the alk phos elevation is caused by?

Answer 25

Gamma glutamyl transferase If high = liver damage

Question 26

What are the three chemical for liver synthesizing functions (NOT the LFTs)?

Answer 26

Bili Albumin INR

Question 27

What are the two serum protein tests?

Answer 27

Albumin | Total protein

Question 28

Lytic bone lesions = ?

Answer 28

Multiple myeloma

Question 29

Total protein - albumin should be what value? What does this indicate?

Answer 29

3.5 g. If higher, indicates CA of some sort

Question 30

Rouleaux formation = ?

Answer 30

RBC stacking in multiple myeloma

Question 31

Increased albumin can be increased in what?

Answer 31

Dehydration

Question 32

What happens to the anion gap with lower albumin?

Answer 32

Lowers

Question 33

What is the value of ammonia levels?

Answer 33

Assess for hepatic encephalopathy

Question 34

What are the four antibodies that are specific to the liver?

Answer 34

Antinuclear ab (ANA) Antimitochondrial ab (AMA) Anti smooth muscle (ASMA) Anti liver-kidney-microsomal (LKM)

Question 35

What are the two lab signs of primary biliary cirrhosis?

Answer 35

Disproportionate increase in alk phos Positive antimitochondrial ab

Question 36

Who gets primary biliary cirrhosis

Answer 36

Middle aged females with sjogren's or raynaud's

Question 37

What is primary sclerosing cholangitis?

Answer 37

Bile duct inflammation and obliterative fibrosis

Question 38

What are the labs that indicate primary sclerosing cholangitis? Imaging findings?

Answer 38

Disproportionate increase in alk phos Beads on a string bile ducts

Question 39

What is the treatment for primary sclerosing cholangitis?

Answer 39

Liver transplant

Question 40

Primary sclerosing cholangitis usually occurs with what disease?

Answer 40

Ulcerative colitis

Question 41

What are the three antibodies that are elevated in autoimmune hepatitis?

Answer 41

ANA Antismooth muscle antibody Anti liver-kidney-muscles ab

Question 42

Who usually gets autoimmune hepatitis? What does this cause?

Answer 42

Young females Hepatocellular damage

Question 43

What Ig is elevated in autoimmune hepatitis?

Answer 43

IgG

Question 44

What are the labs that should be checked to assess for Fe overload?

Answer 44

Ferritin

Question 45

What are the labs that should be checked for copper overload?

Answer 45

Ceruloplasmin

Question 46

What are the labs that should be checked for alpha 1 antitrypsin deficiency?

Answer 46

Alpha 1 antitrypsin levels

Question 47

What are the labs that should be checked with celiac disease?

Answer 47

Tissue transglutaminase | IgA levels

Question 48

What are the labs that should be checked with hepatocellular cancer?

Answer 48

alpha fetoprotein

Question 49

High ferritin can indicate what? Low?

Answer 49

``` High = can be infx Low = can be Fe deficiency ```

Question 50

What is Rotor syndrome?

Answer 50

AR disease characterized by a benign increase in bilirubin and a non-itching jaundice.