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Diagnostics (Final Exam) > Liver Function > Flashcards

Liver Function Flashcards

1
Q

What does a high ALT and AST reflect?

A
  • inflammation

- hepatocellular damage

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2
Q

Does bilirubin rise with inflammation?

A

Bilirubin, Direct bilirubin and indirect bilirubin only rise if inflammation is severe

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3
Q

Which labs will be elevated with cholestasis (obstruction of bile)?

A
  • Bilirubin
  • Bilirubin direct (conjugated)
  • Alkaline Phosphatase

May see:
-GGT

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4
Q

Which labs are typically on a liver function panel?

A
  1. albumin
  2. Bilirubin
  3. Bilirubin direct (conjugated)
  4. Bilirubinn indirect (unconjugated)
  5. Alk phosphatase
  6. Total Protein
  7. ALT (alanin aminotransferase)
  8. AST (aspartate transaminase)
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5
Q

What is Gamma-Glutamul Transpeptidase (GGT) useful for?

A

GGT helps determine source of Alkaline phosphatase elevation

If GGT and Alk phos elevated = liver

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6
Q

What are these labs suggestive of?

Low albumin
Low total protein
Prolonged PT

A

Reduced liver function

  • low albumin
  • low total protein
  • prolonged PT
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7
Q

Is there a direct relationship between severity of liver disease and transaminase levels?

A

NO

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8
Q

Which is worse:

  1. Very high ALT and AST, normal albumin and PT
  2. Normal ALT and AST with low albumin and high PT/INR
A

2

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9
Q

What is the name for a gallstone getting stuck in the common bile duct?

A

choledocholithiasis

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10
Q

What symptoms would someone with choledocholithiasis present with?

A
  1. Pain - biliary colic
  2. Jaundice
  3. Clay-colored stools
  4. Cola colored urine
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11
Q

Which form of bilirubin is excreted from the liver in bile?

A

conjugated bilirubin

conjugated bilirubin is then converted to urobilinogen by bacteria and 90% is excreted in feces - 10% in urine

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12
Q

What is the name for dark urine?

A

bilirubinuria

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13
Q

What is the name for clay colored stools?

A

acholic

Conjugated bilirubin > urobilinogen > stercobilin (brown)

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14
Q

Which form of bilirubin is water soluble: unconjugated or conjugated?

A

conjugated bilirubin is water soluble, so when it can’t reach the duodenum it passes to the bloodstream and excreted by the kidneys

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15
Q

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

A

Gilbert Syndrome

  • benign
  • diagnosis made by ruling out other causes of elevated indirect bilirubin
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16
Q

Where alk phosphatase derived from?

A
  • Liver
  • Bone

(very small amount from intestines)

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17
Q

What are the common causes of reduced liver function?

A
  1. cirrhosis
  2. Severe hepatitis
  3. Toxic insult (eg. acetominophen overdose)
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18
Q

Name 5 signs of reduces liver function

A
  1. Fatigue
  2. Portal Hypertension
  3. Ascites
  4. Jaundice (increased bilirubin due to failure of hepatocyte to conjugate and failure to excrete bile = unconjugated bilirubin accumulates in fatty tissues, most noteably the skin)
  5. Easy bruising/bleeding
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19
Q

Is ALT or AST more specific to the liver?

A

ALT

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20
Q

Name 3 common herbs/vitamins that can cause elevations in ALT and AST

A
  1. Ephedra
  2. Kava
  3. Vitamin A
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21
Q

Name 7 medications that can often cause elevation in transaminases

A
  1. Acetaminophen (because it is often combined with opiates)
  2. Statins
  3. Antifungals
  4. Antibiotics
  5. Anti-TB drugs
  6. NSAIDS
  7. Tegretol
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22
Q

When should you be worried about elevated AST and ALT?

A
  • If other liver tests are abnormal
  • > 3-5 fold elevation of enzyme level
  • Persistently abnormal for > 6 months
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23
Q

If ALT and AST are mildly elevated (<3 times normal) what may be the concern?

A
  1. Fatty liver (Non-alcoholic Fatty Liver Disease)

2. EtOH related

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24
Q

What might elevated AST signify?

A
  1. Alcoholic hepatitis
  2. Common bile duct obstruction (choledocholithiasis)
  3. Cholangitis (infection that can result from choledocholithiasis)
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25
If AST is higher than ALT what does that suggest?
ETOH liver disease (especially if GGT >2x normal)
26
If ALT is higher than AST what does that suggest?
- Acute or chronic viral hepatitis | - NASH (Non-alcoholic steatohepatitis)
27
Having cirrhosis places patient at risk for what?
- liver failure | - liver cancer
28
What are the 4 risk factors for NAFLD and NASH
1. Obesity 2. Hypertriglyceridemia/Dyslipidmia 3. Insulin resistance and DM 4. Medications (corticsteroids, estrogen, tamoxifen, amiodarone, anti HIV medications)
29
What would be found on an ultrasound of a patient with NAFLD?
increased echogenicity *ultrasound is initial test
30
What would be found on a CT of NAFLD?
decreased attenuation
31
What is the general approach to treating NAFLD?
- Weight loss for patients who are obese - Hep A & B vaccinations - Avoid alcohol consumption - Treatment of risk factors for cardiovascular disease
32
What disease is caused by mutation of HFE gene which regulates the uptake of iron?
Hereditary hemochromatosis -autosomal recessive
33
What is the classic triad of hereditary hemochromatosis?
1. Cirrhosis 2. Diabetes mellitus 3. Bronze skin pigmentation
34
What is transferrin?
transferrin is the main iron-binding protein
35
What is ferritin?
marker of iron storage
36
transferrin and ferritin may be elevated in what disease?
hereditary hemochromatosis
37
How is hereditary hemochromatosis managed?
- therapeutic phlebotomy (~1-2 weeks) - avoid iron rich foods - avoid insults to the liver (eg. alcohol)
38
If untreated, what can hereditary hemochromatosis lead to?
``` DM Cardiomyopathy hypopituitarism hypogonadism hypothyroidism extra-hepatic cancer ```
39
What is the prevalence of autoimmune hepatitis?
11-25 per 100,000 people -about 3 times more common in females
40
What other labs tests may be done in addition to elevated ALT and AST in autoimmune hepatitis?
1. Increased total IgG 2. (+) ANA (antinuclear antibodies) 3. (+) ASMA (anti- smooth muscle antibodies)
41
What is the name of the autosomal recessive disease that leads to impaired biliary copper excretion causing accumulation of copper in the liver, brain and cornea?
Wilson disease
42
Will ceruloplasmin be high or low in Wilson's disease?
LOW | ceruloplasmin is the major copper-carrying protein
43
Hepatitis A: transmission
fecal oral
44
Hepatitis A: incubation period
10-50 days
45
Does hepatitis A lead to chronic disease, cirrhosis or hepatocellular cancer?
No
46
Hepatitis A transmission
- Household - Daycare - Sexual contact - injection and non-injection drug users
47
Heptatitis A prognosis children versus adult
Children: >90% asymptomatic Adults: 25-50% asymptomatic
48
What percent of Hep A infections recover completely?
99%
49
When do you vaccinate for Hep A?
Vaccinate within 2 weeks of exposure | if contraindication to vaccine, give immunoglobulin
50
When do you vaccinate children against Hep A?
between 12-23 months of age
51
Explain why patients wil become jaundice with hepatitis
When ALT and AST become very elevated (inflammation in the liver) you will also see a high bilirubin
52
If a patient has IgM anti-HAV negative and IgG anti-HAV positive what does this indicate?
Past infection and/or immunity
53
How is Hepatitis B transmitted?
Blood, sexual contact, parenteral contact (injection)
54
What are common symptoms related to hepatitis infection?
- fever - jaundice - nausea and vomiting - dark urine
55
Contrast Acute HBV and Chronic HBV
Acute HBV: - young children and immunosuppressed= asymptomatic - 30-50% of those older than 5 have typical hepatitis symptoms Chronic HBV: - asymptomatic until late disease - premature death due to cirrhosis
56
How is chronic Hep B infection managed?
antiviral medications
57
How will labs look for Hep B infection?
Acute infection: VERY HIGH ALT and AST Chronic infection: mildly elevated ALT and AST
58
When is the surface antigen for Hep B present in the blood?
Incubation and Acute phase
59
What does Hep B e antigen (HBeAg) presence indicate?
HBeAg indicates high levels of HBV (virus is replicating) -not a primary care concern
60
Total Hep B core antibody
appears at onset and persists for life
61
IF anti-HBc is present, the person has what?
natural immunity
62
If someone has anti-HBs were they vaccinated?
yes. Vaccine gives a person anti-HBs but doesn't give anti-HBc so "c" is natural
63
What is the leading cause of liver transplants in the US?
Chronic HCV (hepatitis C)
64
What is the most common tranmission means of Hep C?
injection drug use Also common: - needlestick in health care - Mom to baby in birth
65
Who needs to be screened for Hepatitis C?
1. Everyone born between 1945-1965 2. Injection drug users 3. Blood product recipients before 1992 4. HIV 5. Known exposure
66
How do you screen for Hepatits C?
1. Look for HCV antibody 2. Look for HCV RNA If both positive: patient has Hep C

Diagnostics (Final Exam) (2 decks)

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