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DS Unit 4 > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

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1
Q

What are the LFT’s?

A 
Total Protein
Albumin
Alkaline Phosphatase
AST (SGOT)
ALT (SGPT)
LDH
Bilirubin 
Total
Direct 
Indirect
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2
Q

What is the total protein adult ri?

A

6.4 – 8.3 g/dl

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3
Q

What is the total protein children ri?

A

Newborn: 4.6 – 7.4 g/dl
Infant: 6 – 6.7 g/dl
Child: 6.2 – 8 g/dl

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4
Q

What are the indications for a total protein test?

A

Used to diagnose, evaluate and monitor following diseases:

Liver disease

Intestinal/renal protein wasting states

Immune disorders

Impaired nutrition

Chronic edematous states

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5
Q

What are the functions of protein?

A 
Muscles
Enzymes
Hormones
Transport substances
Structural components of cell membrane
Channels
Osmotic pressure
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6
Q

What is the function of prealbumin?

A

Transports thyroxine

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7
Q

Where is albumin formed?

A

Liver

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8
Q

how much of the total protein is albumin?

A

60% of serum protein

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9
Q

What is the function of albumin?

A

Transports drugs, hormones & enzymes

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10
Q

What happens to protein levels in liver cell disease?

A

When liver cells diseased, they are unable to synthesize albumin and albumin level decreases. Because half life of albumin is 12-18 days, severe impairment of albumin synthesis may not be recognized for months.

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11
Q

What key proteins do globulins make up?

A

Antibodies, glycoproteins, lipid proteins, clotting factors and complement

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12
Q

What are the three types of globulins?

A

Alpha
Beta
Gamma

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13
Q

What molecules are alpha globulins present in?

A

Alpha1 antitrypsin, haptoglobin, prothrombin, cholinesterase

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14
Q

What molecules are beta globulins present in?

A

Lipoproteins, plasminogen, fibrinogen

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15
Q

What molecules are gamma globulins present in?

A

Immune globulins

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16
Q

What conditions exhibit increased gamma globulin levels?

A
  1. MM: gamma glob from neoplastic plasma cells.
  2. Chronic Inflamm Dis: RA, SLE; have asst autoantibodies.
  3. Malignancy: Hodgkins, lymphoma, leukemia
  4. Cirrhosis: pathophys not known.
  5. Acute or chronic Infection results in ab response
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17
Q

What conditions exhibit decreased gamma globulin levels?

A
  1. Genetic immune disorders
  2. Secondary immune deficiency
    Steroid use
    Nephrotic Syndrome
    Leukemia
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18
Q

What are the adult ri for albumin?

A

3.5-5.0 g/dl

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19
Q

What are the childhood ri for albumin?

A

Newborn: 3.5-5.4 g/dl
Infant: 4.4-5.4 g/dl
Children: 4-5.9 g/dl

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20
Q

What are the indications for albumin testing?

A

Measure of nutritional status
Measure of hepatic function
Measure of renal function

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21
Q

Where is albumin synthesized?

A

Liver

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22
Q

Albumin is a major contributor of what kind of pressure?

A

Osmotic pressure

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23
Q

Albumin is important in the transport of what?

A

Fatty acids
Thyroid hormones
Steroid hormones

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24
Q

What happens to the albumin concentration in dehydration?

A

Increased albumin levels

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25
What conditions are asst with decreased albumin levels?
1. Malnutrition: lack of aa for building proteins; also liver dysfunction asst with malnutrition also contributes to low albumin levels. 2. Pregnancy: increased demands on the body 3. Hepatic disease: Hepatitis, cirrhosis, metastatic liver tumor Liver: site of albumin synthesis. 4. Malabsorption: Crohns Disease 5. Third space losses: ascitis, third degree burns 6. Overhydration
26
What are the normal adult ri for alkaline phosphatase?
30-120 units/L
27
What are the normal elderly ri for alkaline phosphatase?
Slightly higher than adults | Adults 30-120units/L
28
What are the normal elderly ri for alkaline phosphatase?
``` Children (units/l) <2 yrs 85-235 2-8 yrs 65-210 9-15 yrs 60-300 16-21 yrs 30-200 ```
29
What are the indications for alkaline phosphatase?
Detect and monitor diseases of Liver and Bone
30
Where are the highest concentrations of ALP?
1. Liver and biliary tract epithelium: Kupffer cells 2. Bone A. Most frequent extrahepatic source of ALP B. New bone growth = increased ALP levels
31
How do you distinguish between ALP from the bone and the liver?
ALP1 – Liver ALP2 - Bone
32
What conditions are associated with increased ALP
1. Primary cirrhosis 2. Biliary obstruction A. Intrahepatic B. Extrahepatic 3. Liver tumor A. Primary B. Metatstatic 4. Normal bones of growing children 5. Healing fracture 6. Paget’s Disease
33
Aspartate Aminotransferase (AST) normal adult and elderly ri?
0–35 units/l
34
Aspartate Aminotransferase (AST) normal Childhood ri?
10-140 units/l Highest in newborns Lowest in adolescents (10-40 units/l)
35
What are the indications for AST testing?
Suspected occlusive coronary artery disease Suspected hepatocellular disease
36
Where is AST found?
``` Found in metabolically active tissues Heart Liver Skeletal muscle Pancreas RBC’s Kidneys ``` If disease or injury in any of these cells Cells lyse and release AST
37
What is AST level directly related to?
Number of cells injured
38
When is AST increased post injury?
Elevated 8 hours post injury Peaks 24-36 hours post injury Returns to normal in 3-6 days
39
Increased AST are asst with what cardiac conditions?
MI Cardiac surgery Cardiac catheterization Angioplasty
40
Increased AST are asst with what hepatic conditions?
1. Hepatitis AST rises up to 20x normal (700 units/L) 2. Cirrhosis Level depends on amount inflammation 3. Hepatic mets 4. Infectious mono with hepatitis
41
Increased AST are asst with what skeletal muscle conditions?
Muscle trauma Recent noncardiac surgery Severe deep burns Recent seizures
42
Increased AST are asst with what other conditions?
1. Acute pancreatitis 2. Acute extrahepatic obstruction - Gallstone - Level rises 10x normal
43
Decreased ASt levels are asst. with what conditions?
Acute renal disease | Chronic renal dialysis
44
What are Alanine Aminotransferase (ALT) ri for children, adults, and elderly?
4-36 units/l
45
What are the indications for ALT testing?
Hepatocellular disease Identification Monitoring treatment
46
Where is ALT normally found?
Found primarily in liver Injury or disease affecting liver will cause release of this enzyme
47
What test is ALT usually ordered with?
AST
48
What conditions are asst. with increased ALT?
``` Hepatitis Hepatic necrosis Cirrhosis Cholestasis Hepatotoxic drugs Obstructive jaundice ```
49
What are the adult/elderly ri for LDH?
100-190 units/l
50
What are the indications for LDH testing?
``` Heart Liver RBCs Kidneys Skeletal muscle Brain Lungs ```
51
What is the clinical significance of LDH?
Diseased or injured cells lyse  release LDH into bloodstream 5 isoenzymes make up total LDH
52
Where are the 5 LDH enzymes produced?
LDH1 – heart LDH2 – reticuloendothelial system (makes up the greatest part of LDH) LDH3 – lungs LDH4 – kidney, placenta,pancreas LDH5 – liver, striated muscle
53
What happens to the LDH levels after an MI?
Rises within 24-48 hours post MI Peaks in 2-3 days post MI Returns to normal in 5-10 days
54
What conditions are asst with increased LDH
MI Pulmonary disease: embolism, infarction, pneumonia, CHF Hepatic disease RBC disease: hemolytic or megaloblastic anemia Muscular dystrophy Renal parenchymal disease Neoplastic states
55
What are the normal adult, elderly, and children ri for bilirubin?
Total: 0.3 – 1.0 mg/dl Indirect: 0.2 - 0.8 mg/dl Direct: 0.1 – 0.3 mg/dl
56
What are the newborn normal ri for bilirubin?
1.0 – 12.0 mg/dl
57
What are the critical values for bilirubin?
Adult >12 mg/dl Newborn >15 mg/dl
58
What are the indications for bilirubin testing?
Evaluate liver function Hemolytic anemias Newborn jaundice
59
What is the clinical significance of bilirubin?
1. As RBC’s are broken down in spleen, hemoglobin is released Hgb  heme & globin 2. Heme broken down to form biliverdin 3. Biliverdin is transformed into indirect bilirubin 4. Indirect bili is conjugated with glucuronide, Results in conjugated (direct) bili. 5. Direct bili is then excreted from liver cells into intrahepatic canaliculi, then hepatic ducts, then CBD, then bowel
60
What % of total bili is indirect/unconjugated bili?
70-85%
61
What % of total bili is direct/conjugated bili?
15-30%
62
At what Tbili level does jaundice occur?
TBili > 2.5 mg/dl
63
What does jaundice result from?
Normal metabolism of bilirubin Excretion of bilirubin
64
Define physiologic jaundice of newborn
Occurs when infant’s liver does not have sufficient conjugating enzymes Results in high levels unconj (indirect) bili
65
What complications can occur from jaundice of newborn?
Can pass through blood-brain barrier and cause encephalopathy (kernicterus)
66
What newborn bili levels indicate treatment?
Bili > 15 in newborns requires immediate treatment – exchange transfusions, light therapy
67
Increased direct bilirubin implies what type of defect?
1. If defect occurs after conjugation bili, direct bili is increased: A. Consider extrahepatic dysfunction -Obstruction of CBD by gallstone -Tumor blocking CBD
68
Increased indirect bilirubin implies what type of defect?
1. If defect occurs before conjugation bil, increased indirect bili: A. Hepatocellular dysfunction - Hepatitis - Cirrhosis B. Hemolysis C. Drugs D. Gilbert Syndrome
69
What is Gilbert syndrome?
congenital enzyme defect interrupts conjugation of bili; indirect bili rises

DS Unit 4 (9 decks)

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