which test is used to identify hepatocellular disease?
ALT (found in cytosol of liver)
what does ALT stand for?
what are the normal ALT values?
what are the interfering drugs for ALT?
phenothiazine, acetaminophen, methotrexate, statins, procainamide, OCP, dilatin, propoxyphene
myositis, pancreatitis, MI, infections mono and shock would produce what level of ALT/
cirrhosis, cholestasis, hepatic tumor, hepatotoxic drug, obstructive jaundice, severe burns and muscle trauma would produce what level of ALT?
hepatitis, hepatic necrosis and hepatic ischemia would produce what level of ALT/
what does AST stand for?
aspartate aminotransferase (found in liver, heart, skeletal muscle, kidney, pancreas and RBC)
what are normal AST values?
how will AST levels change with injury?
elevates at 8hrs
peaks at 24-26 hrs
normal at 3-7 days
what drugs interfere with AST levels?
salicylates, antihypertensive, verapamil, E-mycin, cholinergics, OCP, digoxin, opiates, INH, coumadin
acute renal dz, beriberi, DKA, pregnancy would cause what levels of AST?
liver dz would cause what level of AST/
where is alkaline phosphatase found?
liver, bone, biliary tract
intestine, kidney, placenta, leukocytes
what are normal ALP levels?
what is ALP1 isoenzyme specific for?
what is ALP2 isoenzyme specific for?
hypophosphatemia, malnutrition, milk-alkali syndrome, pernicious anemia and scurvy would cause what level of ALP?
liver dz, normal pregnancy, normal bone growth, bone tumors, fractures, paget dz, and others would cause what levels of ALP?
which drugs interfere with ALP levels?
what is GGT?
where is GGT found?
biliary tract, liver
kidney, spleen, heart, intestine, brain, prostate
what are normal GGT values?
very high in newborns
which is the most sensitive indicator of liver dz?
-indicates heavy and chronic EtOH use
late pregnancy, clofibrate, OCP, will do what to GGT levels?
EtOH, dilantin, liver dz, MI, pancreatic dz and phenobarbital will do what to GGT levels?
what is 5’ NT?
where is 5’ NT found?
hepatocyte plamsa membrane
what is normal 5’NT value?
how is 5’NT used?
supports dx of obstructive hepatobiliary dz in pts with increased ALP
liver dz will do what to 5’NT levels?
where is albumin formed?
inside the liver
what is the main function of albumin?
maintains colloidal osmotic pressure and transports drugs, hormones and enzymes
what are normal albumin levels?
dehydration will do what to albumin?
inflammation, cirrhosis and nephrotic syndrome will do what to albumin?
what is normal PT value?
what is the best indicator of prognosis in acute liver dz?
what top tube will you collect PT?
what is serum ammonia?
byproduct of protein metabolism, converted to urea
what is normal serum level?
what is the main interfering factor for serum ammonia?
what are normal bilirubin levels?
how is bilirubin used?
assess liver function, hemolytic anemia and jaundice in newborns
which meds will increase bilirubin?
allopurinol anabolic steroids antimalarials cholinergics sulfonamides methotrexate
what does the liver make?
glucagon lipoproteins cholesterol proteins of all kinds bile salts
what does the liver store?
vitamins A, D, E, K, B12, Cu and Fe
what is a Kupffer cell?
macrophage of liver
what tests are used to dx hepatocellular injury?
ALT, AST, bilirubin
what test are used to dx cholestasis?
bilirubin, ALP, GGT
what tests are used to assess liver function?
albumin, PT, ammonia, platelets
what is the de Ritis ratio?
when would de Ritis ratio be greater than 2?
alcohol related liver dz
what doaminotransferase levels greater than 1000 indicate?
what do ALP levels greater than 4times normal indicate?
are isolated elevated GGT levels a good test?
when coupled with ALP, which test works well to suggest liver dz?
normal GGT with elevated ALP suggests what?
increased unconjugated bilirubin,
normal serum conj bili
increased gut conj bili
increased urine urobiligen would indicate
increased unconjugated serum bili
increased conj serum bili
decreased conj bili in stool, urine would indicate
normal unconjugated serum bili
increased conj serum bili
decreased conj bili in gut would indicate
post hepatic jaundice
when is bilirubin in urine normal?
what causes prehepatic jaundice?
what causes intrahepataic jaundice?
damage to liver causes it to be unable to process bilirubin
what causes posthepatic jaundice?
biliary system becomes inflammed or obstructed and bilirubin does not move into the digestive system