which test is used to identify hepatocellular disease?
ALT (found in cytosol of liver)
what does ALT stand for?
alanine aminotransferase
what are the normal ALT values?
4-36 IU/L
what are the interfering drugs for ALT?
PAMS PODP
phenothiazine, acetaminophen, methotrexate, statins, procainamide, OCP, dilatin, propoxyphene
myositis, pancreatitis, MI, infections mono and shock would produce what level of ALT/
mildly elevated
cirrhosis, cholestasis, hepatic tumor, hepatotoxic drug, obstructive jaundice, severe burns and muscle trauma would produce what level of ALT?
moderately elevate
hepatitis, hepatic necrosis and hepatic ischemia would produce what level of ALT/
significantly elevated
what does AST stand for?
aspartate aminotransferase (found in liver, heart, skeletal muscle, kidney, pancreas and RBC)
what are normal AST values?
0-35
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?
SAVE CODOIC
salicylates, antihypertensive, verapamil, E-mycin, cholinergics, OCP, digoxin, opiates, INH, coumadin
acute renal dz, beriberi, DKA, pregnancy would cause what levels of AST?
low
liver dz would cause what level of AST/
elevated
where is alkaline phosphatase found?
liver, bone, biliary tract
intestine, kidney, placenta, leukocytes
what are normal ALP levels?
30-120
what is ALP1 isoenzyme specific for?
liver origin
what is ALP2 isoenzyme specific for?
bone origin
hypophosphatemia, malnutrition, milk-alkali syndrome, pernicious anemia and scurvy would cause what level of ALP?
decreased
liver dz, normal pregnancy, normal bone growth, bone tumors, fractures, paget dz, and others would cause what levels of ALP?
increased
which drugs interfere with ALP levels?
too many
what is GGT?
gamma-glutamyl transpetidase
where is GGT found?
biliary tract, liver
kidney, spleen, heart, intestine, brain, prostate
what are normal GGT values?
8-38
very high in newborns
which is the most sensitive indicator of liver dz?
GGT level
-indicates heavy and chronic EtOH use
late pregnancy, clofibrate, OCP, will do what to GGT levels?
lower
EtOH, dilantin, liver dz, MI, pancreatic dz and phenobarbital will do what to GGT levels?
elevate
what is 5’ NT?
5’ nucleotidase
where is 5’ NT found?
hepatocyte plamsa membrane
what is normal 5’NT value?
0-1.6
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?
increase
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?
3.5-5
dehydration will do what to albumin?
increase
inflammation, cirrhosis and nephrotic syndrome will do what to albumin?
decrease
what is normal PT value?
11-12.5 seconds
what is the best indicator of prognosis in acute liver dz?
PT
what top tube will you collect PT?
blue top
what is serum ammonia?
byproduct of protein metabolism, converted to urea
what is normal serum level?
10-80
what is the main interfering factor for serum ammonia?
smoking
what are normal bilirubin levels?
.3-1 total
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?
glucagon
triglycerides
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?
AST/ALT ratio
when would de Ritis ratio be greater than 2?
alcohol related liver dz
what doaminotransferase levels greater than 1000 indicate?
necrosis
what do ALP levels greater than 4times normal indicate?
ductal injury
are isolated elevated GGT levels a good test?
no
when coupled with ALP, which test works well to suggest liver dz?
GGT
normal GGT with elevated ALP suggests what?
bone dz
increased unconjugated bilirubin,
normal serum conj bili
increased gut conj bili
increased urine urobiligen would indicate
pre-hepatic jaundice
increased unconjugated serum bili
increased conj serum bili
decreased conj bili in stool, urine would indicate
intrahepatic jaundice
normal unconjugated serum bili
increased conj serum bili
decreased conj bili in gut would indicate
post hepatic jaundice
when is bilirubin in urine normal?
never
what causes prehepatic jaundice?
excess hemolysis
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
