1. When ALP is elevated, it confers liver specificity 2. When AST/ALT is more than 2, it supports diagnosis of alcoholic liver disease 🥂

Liver Tests/ Hepatitis Serology Flashcards by Lauren F

What are the 3 categories of liver disease?

Hepatocellular
Cholestatic
Infiltrative

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What is hepatocellular liver disease?

Injury to the hepatocytes

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What is cholestatic liver disease?

Injury of the bile ducts or bile flow obstruction (intra or extra-hepatic compression)

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What is infiltrative liver disease?

Liver is invaded or replaced by non-hepatic substances
Ex: tumor, amyloidosis, TB

We didn’t really talk about this in the lecture

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Why don’t we call them liver function tests anymore?

Because not all of them tell you about the function of the ~liver~

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Which 2 values will definitely be elevated if you have hepatocellular damage?

ALT

AST

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What does ALT stand for?

Alanine aminotranserfase

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What does AST stand for?

Aspartate transaminase

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What are transaminases?

ALT and AST

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Which 3 values are definitely going to be elevated if you have cholestatic liver damage?

(Damage to the bile ducts)

Total bilirubin
Alkaline phosphatase
GGT

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What does an elevated alkaline phosphatase suggest?

Cholestasis (bile can not flow)

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If you have an elevated ALP (alkaline phosphatase), what other 3 values can tell you that it’s definitely coming from the liver?
(There are several places ALP can come from)

ALP isoenzymes-distinguish b/w bone and liver origin

5NP

GGT

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What is total bilirubin?

Direct bilirubin + indirect bilirubin

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What is fractionated bilirubin?

Fraction of total bilirubin that is direct versus indirect

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When is fractionated bilirubin useful?

When standard liver tests are normal and total bilirubin is elevated

Ex: hemolysis, Gilbert’s syndrome

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If you have liver disease, what values will you suspect in:

Direct Bilirubin

Indirect Bilirubin

AST/ALT

Direct bilirubin: high

Indirect bilirubin: normal or high

AST/ALT: high

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If you have hemolysis, what values do you expect:

Direct Bilirubin

Indirecr Bilirubin

AST and ALT

Hemoglobin

Direct Bilirubin: normal

Indirect bilirubin: HIGH

AST and ALT: normal (the liver is healthy!)

Hemoglobin: LOW

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If you have Gilbert’s syndrome, what values do you expect:

Direct bilirubin

Indirect bilirubin

AST and ALT

Hgb

Direct bilirubin: normal

Indirect bilirubin: HIGH

AST and ALT: normal

Hgb: NORMAL

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The labs of someone with hemolysis and someone with Gilbert’s syndrome will look very similar (normal direct bilirubin, HIGH indirect bilirubin, normal AST and ALT).
How would you tell them apart?

The person with hemolysis will also have anemia

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What is Gilberts syndrome?

You are missing the enzymes in your liver that conjugate bilirubin

(Conjugated bilirubin= direct bilirubin

Unconjugated bilirubin= indirect bilirubin)

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What ratio will be over 2 if someone has Alcoholic liver disease

AST
______

ALT

(STop ALcohol)

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When is GGT useful?

When ALP is elevated, it confers liver specificity

2. When AST/ALT is more than 2, it supports diagnosis of alcoholic liver disease 🥂

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What 2 values directly reflect liver function?

Albumin

PT/INR

(Broken liver wont be making clotting factors or albumin)

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Which is more specific to the liver:

AST or ALT?

ALT

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Where are the highest levels of ALT found?

Liver

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

Do normal liver tests mean the liver is normal?

No, it means to repeat it (????) This is one of her “pearls” I’m never going to mayo

What should you do if you get elevated LFTs but your patient has no symptoms?

Repeat the test but with the patient fasting

If just ONE of your values is elevated and everything else is normal, what should that make you suspect?

Something OTHER than the liver is messed up

What is a non-hepatic source of a high bilirubin?

RBCs | Hemolysis, bleeding etc

What is a non-hepatic source of high AST?

Muscle, heart, kidney, brain

What is a non-liver source of ALT?

Muscle, heart, kidneys

What is a non-liver source of LDH?

Literally everything Its in your whole body. Tissue death would cause elevated LDH

What is a non liver source of ALP?

Bone, placenta, intestines

What are some examples of drugs that can cause DILI? | Drug induced liver injury

Ephedra Kava Vitamin A García is Tylenol Statins Antifungals Antibiotics Anti-TB drugs NSAIDs Tegretol Just read through it

What kinds of things should be on your differential if you get elevated liver tests?

Hepatitis Alcoholic liver disease HIV, CMV, HSV, mono, measles, rhabdo Medications Hemochromatosis Gilberts syndrome Celiac Alpha-1 anti trypsin deficiency Wilson’s disease Hypothyroidism Adrenal insufficientcy IM SORRY I DONT KNOW WHAT IS IMPORTNAT

If you have muscle injury/disorders, what labs will be elevated?

CPK Aldolase

What kind of hepatitis will have the highest AST and ALT values?

Acute Hep A

What kind of an event will cause the HIGHEST AST and ALT values?

Ischemia=liver shock

Which will have higher AST and ALT values: chronic or acute hepatitis

Acute

Is someone has a mildly elevated AST ~and~ ALT, what can cause that?

Fatty liver EtOH Chronic hepatitis Medication effect

If someone has an elevated AST only, what could cause that?

Alcoholic hepatitis (AST/ALT will go up.... this is the STop ALcohol thing) Rhabdo and heart stuff

With non-alcoholic fatty liver (NAFLD), is your liver inflamed?

No. Fat is there but not causing problems

What is non-alcoholic steatohepatitis?

Your liver is fatty, it’s inflamed, and it’s going to scar/progress to cirrhosis or failure

Which is worse and is more likely to progress to fibrosis/cirrhosis: Non-alcoholic fatty liver or non-alcoholic steatohepatitis?

Non -alcoholic steatohepatatis

What is the strongest predictor of NASH (nonalcoholic steatohepatits)

Metabolic syndrome

What labs will be elevated with NASH?

AST and ALT will be mildly elevated

How do you manage NASH?

Lifestyle mods Statins Transplant if it progresses to cirrhosis

How do you screen for liver cancer?

AFP- alfa fetoprotein (liver cancer tumor marker) Ultrasound

What labs will be elevated with hereditary hemochromatosis?

AST ALT Transferrin saturation Ferritin

How do you treat hereditary hemochromatosis?

Prevent cirrhosis basically Drain some blood sometimes Hepataitis A and B immunixations \ (Avoid vitamin C, alcohol, iron supplements, uncooked seafood)

What 2 autoimmune liver diseases predominantly affect women?

Primary biliary cirrhosis (PBC) Autoimmune hepatitis (AIH)

“Primary biliary cirrhosis” (PBC) and “Primary sclerosing cholangitis” (PSC) are both autoimmune attacks on the bile ducts. Which lab will be different in each?

AMA (Anti-mitochondrial antibody) will be: POSITIVE in PBC NEGATIVE in PSC

What type of liver disease are primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC)?

Cholestatic

How do you confirm autoimmune hepatitis?

Liver biopsy

Which immunoglobulin will be high in autoimmune hepatits?

IgG

Which immunoglobulin is high in primary biliary cirrhosis?

IgM

What should you suspect in a young non-smoker with emphysema, or when a kid has cirrrhossi?

Alpha-1 antitrypsin deficiency

What is alpha-1 antitrypsin deficiency?

Genetic deficiency in alpha-1 AT, a molecule that protects against tissue injury, ESPECIALLY in the lungs and liver.

What labs will be abnormal in alpha-1 antitrypsin deficiency?

AST/ALT alpha-1 antitrypsin will be low lol

What is Wilson’s disease?

A rare disorder of copper metabolism...copper will accumulate in the liver and kill it

What disease is a Kaiser-Fleisher ring associated with? | Its that thing in the eye

Wilson’s disease

What labs will be abnormal in Wilson’s disease?

AST and ALT high ALP low Ceruloplasmin low 24 hr urine copper high

How do you get acute hepatits A

💩 | A for asses

What labs will be elevated in Hepatitis A?

AST/ALT EXTREMELY HIGH ALP high Bilirubin high +Anti-HAV IgM is diagnostic duh

Does hepatitis A ever become chronic?

NO!!!! NO!!!! NO!!!!!!

At what point during someone’s hepatitis A adventure will they have a positive Anti-HAV IgM?

At the onset of symptoms

How is hepatitis B transmitted?

Blood (B for blood) (Sexual contact, perinatal transmission, etc)

Do most adults progress from acute Hep B to chronic Hep B?

What labs will be high in acute hepatitis B?

Bilirubin ALP AST ALT (VERY HIGH)

Your patient is a 25 year old gay man who partied in Vegas 2 months ago. While there, he got tattoos in a crackheads living room, shared heroin needles with hookers, and went to condomless orgies with other men. If you had to guess, what kind of hepatitis do you think he has?

You’d THINK it was B because of all the blood mixing, but it’s actually Hep A befcuase he licked a lot of ASSES!!!! 💩

Who is most likely to develop chronic Hep B from an acute infection?

The younger you are the more likely you are to progress to chronic

Do babies catch Hep B easily

Yes

“Hepatitis B Surface antigen” (HBsAg) will be positive in patients who have chronic AND acute Hep B. What lab will let you distinguish between the two?

IgM anti-HBc will be positive in an ACUTE exposure

What are the risk factors for Hep C?

Born 1945-1965 (bb boomers) IVDU Hemodialysis Clotting factor recipient before 1987 Transfusion/transplant before 1992 Piercing/tattoo in unregulated setting Snorting drugs Healthcare workers Prisoners High risk sex acts HIV infection SORRY

Which kind of hepatitis spreads from mom to baby the easiest?

Hep B | Hep C rare to spread to baby

How can you tell the difference between Acute and chronic hep C?

Acute: AST and ALT in the 100’s Bilirubin high Chronic: Asymptomatic AST and ALT less than 100

If you test your patient for Hep C, and the HCV-antibody is nonreactive, what do you need to do?

Nothing If you suspect a recent exposure, test for HCV RNA

True or false: For patients who have been exposed within the last 6 moths or immunocompromised, testing for HCV RNA should always be considered

True

What will the AST/ALT ratio be like for acute hepatitis?

Over 5!!! acute hepatits can be caused by: ``` Acute hepataits A B C D E G EBV CMV Acute alcoholic DILI Mushroom ingestion Acute hep of pregnancy Shock liver ```

In chronic problems, like Wilsons, what will you expect the AST/ALT ratio to be?

Less than 5

ALP dominates in what kind of liver disease?

Cholestatic

AST and ALT predominate in what kind of liver disease?

Hepatocellular

What are some ecamples of chronic issues?

Chronic alcoholic hep Chronic hep b or c DILI (can be acute or chronic) Celiac HCC/Metastatic CA (HCC=hepatocellular cancer) Fatty liver Hemochromatosis Autoimmune hepatitis Alpha-1 anti-trypsin deficient Wilson’s disease

Liver Tests/ Hepatitis Serology Flashcards

(84 cards)