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GI > 10. Interpretation of Liver Biochemisty > Flashcards

10. Interpretation of Liver Biochemisty Flashcards

1
Q

What does GGT stand for?

A

Gamma glutamyl transpeptidase

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2
Q

Where are AST and ALT located?

A

Heptocytes

AST: cytoplasm and mitochondria

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3
Q

Which is more specific to the liver, ALT or AST?

A

ALT more specific to the liver

**skeletal and myocardial muscle injury cause increased AST, increased ALT to a lesser extent

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4
Q

Where is alkaline phosphatase localized in the liver?

A

Surface of liver cells that are adjacent to the bile canaliculi

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5
Q

Where are the four places that alkaline phosphotase is located?

A

Liver
Bone
Intestine
Placenta

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6
Q

If not sure that ALP elevation is attributed to the intestine, what should be checked?

A
  1. GGT
  2. Isoenzymes
  3. 5’ nucleotidase
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7
Q

Liver cells conjugate indirect bilirubin through the action of:

A

UDP-glucuronyltransferase

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8
Q

What type of bilirubin will be increased in Hemolysis and Gilbert’s?

A

Indirect/unconjugated

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9
Q

What are two good indicators of liver synthetic function?

A

Albumin

INR

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10
Q

Replacement of ____ corrects INR due to nutritional deficiency but not due to hepatic dysfunction

A

Vitamin K

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11
Q

What type of bilirubin is increased in liver injury, bile duct problems, and rare metabolic problems?

A

Direct/conjugated

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12
Q

Normal ranges for AST/ALT

A

AST: 10-45 U/L
ALT: 8-40 U/L

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13
Q

Normal ranges of alkaline phosphatase

A

40-129 U/L

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14
Q

Normal ranges of total and direct bilirubin

A

Total: 0.2-1 mg/dL
Direct: 0-0.2 mg/dL

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15
Q

Normal range for INR

A

0.9-1.3

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16
Q

Normal range for albumin

A

3.5-5 g/dL

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17
Q

Normal range for GGT

A

0-50 U/L

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18
Q

What are hepatocellular injuries that will raise ALT and AST?

A 
Alcohol
Viral hepatitis
AI hepatitis 
Hemochromatosis
Wilson's disease 
Fatty liver
Alpha-1 antitrypsin deficiency
Medications
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19
Q

What are cholestatic/obstructive issues that lead to increase in ALP?

A

Stones
Primary biliary cirrhosis
Primary sclerosing cholangitis
Medications

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20
Q

What lab changes will be seen with infiltrative liver disease?

A

ALP elevation

Occasional bilirubin elevation

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21
Q

What are three exs of infiltrative liver disease?

A

Amyloid
Sarcoid
Tumors

22
Q

When is GGT most useful?

A

Determining the source of alkaline phosphate elevation (bone vs liver)

23
Q

What are the problems that lead to an ALT over 500?

A 
Hepatitis A
Hepatitis B
Autoimmune hepatitis 
Medications 
Ischemia
**Sometimes stone passage
24
Q

Alcoholic liver disease rarely results in transaminases over

A

300

25
Q

AST:ALT over ____ is suggestive of alcoholic liver disease

A

2:1

26
Q

What is the best way to determine if the liver problem is acute or chronic?

A

INR

27
Q

Serum enzyme tests can be grouped into two categories based on the cause of elevated activity:

A
  1. Hepatocellular damage

2. Cholestasis

28
Q

What is cholestasis?

A

Any condition in which the flow of bile to the liver is inhibited or blocked

29
Q

What is the role of ALT and AST?

A

Catabolize glucogenic amino acids

If you are in starvation mode, you can breaking down protein to feed into the TCA cycle

30
Q

What are the two isoforms of AST?

A

GOT1: cytoplasmic
GOT2: mitochondrial

31
Q

What do both GOT1 and GOT2 require as a cofactor?

A 
Pyridoxal phosphate (PLP) 
**this is AST/SGOT
32
Q

What is the tissue distribution of AST/SGOT?

A

BROAD: liver, cardiac muscle, skeletal muscle, kidney, brain, pancreas, lung. leukocytes

33
Q

What isoform of AST is resposible for 80% of the activity in human liver?

A

GOT2 (mitochondrial form)

34
Q

What is the other name for ALT?

A

SGPT (serum glutamic pyruvic transaminase)

35
Q

WHat is the cofactor for ALT/SGPT?

A

Pyridoxyl phosphate (PLP)

36
Q

What is the tissue distribution of ALT/SGPT?

A

Mostly found in the liver

37
Q

ALT converts alanine and alpha ketoglutaric acid to:

A

L-glutamic acid

Pyruvate

38
Q

Elevated AST and ALT are NOT specific for hepatobiliary disorders, also found in patients with:

A

Severe cardiac and skeletal muscle damage

39
Q

Which transaminase is more often increased in patients with MI?

A

AST

40
Q

Why is ALT lower than AST in alcoholic hepatitis?

A

Liver ALT is more sensitive to PLP deficiency than the liver

41
Q

What is a membrane-bound metaloenzyme that catalyzes the hydrolysis of phosphomonoesters at an alkaline pH?

A

Alkaline phosphatase

42
Q

Where are the four isozymes of ALP found?

A

Non-specific liver/bone/kidney
Intestinal
Placental
Germ-cell

43
Q

ELevated serum ___ is seen in disorders of bone with increased osteoblastic activity, and with normal growth and pregnancy

A

ALP

44
Q

What is 4’ nucleotidase involved in?

A

Purin catabolism
Hydrolysis of nucleotides like adenosine 5’ phosphate in which the phosphate is attached to the 5’ position of the pentose ring

45
Q

What is the tissue distribution of 5’ nucleotidase?

A

Liver, intestines, brain, heart, blood vessels, pancrease

**in the liver, the enzyme is associated primarily with canalicular and sinusoidal plasma membranes

46
Q

In contrast to alkaline phosphatase, 5’ nucleotidase is not elevated in:

A

Bone disease or pregnancy

47
Q

What is the role of GGT (gamma glutamyl transpeptidase)?

A

Catalyzes the transfer of the gamma glutamyl group for the gamma glutamyl containing peptides such as glutathione to other peptides, amino acids, and water
**amino acid transport across membranes, hydrolysis of glutathione/glutathione homeostasis

48
Q

What is the tissue distribution of GGT?

A

Broad: liver, kidney, brain, heart, spleen, and pancreas

49
Q

Unlike alkaline phosphatase, GGT is NOT elevated in:

A

Bone disease

50
Q

Certain meds like ___ and ___ along with ___ abuse can elevate levels of GGT?

A

Barbituates and anti-convulsants

Alcohol abuse: increases hepatic microsomal GGT

GI (28 decks)

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