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Tri 6 - Clinical Dx (Tom) > 15. Liver > Flashcards

15. Liver Flashcards

1
Q

Found primarily in liver, heart, kidney, pancreas, and muscles. Elevated with significant tissue damage

A

AST (7-40)

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2
Q

Increased levels primarily in hepatocellular necrosis, liver damage, myocardial infarction, and to a lesser extent kidney infection.

A

ALT (5-36)

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3
Q

Increases are usually found in cellular death and/or leakage from cell. Can confirm myocardial or pulmonary infarction. By itself usually means hemolysis.

A

LDH (5-150)

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4
Q

Increases in biliary obstruction. Also present in blastic bone disease, pregnancy, or skeletal growth.

A

Alkaline phosphatase (30-120)

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5
Q

May be elevated in liver disease, particularly alcohol abuse, occult bile duct obstruction, cholangitis, and drug abuse.

A

Gama-Glutamyl Transpeptidase (GGT) (0-30)

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6
Q

Elevated in liver disease, hemolytic anemia, and toxic effects to some drugs

A

total bilibrubin (.2-1.5)

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7
Q

unconjugated bilirubin is transported with

A

ligandin or z protein

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8
Q

unconjugated bilirubin is conjugated to

A

glucouronic acid

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9
Q

conjugated bilirubin in the SI is converted to urobilinogen by

A

bacterial proteases

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10
Q

90% of urobilinogen is excreted in

A

feces

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11
Q

major cause of prehepatic jaundice

A

RBC hemolysis

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12
Q

major cause of hepatic jaundice

A

Viral hep, drugs, cirrhosis, and tumors

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13
Q

major cause of posthepatic jaundice

A

Gallstones or cancer of bile ducts

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14
Q

weakness, dark urine, anemia, icterus, and splenomegaly

A

hemolytic jaundice

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15
Q
  • Increased UB without bilirubinuria
  • increased fecal and urine urobilinogen
  • hemolytic anemia
  • hemoglobinuria
  • increased reticulocytes
A

hemolytic jaundice

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16
Q

hemoglobinuria seen in

A

acute intravascular hemolysis

17
Q

urinary changes in hemolytic jaundice

A

absent bilirubin and increased/normal urobilinogen

18
Q

fecal changes in hemolytic jaundice

A

normal stercobilinogen

19
Q

due to intra/extra hepatic obstruction of bile ducts

A

obstructive jaundice

20
Q

Hepatitis, PBC, and drugs can cause

A

intrahepatic jaundice

21
Q

Stones, stricture, inflammation, and tumors can cause

A

extra hepatic biliary obstruction

22
Q

examples of impaire/absent hepatic conjugation of bilirubin leading to hepatic jaundice

A
  • decreased GT activity (Gilberts) can cause

- hereditary absence/def of UDPGT (Grigler-Najjar synd)

23
Q

hereditary absence/def of UDPGT

A

Grigler-Najjar synd

24
Q

decreased GT activity

A

Gilberts

25
Q

familial or hereditary disorders causing hepatic jaundice

A
  • Dubin-Johnson synd

- rotor synd

26
Q

acquired disorders that cause hepatic jaundice

A
  • hepatocellular necrosis

- intrahepatic cholestasis

27
Q

intrahepatic-liver cell damage/blockage of bile canaliculi will cause

A

obstructive jaundice

28
Q

examples of intrahepatic-liver cell damage/blockage of bile canaliculi

A
  • drugs/toxins
  • Dubin-Johnson synd
  • E or preg
  • hep/virus
  • tumors
  • intrahepatic biliary hypo
  • primary biliary cirrhosis
29
Q

weakness, low appetite, hepatomegaly, palmar erythema, spider angioma

A

symptoms of hepatic jaundice

30
Q
  • normal liver function
  • elevated CB and UCB
  • elevated bilirubinuria
A

lab findings of hepatic juandice

31
Q

examples of extrahepatic/obstructive bile ducts causing obstructive jaundice

A
  • tumor compression/obstruction
  • choledochal cyst
  • extrahepatic biliary atresia
  • intraluminal stones
  • stenosis/postop
32
Q
  • pain
  • fever from ascending cholangitis
  • palpabe/tender gallbladder
  • enlarged/smooth liver
A

cholestasis

33
Q
  • increased serum bilirubin, bilirubinuria, ALP, and cholesterol
  • decreased or absent feceal urobilinogen
A

obstructive jaundice

34
Q

increased bilirubin and reduced/absent urobilinogen

A

urinary changes from extrahepatic obsructive jaundice

35
Q

reduced/absent faecal

A

faecal changes from extrahepatic obsructive jaundice

36
Q

proportion of conj bilirubin to the total raised bilirubin that is more suggestive of hepatic than posthepatic jaundice

A

20-40% of total

37
Q

proportion of conj bilirubin to the total raised bilirubin that is more suggestive of posthepatic than hepatic jaundice

A

over 50% of total

38
Q

proportion of conj bilirubin to the total raised bilirubin that is more suggestive of juandice secondary to haemolysis or constitutional (Gilberts, Crigler-Najjar)

A

less than 20%

Tri 6 - Clinical Dx (Tom) (15 decks)

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