15. Liver

Question 1

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

Answer 1

AST (7-40)

Question 2

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

Answer 2

ALT (5-36)

Question 3

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

Answer 3

LDH (5-150)

Question 4

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

Answer 4

Alkaline phosphatase (30-120)

Question 5

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

Answer 5

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

Question 6

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

Answer 6

total bilibrubin (.2-1.5)

Question 7

unconjugated bilirubin is transported with

Answer 7

ligandin or z protein

Question 8

unconjugated bilirubin is conjugated to

Answer 8

glucouronic acid

Question 9

conjugated bilirubin in the SI is converted to urobilinogen by

Answer 9

bacterial proteases

Question 10

90% of urobilinogen is excreted in

Answer 10

feces

Question 11

major cause of prehepatic jaundice

Answer 11

RBC hemolysis

Question 12

major cause of hepatic jaundice

Answer 12

Viral hep, drugs, cirrhosis, and tumors

Question 13

major cause of posthepatic jaundice

Answer 13

Gallstones or cancer of bile ducts

Question 14

weakness, dark urine, anemia, icterus, and splenomegaly

Answer 14

hemolytic jaundice

Question 15

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

Answer 15

hemolytic jaundice

Question 16

hemoglobinuria seen in

Answer 16

acute intravascular hemolysis

Question 17

urinary changes in hemolytic jaundice

Answer 17

absent bilirubin and increased/normal urobilinogen

Question 18

fecal changes in hemolytic jaundice

Answer 18

normal stercobilinogen

Question 19

due to intra/extra hepatic obstruction of bile ducts

Answer 19

obstructive jaundice

Question 20

Hepatitis, PBC, and drugs can cause

Answer 20

intrahepatic jaundice

Question 21

Stones, stricture, inflammation, and tumors can cause

Answer 21

extra hepatic biliary obstruction

Question 22

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

Answer 22

• decreased GT activity (Gilberts) can cause

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

Question 23

hereditary absence/def of UDPGT

Answer 23

Grigler-Najjar synd

Question 24

decreased GT activity

Answer 24

Gilberts

Question 25

familial or hereditary disorders causing hepatic jaundice

Answer 25

- Dubin-Johnson synd | - rotor synd

Question 26

acquired disorders that cause hepatic jaundice

Answer 26

- hepatocellular necrosis | - intrahepatic cholestasis

Question 27

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

Answer 27

obstructive jaundice

Question 28

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

Answer 28

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

Question 29

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

Answer 29

symptoms of hepatic jaundice

Question 30

- normal liver function - elevated CB and UCB - elevated bilirubinuria

Answer 30

lab findings of hepatic juandice

Question 31

examples of extrahepatic/obstructive bile ducts causing obstructive jaundice

Answer 31

- tumor compression/obstruction - choledochal cyst - extrahepatic biliary atresia - intraluminal stones - stenosis/postop

Question 32

- pain - fever from ascending cholangitis - palpabe/tender gallbladder - enlarged/smooth liver

Answer 32

cholestasis

Question 33

- increased serum bilirubin, bilirubinuria, ALP, and cholesterol - decreased or absent feceal urobilinogen

Answer 33

obstructive jaundice

Question 34

increased bilirubin and reduced/absent urobilinogen

Answer 34

urinary changes from extrahepatic obsructive jaundice

Question 35

reduced/absent faecal

Answer 35

faecal changes from extrahepatic obsructive jaundice

Question 36

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

Answer 36

20-40% of total

Question 37

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

Answer 37

over 50% of total

Question 38

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

Answer 38

less than 20%