15.12 Biochemistry: liver enzymes

Question 1

When do we see hydropic swelling?

Answer 1

Severe injury

Question 2

What is membrane blebbing?

Answer 2

Cytoskeleton breaking down but doesn’t rupture, instead blisters

Question 3

What does release of cellular contents indicate?

Answer 3

Cell damage (not necessarily death)

Question 4

Where are small and large enzymes usually taken up?

Answer 4

Small: kidney
Large: MP/liver

Question 5

What are liver enzymes that appear in liver enzyme cytoplasm?

Answer 5

ALT, AST, LD

Question 6

What do we expect to see with liver cell death?

Answer 6

Expect EVERYTHING to appear in blood

Question 7

What does it suggest if we only see ALP and GGT?

Answer 7

Cytoplasm fine but cell membrane is falling apart (in diseases that obstruct biliary tree)

Question 8

What cycle is ALT involved it?

Answer 8

Cori cycle (glucose into pyruvate-lactate)

Question 9

What cycle is AST involved in?

Answer 9

Malate shuffle (mitochondrial energy)

Question 10

What is the difference between ALT and AST?

Answer 10

ALT: cytosol, more liver specific
AST: cytosol and mitochondrial, everywhere

Question 11

What does AST>ALT suggest?

Answer 11

Acute, affecting mitochondria (liver, muscle, WBCs, anywhere)

Question 12

What does ALT>AST suggest?

Answer 12

Chronic/resolving, esp. hepatitis (liver specific) (ALT is larger so takes longer to clear)

Question 13

What do we see in liver enzymes with hep A?

Answer 13

Up to 5000 ALT

Question 14

What do we see with liver enzymes for HBV? (or HCV?)

Answer 14

Acute: 2500-5000 ALT (similar to HAV)
Chronic:

Question 15

What occurs as a result of paracetamol overdose?

Answer 15

Hepatic necrosis

Question 16

What is chronic inflammation of a fatty liver?

Answer 16

Steatohepatitis

Question 17

What could be a diagnosis with a 26yo. female, high AST/ALT?

Answer 17

Liver cell death, glandular fever

Question 18

What is a diagnosis with a patient on Simvistatin with a raised AST?

Answer 18

Nothing wrong! AST can come from anywhere that has mitochondria

Question 19

What does an elevation in ALT suggest in a 21yo. female (opioid addict)

Answer 19

HCV

Question 20

Why would an alcoholic have a GGT of only 61 (but increased ALP, BILI)

Answer 20

End stage of cirrhosis, not enough liver to damage

Question 21

What does GGT increase in (medication)?

Answer 21

Anti-convulsants

Question 22

What would we expect with liver secondaries?

Answer 22

Increased ALP, GGT (mainly blockage, not a lot of liver cell death)