2. DSA Elevated Liver Enzymes

Question 1

The following are associated with what cell injury?
AST
ALT
LDH

Answer 1

Hepatocyte Integrity

Question 2

The following are associated with what cell injury?
Bilirubin
Total: unconjugated + conjugated
Direct
Urine bilirubin
Alkaline Phosphatase
Serum GGT

Answer 2

Biliary Exretory Function

Question 3

The following are associated with what cell injury?
Serum Albumin
PT/PTT
Serum Ammonia

Answer 3

Hepatocyte TRUE liver function

Question 4

Hepatocellular injury is primary injury to the hepatocytes where primary AST/ALT elevation is seen rather than ALP/ bilirubin elevation, with which being MORE specific for liver injury?

Answer 4

ALT more than AST

Question 5

Cholestatic injury is injury to the bile ducts, primarily will see alkaline phosphatase and bilirubin elevation due to failure of bile to reach duodenum, causing jaundice and pruritiis - no signs of hepatocellular necrosis, what else is see to make sure ALP is from liver cause?

Answer 5

GGT elevated = liver cause

Normal = bone cause

Question 6

What is higher in infancy due to bone growth?

Answer 6

Alk Phos

Question 7

Coagulations factors are checked using INR, if patient is above 1 and is not on medication like coumadin/warfarin, could be liver disease. It is the single best acute measure of hepatic synthetic function* , what prolongation may be from malabsorption distinguished from hepatic disease by rapid and complete response to vit K replacement?

Answer 7

PT prolongation

Question 8

What decrease is seen in patients with chronic liver disease, the degree of hypo correlating with the severity of dysfunction?

Answer 8

Albumin/Hypoalbuminemia

Question 9

What is checked for function of the liver for the presence or degree of acute encephalopathy?

Answer 9

Ammonia

Question 10

If AST, ALT is higher than ALP, hepatocellular disease is expected, if ALP is higher than AST/ALT, or elevated ALP with normal AST/ALT, then what can be expected?

Answer 10

Cholestatic disease

Question 11

Liver dz causes elevation of both direct and indirect bilirubin, often with elevated liver enzyme tests. What causes normal direct bilirubin, but elevated indirect, associated with anemia, increased reticulocyte count but NORMAL liver enzymes (LDH may be elevated)?

Answer 11

hemolysis

Question 12

What is associated with normal direct bilirubin, elevated indirect or unconjugated bilirubin and associated with nor abnormal liver tests, no anemia, onset is late adolescence, fasting makes bilirubin rise?

Answer 12

Gilbert’ Syndrome

Question 13

Other associations with elevated levels:
Bilirubin: red blood cells: hemolysis/hematoma/GI bleed
AST: skeletal muscle, cardiac muscle, RBC
ALT: skeletal muscle, cardiac muscle, kidneys
LDH: heart, RBC (hemolysis)
Alk Phos: Bone, first trimester placenta, kidneys, intestines

Answer 13

MEOW