acute GI pt 2

Question 1

AST vs ALT

Answer 1

AST - liver, heart, kidney, RBC
ALT - just liver

ALT more specific for hepatobiliary disease

AST>ALT 2:1 ETOH hepatitis

Question 2

liver synthetic function tests

Answer 2

albumin, INR

Question 3

alk phos

Answer 3

found in liver, bone, intestines, kidney, WBCs, placenta

helpful in detecting biliary tract obstruction

elevated - check ggt

elevated alk phos & ggt - biliary disease
normal alk phos & elevated ggt - ETOH
elevated alk phos & normal ggt - bone disease

Question 4

elevated conjugated bili may indicate

Answer 4

direct hyperbilirubinemia!!!

intrahepatic cholestasis (ESLD, hepatitis, drug induced, TPN)

extra hepatic cholestasis (biliary obstruction)

Question 5

elevated unconjugated bili (indirect) may indicate

Answer 5

increased bill production (hemolysis, reabsorption of hematoma)

impaired uptake or conjugation (CHF, Gilbert’s, Crigler-Najjar)

Question 6

hemochromatosis dx and tx

Answer 6

iron saturation >45%
elevated ferritin
liver biopsy

tx w phlebotomy

Question 7

Gilbert’s disease

Answer 7

elevation of indirect bilirubin

impaired hepatocyte uptake of bilirubin

no tx required

Question 8

NAFLD

Answer 8

nonalcoholic fatty liver disease
most common cause of chronic liver disease in the western world
dx w US
liver biopsy to assess for cirrhosis
hepatic manifestation of metabolic syndrome

supportive tx - reduce RF

Question 9

when to monitor LFTs without diagnostics

Answer 9

recheck in 2-3 months

asymptomatic
no RF for liver disease
pt feels well
liver function well preserved