Carmen - LFTs

Question 1

Alkaline phosphatase and bilirubin

Answer 1

Abnormal levels can indicate damage to the bile duct. Normal bili = 0-1 mum/dL
Normal Alk phos = 0-122 units/dL
- For alkaline phosphatase, it is usually something in the bile duct which it irritating it. This causes increased secretion of alkaline phosphatase.
- For instance, a common bile duct stone

Question 2

Albumin, Prothrombin time, INR

Answer 2

Markers of chronic disease.

• Albumin is exclusively made in the liver, so it is in association with liver disease. A low level means that the hepatocyte is too sick to make it.
• With regards to prothrombin time/INR, they assess the clotting cascade. Many clotting factors are made in the liver. A lengthening INR/Prothrombin time suggests hepatic failure

Question 3

Amylase/Lipase

Answer 3

• abnormal values indicate pancreatitis. Might be due to a gallstone.
• Amylase - Catalyzes hydrolysis of starches/sugars. Elevated means inflammation in the pancreas
• lipase - Catalyzes lipid hydrolysis cleaves glycerol backbone in TG’s. More specific for pancreatic inflammation.

Question 4

What is supposed to be Greater AST or ALT? In what situations would the other be higher?

Answer 4

ALT is supposed to be higher but if the patient has alcohol related liver disease then AST will be higher.

Question 5

Cholestasis - extrahepatic vs. intrahepatic.

Answer 5

Obstruction of bile flow. It can be extra hepatic, which means it is a tumor, stone, or stricture. Or, it can be intrahepatic, which means that it can be a virus, drug, or deficiency of an enzyme.

Question 6

Endoscopic retrograde cholangiopancreatography

Answer 6

Put a catheter in the sphincter of Oddi.

Question 7

Sphincter of Oddi

Answer 7

Sphincter from the biliary tree to the duodenum

Question 8

Alkaline phosphatase said are found in bone, ovary, kidney, and WBCs in addition to the liver so how do we know if the increase in alkaline phosphatase is due to liver/biliary tree dysfunction?

Answer 8

We look at Gamma Glutamyl Transpeptidase (GGTP)

Question 9

If you had an obstruction of flow somewhere between the bile canalicuuli and the sphincter of Oddi what would the AST/ALT, bili, and Alk phos levels look like?

Answer 9

AST/ALT = low
Bili = high
Alk phos = high

Question 10

AST/ALT

Answer 10

High levels indicates damage Damage to the hepatocyte Because the enzymes will begin to leak into the plasma. Apoptosis occurs, which causes inflammation as well. Normal is 0-40 IU/dL.
- We generally think of levels as low, medium, or high. If they are high we don’t care about slight increases but rather 2x normal, 5x normal and 10x normal.