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General Medicine & Family Medicine > Chemical Pathology/ Abnormal Liver Function Tests > Flashcards

Chemical Pathology/ Abnormal Liver Function Tests Flashcards

1
Q

What are the most common causes of transaminase elevation?

A
  • viral hepatitis
  • alcohol-induced liver damage
  • nonalcoholic steatohepatitis (NASH)
  • hepatotoxic medications/herbs
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2
Q

Name some physical signs that may indicate that elevated transaminase elevations are due to chronic liver disease or cirrhosis. (8)

A
  • gynecomastia
  • testicular atrophy
  • spider nevi
  • asterixis
  • finger nail clubbing
  • ascites
  • organomegaly
  • palmar erythema
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3
Q

What liver function test is most specific for hepatocyte injury?

A

Alanine transaminase (ALT)

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4
Q

What causes of transaminase elevation result in an AST/ALT ratio >2?

A

Alcoholism and Wilson disease

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5
Q

What liver function tests are markers of cholestasis?

A
  • ALP
  • GGT
  • serum bilirubin
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6
Q

What tests are markers of liver function and protein synthesis?

A

Serum albumin and prothrombin time

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7
Q

The following lab result would suggest that a patient’s elevated transaminases are due to what disease?

  • High ferritin, high serum iron, and low TIBC
A

Hemochromatosis

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8
Q

The following lab result would suggest that a patient’s elevated transaminases are due to what disease?

-Low ceruloplasmin

A

Wilson Disease

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9
Q

The following lab result would suggest that a patient’s elevated transaminases are due to what disease?

High antinuclear antibody and anti-smooth muscle antibody

A

Autoimmune hepatitis

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10
Q

The following lab result would suggest that a patient’s elevated transaminases are due to what disease?

Low Alpha-1-antitrypsin

A

Alpha-1-antitrypsin deficiency

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11
Q

What patient characteristics and/or comorbid diseases would make you suspect NASH?

A
  • obesity
  • hyperlipidemia (especially hypertriglyceridemia)
  • diabetes mellitus
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12
Q

If a workup for elevated transaminases yields no specific cause and the patient profile does not fit a diagnosis of NASH, what is the next step in management?

A

Referral to gastroenterologist for liver biopsy

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13
Q

In the United States, what over-the-counter medication is the most common cause of drug-related acute liver failure?

A

Acetaminophen

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14
Q

For most adults, what is the maximum safe dose (g/day) of acetaminophen?

A

4 g/day

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15
Q

What antibiotic is the most common drug cause of acute hepatitis?

A

Amoxicillin-clavulanic acid (Augmentin)

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16
Q

What medications (or classes of medications) used to treat diabetes may cause hepatotoxicity?

A
  • Acarbose
  • Pioglitazone
  • Sulfonylureas
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17
Q

What medications (or classes of medications) used to treat hyperlipidemia may cause hepatotoxicity?

A

Statins, nicotinic acid

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18
Q

Lab values showing an AST to ALT ratio greater than 2:1, hypoalbuminemia, markedly elevated GGT, elevated alkaline phosphatase, and macrocytic anemia are suggestive of what type of liver disease?

A

Alcoholic hepatitis

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19
Q

What vitamin supplements should be given to patients who consume alcohol regularly?

A

Folate and thiamine

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20
Q

What are the symptoms of hepatitis A?

A

Early signs: fever, malaise, headache, decreased appetite, nausea and vomiting, abdominal pain, diarrhea

Later signs: jaundice, tender hepatosplenomegaly, pale stool

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21
Q

What is the mode of transmission of hepatitis A?

A
  • Fecal-oral (affected person may shed virus in stool for months, even when asymptomatic)
  • food and water sources may be contaminated and produce epidemics
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22
Q

What is the incubation period of hepatitis A?

A

15-45 days

23
Q

Children with hepatitis A are more often asymptomatic while adults are more often symptomatic. True or false?

A

True

24
Q

It is possible for a hepatitis A infection to last several months; however, there is no chronic carrier state. True or false?

A

True

25
Q

How can hepatitis A be prevented?

A
  • Meticulous hygiene
  • hepatitis A vaccine
  • hepatitis A immunoglobulin (only for travelers to endemic areas and for those with known close contact to an infected individual)
26
Q

How is hepatitis B virus (HBV) transmitted?

A
  • Through infected blood (eg, drug use, tattoos, healthcare accidents)
  • saliva
  • semen, and vaginal secretions (Note: while sexual transmission is common, perinatal exposure can infect infants.)
27
Q

What is the incubation period of hepatitis B?

A

60-90 days

28
Q

What percent of those infected with HBV will develop chronic liver disease?

A

10%

29
Q

Chronic hepatitis B infection can lead to what complications?

A

Cirrhosis and hepatocellular carcinoma

30
Q

Which virological marker is the first to emerge after infection with HBV?

A

Hepatitis B surface antigen (HBsAg)

31
Q

Which virological marker correlates with the infectivity of HBV?

A

Hepatitis B e antigen (HBeAg)

32
Q

Which virological marker allows you to distinguish between recent and chronic infection with HBV?

A

Hepatitis B core antibody (HBcAb)

33
Q

Is HBcAb IgM positive in recent or chronic infection?

A

Recent infection

34
Q

Is HBcAb IgG positive in recent or chronic infection?

A

Chronic infection

35
Q

Interpret these Hepatitis B virological marker panels. HBsAg negative, anti-HBsAb positive, and anti-HBc IgG positive

A

Past HBV exposure

36
Q

Interpret: HBsAg negative and anti-HBsAb positive

A

Prior immunization

37
Q

Interpret: HBsAg positive, anti-HBsAb negative, and anti-HBc IgM positive

A

Acute hepatitis

38
Q

Intepret: HBsAg positive and anti-HBc IgG positive

A

Chronic hepatitis

39
Q

How does an acute infection with HBV present?

A
  • Viral prodrome 4-12 weeks after infection
  • then with jaundice
  • scleral icterus
  • enlarged liver
  • right upper quadrant pain
40
Q

Which laboratory tests may appear elevated during acute infection with HBV?

A
  • aspartate transaminase (AST)
  • alanine transaminase (ALT)
  • bilirubin
  • alkaline phosphatase
  • lymphocytes (especially atypical)
  • prothrombin time (PT)
41
Q

in the United States, what disease is the most common cause of liver transplant?

A

Chronic hepatitis C

42
Q

What is the average incubation period of hepatitis C?

A

7-8 weeks

43
Q

What is the mode of transmission of hepatitis C?

A
  • Most commonly through exposure of infected blood (IV drug use
    • blood transfusion
    • tattooing
    • organ transplant, etc)
  • although exposure by other body fluids is possible
44
Q

What percent of adults with acute hepatitis C develop chronic hepatitis C infection?

A

70% (even more develop persistent infection)

45
Q

What is the initial test for diagnosis of hepatitis C?

A

Enzyme immunoassay (EIA) for anti-HCV

46
Q

Why should patients with hepatitis C avoid alcohol? (2)

A
  • Alcohol consumption increases the severity and rate of progression of liver disease.
  • Alcohol also decreases the response to treatment (interferon therapy).
47
Q

What complications may arise from chronic hepatitis C infection?

A

Cirrhosis and hepatocellular carcinoma

48
Q

About what fraction of US patients have nonalcoholic steatohepatitis (NASH)?

A

Almost 1 in 4

49
Q

Although NASH is usually asymptomatic, with what signs may it present?

A
  • Fatigue
  • malaise
  • right upper quadrant pain
50
Q

What percentage of patients with NASH has hepatomegaly?

A

50%

51
Q

How much do transaminase levels increase when a patient has NASH?

A

About 2-3 times normal levels (alkaline phosphates and GGT may also be elevated)

52
Q

What is the preferred first-line and most cost-effective imaging modality for diagnosing NASH?

A

Right upper quadrant ultrasound (shows fatty infiltrates although does not determine severity of disease)

53
Q

How is NASH managed?(4)

A
  • Weight reduction, alcohol restriction, lipid and glucose control

General Medicine & Family Medicine (150 decks)

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