Chemical Pathology/ Abnormal Liver Function Tests Flashcards
What are the most common causes of transaminase elevation?
- viral hepatitis
- alcohol-induced liver damage
- nonalcoholic steatohepatitis (NASH)
- hepatotoxic medications/herbs
Name some physical signs that may indicate that elevated transaminase elevations are due to chronic liver disease or cirrhosis. (8)
- gynecomastia
- testicular atrophy
- spider nevi
- asterixis
- finger nail clubbing
- ascites
- organomegaly
- palmar erythema
What liver function test is most specific for hepatocyte injury?
Alanine transaminase (ALT)
What causes of transaminase elevation result in an AST/ALT ratio >2?
Alcoholism and Wilson disease
What liver function tests are markers of cholestasis?
- ALP
- GGT
- serum bilirubin
What tests are markers of liver function and protein synthesis?
Serum albumin and prothrombin time
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
Hemochromatosis
The following lab result would suggest that a patient’s elevated transaminases are due to what disease?
-Low ceruloplasmin
Wilson Disease
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
Autoimmune hepatitis
The following lab result would suggest that a patient’s elevated transaminases are due to what disease?
Low Alpha-1-antitrypsin
Alpha-1-antitrypsin deficiency
What patient characteristics and/or comorbid diseases would make you suspect NASH?
- obesity
- hyperlipidemia (especially hypertriglyceridemia)
- diabetes mellitus
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?
Referral to gastroenterologist for liver biopsy
In the United States, what over-the-counter medication is the most common cause of drug-related acute liver failure?
Acetaminophen
For most adults, what is the maximum safe dose (g/day) of acetaminophen?
4 g/day
What antibiotic is the most common drug cause of acute hepatitis?
Amoxicillin-clavulanic acid (Augmentin)
What medications (or classes of medications) used to treat diabetes may cause hepatotoxicity?
- Acarbose
- Pioglitazone
- Sulfonylureas
What medications (or classes of medications) used to treat hyperlipidemia may cause hepatotoxicity?
Statins, nicotinic acid
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?
Alcoholic hepatitis
What vitamin supplements should be given to patients who consume alcohol regularly?
Folate and thiamine
What are the symptoms of hepatitis A?
Early signs: fever, malaise, headache, decreased appetite, nausea and vomiting, abdominal pain, diarrhea
Later signs: jaundice, tender hepatosplenomegaly, pale stool
What is the mode of transmission of hepatitis 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
What is the incubation period of hepatitis A?
15-45 days
Children with hepatitis A are more often asymptomatic while adults are more often symptomatic. True or false?
True
It is possible for a hepatitis A infection to last several months; however, there is no chronic carrier state. True or false?
True
