Chemistry 2 (Hepatic) Flashcards
AST is present in
Cardiac>liver>sk. musc>kidney>brain>lung>panc
which is more specific for liver (AST or ALT)
ALT (in liver and kindey)
which is 80% mitochondrial and 20% cytoplasmic
AST
which has marked diurnal variation
ALT
Fast LDH isoenzymes are, and are seen in
LD1>2
heart, RBC, kidney
In adults, ___ tends to be slightly higher than ___
ALT>AST
Slow LDH isoenzymes are, and are found in
LD4&5
liver and skeletal muscle
LDH isoenzymes that is “dire finding”
LD6
hepatic vascular insufficiency
order of normal [LDH] by isotype
2>1>3>4>5
what is “flipped LD ratio” and when is it seen
LD1>LD2
acute MI, hemolysis, renal infarct
[LDH] order in normal CSF
1>2>3>4>5
where is acid phosphatase found
prostate
RBCs
bone
What separates RBC acid phosphatase from others
susceptible to inhibition by 2% formaldehyde
resistant to inhibition by tartrate (TRAP of hairy cell)
Sources of Alkaline phosphatase
bone, bile ducts, intestine, placenta
Alk phos decreased in
hypophosphatemia
malnutrition
alk phos isoenzyme that is inactivated by hear or urea
bone (100%)
biliary (50%)
most sensitive marker of hepatic metastases
biliary alk phos
bone alk phos produced by osto___
osteoblasts (during bone formation)
Regan isoenzyme
seen in 5% of pts with CA
identical to placental alk phos
blood groups that are particularly susceptible to false increase in alk phos when not fasting
Lewis+ B or O secretors
mild alk phos increase
pregnancy
CHF
hyperthryroidsm
NSAIDs
most sentitive marker to biliary injury
GGT
Toxins that increase GGT
warfarin, barbiturates, Dilantin, valproate, methotrexate, EtOH
5’-nucleotidase found in, and increased in
biliary epithelium
cholestasis
transport requirements for ammonia
fresh sample, chilled during transport, no hemolysis
which bilirubin type appears in urine
conjugated only
Unconjugated hyperbilirubinemia seen n
Crigler-Najjar
Gilbert
Hemolysis
cirrhosis
Conjugated hyperbilirubinemia seen in
Dubin-Johnson hepatitis estrogen obstruction Rotor
what is delta-bilirubin
conjugated bilirubin attached to albumin
can’t be excreted so lasts a long time
T1/2 of Factor 7
12 hr
Vit K deficiency can be caused by
impaired bile secretion (bile salts needed for K+ absorption
Immunoglobulins in autoimmune hepatitis
polyclonal IgG
Immunoglobulins in primary biliary cirrhosis
polyclonal IgM
A/G ratio in liver disease
<1.0
physiologic and breast milk jaundice are both___
unconjugated
2 inherited unconjugated bilirubinemias
Crigler-Najjar
Gilbert
2 inherited conjugated bilirubinemias
Dubin-Johnson
Rotor
Physiologic jaundice seen at ____ days of life, rises at ____
2-3days
5-6mg/dL
Concerning signs in neonatal jaundice
appears within ___, rising beyond ____, persisting beyond___, total >____, single day increase>___, conjugated >___
appear within 24hr rising beyond 1 wk persisting beyond 10d total > 12mg/dL single day increase >5mg/dL conjugated >2 mg/dL
exchange transfusion when bili
> 20mg/dL
phototherapy not useful for ___
conjugated hyperbili
Jaundice in 1st 24hr ddx
HDFN, hemorrhage, sepsis, TORCH
Jaundice after 1st week ddx
breast milk jaundice, extrahepatic biliary atresia, CF, Alagille
AST/ALT ratio in toxic/ischemic/Etoh vs Viral
toxic >2
viral <1
best indicator of prognosis in acute hepatic injury
PT longer than 4s
