Clinical Flashcards
What are the 2 aminotransferases found in hepatocytes?
ALT and AST
Which aminotransferase is more specific for liver injury?
ALT
Other than the hepatocyte membrane, where else can u find alkaline phosphate?
bone and placenta
So if u test and find a high alk phos, why must u need to further test?
to see if the increase is from the liver or other tissues
Which test can u do to test for liver alk phos?
Alk phos isoenzyme
How can u test for liver fxn by using an enzyme of intrahepatic biliary ducts that is more specific than alk phos?
GGT
Case: your pt has highly conjugated bile. What could be the 2 etiologies?
hepatocyte dysfxn or impaired bile flow
Case: your pt has lowly conjugated bile. What could be the 2 etiologies?
Hemolysis and resorption of hematomas
Which 4 factors does INR measure the level of, as a part of liver fxn tests?
II, V, VII, X
Factors II, V, VII, and X are also dependent on what vitamin?
Vitamin K
What are the 3 main causes of vitamin K deficiencies?
- taking an antibiotic while fasting
- small bowel mucosal disorders (celiacs)
- severe cholestasis
If you’re missing vitamin K, do u bleed longer or shorter?
Longer.
So to determing if prolonged PT is from vit K deficiency or liver dysfxn, what will be the results of the PT if it is indeed a vitamin K deficiency?
it will normalize once u give 10mg x 3 days of vit K
Which 2 enzymes are elevated in hepatocellular disorders?
ALT + AST
The differentating point between acute and chronic disorders of the liver is before/after what time?
3 months
What are the most common Sx of acute hepatitis?
malaise, anorexia, abd pain, jaundice, AST/ALT > 500 U/L
How much is AST increased vs ALT in alcoholic hepatitis?
AST:ALT > 2:1
In alcoholic hepatitis, what other substance is elevated within the blood?
bilirubin
How much are the aminotransferases increased in chronic hepatitis?
2-5 fold
Jaundice will occur in a patient with a serum bilirubin over what level?
2.5 mg/dL
What Sx suggest biliary obstruction to cause jaundice?
abd pain, fever, or palpable gallbladder
How can u Dx cholestatis?
US
How often should u do a liver US for PHC in a pt with HBV and liver cirrhosis?
6-12 months
IF there is an accidental needle-stick with a pt with HCV, what is the necessary followup testing?
HCVAb and ALT at 4-6 months.
What % of NEONATAL pt’s develop chronic hepatitis in HBV infections?
90%.
What % of adult pt’s develop chronic hepatitis in HBV infections?
5%
During the prolonged immune tolerant phase of chronic HBV infections, what is the ALT levels?
normal
During the HBeAg+ chronic HBV phase of chronic HBV infections, what is the ALT levels?
elevated (its an active infection)
Case: a young female presents to the office with signs of chronic liver disease + amenorrhea. She has a Hx of Hashimoto thyroiditis. What is the most likely Dx?
autoimmune hepatitis
What things will show up on the labs for autoimmune hepatitis?
ANA, SMA, SLAA, LKM Abs
What is the first choice for treatmetn of autoimmune chronic hepatitis?
corticosteroids (prednisone, 30-60mg daily)
Which drug can u give with prednisone so u can lower the dose of the steroid?
azathioprine
Which enzyme is incrased in hepatomas?
α-fetoprotein level
What is the equation for serum-ascitic fluid albumin gradient (SAAG)?
SAAG = [serum albumin] - [ascetic fluid albumin]
A SAAG . 1.1 g/dL indicates what?
portal HTN
What can cause a SAAG of , 1.1g/dL?
ascites from peritoneal carcinomatosis or TB
What are the 2 drugs u can give for the Tx of ascites?
sprionolactone and furosemide
What is the goal (in volume) of fluid loss per day in the Tx of ascites?
1 L/day
This is a bacterial infection of ascetic fluid without an intra-abdominal source of infection.
spontaneous bacterial peritonitis (SBP)
What are the Sx of SBP?
fever, abd pain, and abd tenderness
How do u Dx SBP?
paracentesis and a WBC count and culture
Which antibiotic should u give for the Tx of SBP?
3rd generation cephalosporin
Which antibiotic should u give for the prophylaxis of SBP, typically in cirrhotic pts?
norfloxacin
What 3 things can predispose u to hepatic encephalopathy?
increased dietary protein, constipation, or sedatives.
Which 2 beta blockers can u give to prevent bleeding of esophageal vasices?
nadolol or propranolol
In which patients should u use TIPS?
to control refractory variceal bleeding
Should you Tx pt’s with asymptomatic gallstones?
No
