Clinical DSA 2: Hepatobiliary - Liver Enzymes and Jaundice Flashcards
Types of Liver/Biliary Disease:
Primary injury to hepatocytes
AST/ALT elevation
Hepatocellular liver disease
Types of Liver/Biliary Disease:
Primary injury to bile ducts
Alk phos and Bilirubin elevation
Cholestatic liver disease
ALT or AST is a more specific measure of liver injury
ALT
AST is also found in striated muscle and other organs (heart)
AST/ALT in ethanol induced liver injury
AST>ALT (2:1) with modest increases in both
Elevation of what liver enzyme is seen normally in childhood or pregnancy, or pathologically in liver disease (cholestatic) and bone disease?
Alk phos
In a patient with elevated Alk phos, measurements of GGT will be _____ in liver disease and _____ in bone disease
Elevated Alk phos with elevated GGT = liver disease
Elevated Alk phos with normal GGT = bone disease
True liver function tests
Best = Coagulation factors: INR (PT)
Albumin (decreased liver function = decreased albumin)
Ammonia (decreased liver detoxification = elevated ammonia)
Clinical jaundice can be observed when serum bilirubin is greater than _____
> or = 2mg/dL
Unconjugated bilirubin is the same as
indirect bilirubin
Conjugated bilirubin is the same as
direct bilirubin
Types of jaundice:
Caused by excessive hemolysis
i.e. transfusion rxn, sickle cell, thalassemiam autoimmune hemolytic anemia
Prehepatic
Types of jaundice:
Caused by pathology within the liver itself
i.e. hepatitis, cancer, cirrhosis, congenital disorder, drugs
Hepatic
Types of jaundice:
Caused by blockage of bile flow into the intestines
i.e. gallstones, bile duct inflammation or scar tissue, tumors
Posthepatic
Causes of unconjugated/indirect hyperbilirubinemia (in this lecture)
Hemolysis and Gilbert syndrome
Presentation is consistent with which diagnosis?
Jaundice with low haptoglobin, high reticulocyte count, high LDH, elevated indirect bilirubin
Hemolysis
prehepatic and indirect hyperbilirubinemia
