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Labs Medicine > Clinical Lab in GI Disease > Flashcards

Clinical Lab in GI Disease Flashcards

1
Q

What are the diagnostic criteria for acute pancreatitis?

A

Need two of three:

Abdominal pain characteristic of disease

amylase and/or lipase at least 3x the ULN

characteristic imaging findings

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2
Q

Which is better for pancreatitis and why: amylase or lipase?

A

lipase because it is more sensitive and more specific

also remains elevated longer than amylase

IN FACT: CURRENT REC IS FOR LIPASE ALONE

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3
Q

What are some other causes for elevated pancreatic enzymes?

A 
macroamylasemia/macrolipasemia
renal failure
acute appendicitis
cholecystitis
intestinal ischemia/obstruction
peptic ulcer disease
gynecological disease
diabetes (esp lipase)
parotid/salivary gland (amylase only)
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4
Q

What are the two most common causes of acute pancreatitis?

A

gallstones and alcohol

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5
Q

What are some other less common causes of acute pancreatitis?

A

post-ERCP, trauma/injury
Genetic - like CF mutations
Drugs (azathioprine, sulfonamides, NSAIDs, steroids, tetracycline)
Viral infections (mumps, rubella, EBV, CMV, hepatitis)
Hypertrigliceridemia
Hypercalcemia

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6
Q

What are the first tier LFT labs?

A 
transaminases
bilirubin
alk phos
GGT
albumin
prothrombin time/INR
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7
Q

What is the general pattern of liver labs in hepatocellular injury/necrosis?

A

ALT and AST significantly elevated, moreso than alk phos

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8
Q

What is the general pattern of liver labs in cholestatic disease?

A

alk phos elevated higher than ALT/AST

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9
Q

What is the general pattern of liver labs in infiltrative liver disease?

A

elevated AP with either normal or just slightly elevated AST/ALT

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10
Q

Which transaminase is more specific for liver disease?

A

ALT

AST is also found in muscle and red cells, so with extensive muscle breakdown, both ALT and AST will rise

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11
Q

Which transaminase has a longer half-life?

A

ALT

So Liver and Longer

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12
Q

Where on the cell is alk phos located?

A

on the hepatocyte membrane bordering the bile canaliculi, which is why it elevated in obstructive disease

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13
Q

Where in the body are other alk phos isoemzymes located?

A

bone and placenta

also elevated in other GI and kidney diseases

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14
Q

What can you use to confirm a liver course of an elevated alk phos?

A

GGT - there are few reasons to order a GGT other than this!

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15
Q

What are the main causes of acute rises in transaminases?

A 
Viral hepatitis
Drug-induced hepatitis
alcoholic hepatitis
Ishcemic "shock liver"
acute ductal obstruction
autoimmune hepatitis
Wilson's disease
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16
Q

ALT is often in the thousands with acute hepatitis. If it’s over 5,000 U/L, though, what should you consider?

A

Acetaminophen
hepatic ischemia
unusual viruses like HSV

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17
Q

What are the four main causes of chronic hepatitis?

A

Hep C
Hep B
NASH
Alcoholic liver disease

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18
Q

What is the time cutoff for hepatitis to be called chronic?

A

over 3 months

19
Q

What are some common causes of cholestasis?

A 
Stones
Primary biliary cholangitis
primary sclerosing cholangitis
drug-induced stasis
infiltrative/malignancy
severe inflammation
20
Q

Which suggests liver disease: elevated unconjugated bilir (indirect) or elevated conjugated bili (direct)?

A

conjugated (direct)

elevations in unconjugated (indirect) suggest hemolysis

21
Q

Jaundice will become visible at what bili level?

A

> 2.5 mg/dL

22
Q

Can bilirubin help you determine whether liver disease is hepatocellular, cholestatic or infiltrative?

A

not really

23
Q

What are some causes for unconjugated hyperbilirubinemia besides hemolysis?

A

resorption of large hematoma
ineffective erythropoiesis (like B12 def)
neonatal physiologic hyperbilirubinemia
Gilbert syndrome

24
Q

What is the typical pattern of LFTs in alcoholic hepatitis?

A

AST > 2 x ALT

but AST less than 400 UL

25
Q

What are the two main autoantibodies seen in autoimmune hepatitis?

A

type 1 with anti-smooth muscle and antinuclear

type 2 with liver-kidney microsome type 1

26
Q

Who gets PBC and how do they present?

A

middle aged women

presenting with fatigue and pruritus

27
Q

What will labs look like in PBC?

A 
increased alk phos
increased IgM
Fal soluble bitamin deficiencyes
high HDL
later increased Bili
28
Q

If you did a biopsy of a liver with PBC, what would you see?

A

granulomatous infiltration of the septal bile ducts

29
Q

What is the main antibody seen in PBC?

A

anti-mitochondrial antibodies

30
Q

What symptoms occur in stage I of acetaminophen toxicity?

A

anorexia
nausea
vomiting

31
Q

What symptoms occur in stage II?

A

RUQ pain

AST and ALT elevation (and sometimes bili, PT and/INR)

32
Q

What symptoms occur in stage III?

A

vomiting and jaundice
LFTs peak
sometimes renal failure and pancreatitis

33
Q

What happens in stage IV?

A

resolution or progression to multiple organ failure and sometimes death

34
Q

What are two major causes of iron overload liver damage?

A

hereditary hemochromatosis or multiple blood transfusions

35
Q

What will iron labs look like in iron overload? How do you confirm?

A

Transferrin saturation will be high
Ferritin also high (?)

liver biopsy

36
Q

What gene is defective in Wilson disease?

A

ATP7B

37
Q

How will wilson disease present?

A 
Kayser-Fleischer ring
hepatitis
splenomegaly
hypersplenism
Coomb's neg hemolytic anemia
portal hypertension
neuro-psychiatric disease
38
Q

How do you test for Wilson disease?

A

urinary copper (high)
ceruloplasmin (low)
hepatic Cu (high)
genetic testing

39
Q

What causes Crigler Najjar type 1? Who gets it?

A

Absent UDPGT activity (so unconjugated hyperbilirubinemia)

newborns and it’s fatal due to kernicterus unless they get a liver transplant.

40
Q

What causes Crigler Najjar type 2?

A

milder deficiency of UDPGT, so milder form than Type 1 and fortunately more common

can survive to adulthood

41
Q

What are the two other genetic bilirubin metabolism disorders that cause conjugated hyperbilirubinemia and asymptomatic jaundice?

A

Dubin-Johnson

Rotor syndrome

42
Q

What percentage of newborns will have jaundce?

A

60%

43
Q

What are the typical causes for neonatal jaundice?

A

usually immaturity of conjugating enzymes

hemolytic disease
bruising (cephalohematoma)
sepsis

44
Q

What’s the major concern with jaundice in newborns?

A

acute encephalopathy and kernicterus

Labs Medicine (27 decks)

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