DSA 2 - Hepatobiliary Patient Elevated Liver Enzymes (McGowan)

Question 1

What are the true liver function tests (LFTs)?

Answer 1

• • PT/INR
• • Albumin
• • Cholesterol
• • Ammonia

Question 2

In hepatocellular disease, primary injury is to the hepatocytes and there will be an elevation of…

Answer 2

AST (Aspartate aminotransferase)

ALT (Alanine aminotransferase)

Question 3

Between AST and ALT, which is more specific for liver injury? Why?

Answer 3

ALT, because AST is also found in striated muscles and other organs

Question 4

In cholestatic disease, primary injury is to the bile ducts. There is an elevation of…

Answer 4

ALP (Alkaline phosphatase)
Bilirubin

***AST and ALT will be normal!

Question 5

In cholestatic disease there is failure of the bile to reach the duodenum, resulting in _______ and _______.

Answer 5

Jaundice

Pruritus

Question 6

This liver test provides indication of hepatic uptake, metabolic (conjugation), and excretory functions.

Answer 6

Bilirubin

Question 7

Aminotransferases are sensitive indicators of liver cell injury. The greatest elevations are seen in hepatocellular ________ (ie, viral hepatitis, toxic or ischemic liver injury, acute hepatic vein obstruction).

Answer 7

Necrosis

Question 8

T/F. There is a poor correlation between degree of liver cell damage and level of aminotransferases.

Answer 8

True

Question 9

Alcohol induced liver injury usually produces modest increases in aminotransferases, with a greater increase in…

Answer 9

AST — There is AST/ALT ratio of 2:1

***Very characteristic!!!

Question 10

This liver test is a sensitive indicator of cholestasis, biliary obstruction, and liver infiltration.

Answer 10

ALP

***ALP increases more quickly than serum bilirubin, so it’s more helpful at first!

Question 11

When are elevations of ALP seen besides being related to the gallbladder?

Answer 11

Normal childhood
Pregnancy
Bone diseases

Question 12

This liver test correlates with serum ALP activity. If it’s elevated ALWAYS think liver! If it’s normal, think other source like bone disease or placenta.

Answer 12

GGT (y-Glutamyl transpeptidase)

Question 13

This LFT is used to test coagulation factors. If it is above 1 and the patient is not on medication like Coumadin/Warfarin, we should wonder if it is liver disease.

Answer 13

INR

Question 14

Prolongation of INR results from clotting factor deficiency or inactivity. It is a useful test because all clotting factors except ________ are synthesized in the liver. Deficiency can occur rapidly from widespread liver disease as in hepatitis, toxic injury, or cirrhosis.

Answer 14

Factor VIII

Question 15

This LFT is the single best acute measure of hepatic synthetic function. It is very helpful in diagnosis and prognosis of acute liver disease.

Answer 15

INR

Question 16

Clotting factors II, VII, IX, X function only in the presence of ________. It’s important to determine if PT prolongation is from hepatic disease or due to fat malabsorption.

Answer 16

Vitamin K (fat-soluble vitamin)

***If patient recovers from Vitamin K replacement, then it is not hepatic disease!

Question 17

For this LFT, decreased serum levels result from decreased hepatic synthesis (chronic liver disease or prolonged malnutrition). There are excessive losses in urine or stool.

Answer 17

Albumin

Question 18

Is Albumin helpful in diagnosing acute hepatic dysfunction? Why or why not?

Answer 18

No, because its serum half-life is 2-3 weeks

Question 19

In patients with chronic liver disease, degree of _________ correlates with the severity of the liver dysfunction.

Answer 19

Hypoalbuminemia

Question 20

For this LFT, elevated blood levels result from deficiency of hepatic detoxification pathways and portal-systemic shunting.

Answer 20

Ammonia

Question 21

Elevation of blood ammonia does not correlate well with hepatic function or the presence or degree of acute _________.

Answer 21

Encephalopathy