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GI II Exam 1 > DSA: Liver enzymes > Flashcards

DSA: Liver enzymes Flashcards

1
Q

Liver function tests (LFTs), a misnomer, include what tests?

A
  1. AST/ALT (transaminases)
    1. aspartate aminotransferase (AST)
    2. Alanine aminotransferase (ALT
  2. ALP (alkaline phosphatase)
  3. Bilirubin
  4. LDH and GGT
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2
Q

TRUE liver function tests include:

A
  1. PT/INR (tests coag factors)
  2. Albumin
  3. Cholesterol
  4. Ammonia
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3
Q
  • In hepatocellular injury => _______ in _________ enzymes
    • ____ is MORE specific for liver injury
A
  1. ↑ AST/ALT
    1. ALT is MORE specific for liver injury
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4
Q

In cholestatic injury (injury to bile ducts) => _______ in _________ enzymes

A
  • ↑ ALP and bilirubin
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5
Q

In __________, bile cannot reach duodenum.

A

Cholestatic injury

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6
Q

Signs of cholestatic injury

A
  1. Jaundice
  2. Pruritis (very itchy)
  3. Pure cholestasis (no signs of hepatocellular necrosis)
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7
Q

On labs, if we see ↑ ALP, indicates problems with _________ or _______.

How do we differentiate?

A
  • Bone or liver (cholestasis)
  • To differentiate, measure GGT
    • NL GGT = bone
    • ↑ GGT = liver (cholestatic)
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8
Q

↑ ALP in NL in _____________.

A

Childhood, as we are growing and pregnancy

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9
Q

When is ↑ INR problematic?

A

If a patient is NOT on coumadin/warfarin, then they can have liver disease.

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10
Q

________ is the best test to measure acute hepatic functioning (acute liver failure).

A

INR

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11
Q

INR measures what?

A

Deficiency of all cloting factors except factor 8 => liver disease, hepatitis, toxic injury, cirrohosis.

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12
Q

PT prolongation due to fat malasbsoprtion can be distinguished from liver disease by _____________.

A

Rapid and complete response to vitamin K.

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13
Q

Albumin tests the ________ of the liver.

↓ serum albumin often occurs due to?

A
  • Function of the liver (degree of hypoalbuminia = severity of liver dysfunction)
  • ↓ in patients with chronic liver disease
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14
Q

Ammonia tests the ________ of the liver.

↑ blood ammonia often occurs due to?

A
  • Function of the liver
  • Hepatic detoxification is not working or acute encephalopthy
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15
Q

↑ indirect-reacting bilirubin, with all other enzymes NL) can be due to __________________.

A
  1. Hemolysis (↑ = more than 90% of total bilirubin)
  2. Gilbert’s syndrome (↑ = more than 90% of total bilirubin)
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16
Q

Associated features with hemolysis (↑ isolated indirect-acting bilrubin)

A
  • Anemia
  • ↑ reticulocyte count
  • NL enzyme levels (LDH may be ↑)
17
Q

Associated features with Gilberts (↑ isolated indirect-acting bilrubin)

A
  • Benign course that beings in late adolescence that occurs during fasting
  • No abnormal liver tests
  • No anemia
18
Q

Many types of liver disease will have ↑ ___________.

A

Direct-reacting bilirubin

19
Q

Non-hepatic reasons for ↑ bilirubin

A
  • RBC (hemolysis, intra-abdominal bleeding, hematoma)
20
Q

Non-hepatic reasons for ↑ AST

A
  • Skeletal muscle
  • Cardiac muscle
  • RBC
21
Q

Non-hepatic reasons for ↑ ALT

A
  • Skeletal muscle
  • Cardiac muscle
  • Kidneys
22
Q

Non-hepatic reasons for ↑ LDH

A
  • Heart
  • RBC (hemolysis)
23
Q

Acute (<6 months) abnormal liver ezymes tests that indicate hepatic injury => check for?

A
    1. IgM Anti-HAV, [HBsAg & IgM Anti- Hbc], Anti-HCV => Hep A, B, C
    1. SMA => autoimmune hepatitis
    1. Mono heterphile => Mono
    1. Ceruloplasm => Wilsons disease
    1. Alcohol history => alcoholic hepatitis
    1. Drug history
24
Q

Small elevation of AST/ALT => mostly due to _______

A

nonalcoholic fatty liver disease

25
Q

Acute (< 6 months) abnormal liver ezymes tests that indicate cholestatic injury => check for?

A
  1. AMA => primary biliary cirrhosis
  2. Drug history
  3. US/MRI => structural problems, hepatic vein thrombosis
  4. MRCP/ECRP
26
Q

Chronic (> 6 months) abnormal liver ezymes tests that indicate hepatitic injury => check for?

A
  1. HbsAg and Anti-HCV => Hep B and C
  2. Fe saturation, ferritan
  3. Ceruloplasm
  4. a-AT1
  5. ANA, SMA => AI hepatitis
  6. US
  7. Alcohol history
27
Q

Chronic (> 6 months) abnormal liver ezymes tests that indicate cholestatic injury => check for?

A
  1. Meds
  2. AMA
  3. p-ACNA
  4. US
  5. MRCP/ERCP

GI II Exam 1 (19 decks)

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