Elevated Liver Enzymes and Jaundice Flashcards
Are “Liver Function Tests” markers for liver function?
NO - liver damage markers
AST
Aspartate Aminotransferase
ALT
Alanine Aminotransferase
Hepatocellular
Primary injury to hepatocytes
– Increased AST/ALT
Between AST and ALT - which is more specific to liver injury?
ALT
Cholestasis
Primary injury to bile ducts
– Increased Alkaline Phosphatase/Bilirubin
Signs of Cholestasis
Jaundice and Pruritus
What are the 4 Liver Enzyme Tests?
- Bilirubin
- AST and ALT
- Alkaline Phosphatase
- GGT
This liver enzyme test is an indication of hepatic uptake, metabolic and excretory functions
Bilirubin - indirect vs direct
This liver enzyme test is sensitive indicator of liver cell injury (ex. necrosis)
AST and ALT = ELEVATION
Normally, ALT is more specific to livery cell injury. What will cause a 2:1 increase of AST:ALT?
Ethanol induced livery injury
This liver enzyme test is a sensitive indicator of cholestasis, biliary obstruction and liver infiltration
Alkaline Phosphatase
When are elevations of Alkaline Phosphatase possibly normal?
Childhood
Pregnancy
Bone diseases
If Alkaline Phosphatase is elevated, what should you check?
GGT (gamma-Glutamyl Transpeptidase)
If GGT is normal =
Bone involvement
If GGT is elevated =
Liver issues
What are the 3 Liver FUNCTION tests?
- Coagulation factors
- Albumin
- Ammonia
What are the 3 Liver FUNCTION tests?
- Coagulation factors
- Albumin
- Ammonia
What is the best measure of hepatic synthetic function?
Coagulation factors
All clotting factors except for ____ are synthesized in the liver
Factor VIII
A _____ in clotting factors is helpful in diagnostic/prognostics of liver disease
DECREASE
Which clotting factors need vitamin K to function?
2, 7, 9, 10
INR (international normalized ration) is commonly used for which liver function test?
Coagulation factors
A DECREASE in Albumin is due to?
DECREASED liver synthesis
Decreased Albumin means that there will be excessive loss of it in?
Urine/stool
Why is Albumin NOT sensitive to acute liver issues?
The serum half life is too long!! (2-3 weeks)
What type of liver disease (acute or chronic) is Albumin more sensitive to?
Chronic
In patients with chronic liver disease, the degree of HYPOALBUMINEMIA correlates with?
Severity of livery dysfunction
An INCREASE in Ammonia is due to?
Defective hepatic detoxification pathways
Increased Ammonia does not correlate well with?
Hepatic function or in presence of encephalopathy
Jaundice will be seen when the bilirubin is greater than?
2
What skin segments will most likely be visibly yellow with jaundice?
Sclera
Oral mucosa
Palms
Hyperbilirubinemia presents as?
Jaundice
Treatment of Jaundice?
Treat the cause
Prehepatic jaundice
Blood issues
- sickle cell, thalassemia, transfusion reactions
Hepatic jaundice
Liver issues
- hepatitis, cirrhosis, cancer, drugs
Posthepatic jaundice
Downstream of the liver
- gallstones, tumors blocking flow of bile
Bilirubin can be either?
Indirect (unconjugated)
Direct (conjugated)
What can cause Unconjugated (indirect) hyperbilirubinemia?
Increased bilirubin production or impaired uptake
What issues will be associated with Unconjugated hyperbilirubinemia?
Hemolysis
Gilbert Syndrome
What can cause Conjugated (direct) hyperbilirubinemia?
Impaired excretion or hepatocellular dysfunction
What issue will be associated with Conjugated hyperbilirubinemia?
Meds
Gilbert Syndrome
Unconjugated Hyperbilirubinemia
- Asymptomatic hereditary jaundice
With Gilbert Syndrome, what will increase the bilirubin?
FASTING
FASTING that increases the indirect bilirubin is seen with?
Gilbert Syndrome
