Elevated Liver Enzymes and Jaundice

Question 1

Are “Liver Function Tests” markers for liver function?

Answer 1

NO - liver damage markers

Question 2

AST

Answer 2

Aspartate Aminotransferase

Question 3

ALT

Answer 3

Alanine Aminotransferase

Question 4

Hepatocellular

Answer 4

Primary injury to hepatocytes

– Increased AST/ALT

Question 5

Between AST and ALT - which is more specific to liver injury?

Answer 5

ALT

Question 6

Cholestasis

Answer 6

Primary injury to bile ducts

– Increased Alkaline Phosphatase/Bilirubin

Question 7

Signs of Cholestasis

Answer 7

Jaundice and Pruritus

Question 8

What are the 4 Liver Enzyme Tests?

Answer 8

1. Bilirubin
2. AST and ALT
3. Alkaline Phosphatase
4. GGT

Question 9

This liver enzyme test is an indication of hepatic uptake, metabolic and excretory functions

Answer 9

Bilirubin - indirect vs direct

Question 10

This liver enzyme test is sensitive indicator of liver cell injury (ex. necrosis)

Answer 10

AST and ALT = ELEVATION

Question 11

Normally, ALT is more specific to livery cell injury. What will cause a 2:1 increase of AST:ALT?

Answer 11

Ethanol induced livery injury

Question 12

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

Answer 12

Alkaline Phosphatase

Question 13

When are elevations of Alkaline Phosphatase possibly normal?

Answer 13

Childhood
Pregnancy
Bone diseases

Question 14

If Alkaline Phosphatase is elevated, what should you check?

Answer 14

GGT (gamma-Glutamyl Transpeptidase)

Question 15

If GGT is normal =

Answer 15

Bone involvement

Question 16

If GGT is elevated =

Answer 16

Liver issues

Question 17

What are the 3 Liver FUNCTION tests?

Answer 17

1. Coagulation factors
2. Albumin
3. Ammonia

Question 18

What are the 3 Liver FUNCTION tests?

Answer 18

1. Coagulation factors
2. Albumin
3. Ammonia

Question 19

What is the best measure of hepatic synthetic function?

Answer 19

Coagulation factors

Question 20

All clotting factors except for ____ are synthesized in the liver

Answer 20

Factor VIII

Question 21

A _____ in clotting factors is helpful in diagnostic/prognostics of liver disease

Answer 21

DECREASE

Question 22

Which clotting factors need vitamin K to function?

Answer 22

2, 7, 9, 10

Question 23

INR (international normalized ration) is commonly used for which liver function test?

Answer 23

Coagulation factors

Question 24

A DECREASE in Albumin is due to?

Answer 24

DECREASED liver synthesis

Question 25

Decreased Albumin means that there will be excessive loss of it in?

Answer 25

Urine/stool

Question 26

Why is Albumin NOT sensitive to acute liver issues?

Answer 26

The serum half life is too long!! (2-3 weeks)

Question 27

What type of liver disease (acute or chronic) is Albumin more sensitive to?

Answer 27

Chronic

Question 28

In patients with chronic liver disease, the degree of HYPOALBUMINEMIA correlates with?

Answer 28

Severity of livery dysfunction

Question 29

An INCREASE in Ammonia is due to?

Answer 29

Defective hepatic detoxification pathways

Question 30

Increased Ammonia does not correlate well with?

Answer 30

Hepatic function or in presence of encephalopathy

Question 31

Jaundice will be seen when the bilirubin is greater than?

Answer 31

2

Question 32

What skin segments will most likely be visibly yellow with jaundice?

Answer 32

Sclera Oral mucosa Palms

Question 33

Hyperbilirubinemia presents as?

Answer 33

Jaundice

Question 34

Treatment of Jaundice?

Answer 34

Treat the cause

Question 35

Prehepatic jaundice

Answer 35

Blood issues | - sickle cell, thalassemia, transfusion reactions

Question 36

Hepatic jaundice

Answer 36

Liver issues | - hepatitis, cirrhosis, cancer, drugs

Question 37

Posthepatic jaundice

Answer 37

Downstream of the liver | - gallstones, tumors blocking flow of bile

Question 38

Bilirubin can be either?

Answer 38

Indirect (unconjugated) | Direct (conjugated)

Question 39

What can cause Unconjugated (indirect) hyperbilirubinemia?

Answer 39

Increased bilirubin production or impaired uptake

Question 40

What issues will be associated with Unconjugated hyperbilirubinemia?

Answer 40

Hemolysis | Gilbert Syndrome

Question 41

What can cause Conjugated (direct) hyperbilirubinemia?

Answer 41

Impaired excretion or hepatocellular dysfunction

Question 42

What issue will be associated with Conjugated hyperbilirubinemia?

Answer 42

Meds

Question 43

Gilbert Syndrome

Answer 43

Unconjugated Hyperbilirubinemia | - Asymptomatic hereditary jaundice

Question 44

With Gilbert Syndrome, what will increase the bilirubin?

Answer 44

FASTING

Question 45

FASTING that increases the indirect bilirubin is seen with?

Answer 45

Gilbert Syndrome