Elevated Liver Enzymes DSA - McGowan

Question 1

what are the true liver function tests that McGowan wants us to know?

Answer 1

• serum albumin
• PT/PTT
• serum ammonia

Question 2

• AST
• ALT
• LDH

are tests of what?

Answer 2

hepatocyte integrity

Question 3

• serum bilirubin
• total bilirubin (conjugated + unconjugated)
• direct bilirubin (conjugated only)
• urine bilirubin
• serum alk phos
• serum GGT

are tests of what?

Answer 3

biliary excretory function

Question 4

this test provides indication of hepatic uptake, metabolic (conjugation) and excretory functions; conjugated fraction (direct) distinguished from unconjugated by chemical assay

Answer 4

bilirubin

Question 5

sensitive indicators of liver cell injury, greatest elevations seen in hepatocellular necrosis, occasionally with sudden, complete biliary obstruction

Answer 5

aminotransferases

Question 6

sensitive indicator of cholestasis, biliary obstruction, and liver infiltration; mild elevations in other forms of liver disease
- elevations seen in normal childhood, pregnancy and bone disease

Answer 6

alk phos

Question 7

this test correlated with serum alk phos actiity

• if elevated, think LIVER
• if normal, think other source

Answer 7

y-Glutamyl transpeptidase (GGT)

Question 8

this test is the single best acute measure of hepatic synthetic function, (all clotting factors except factor 8 are synthesized in the liver)

Answer 8

coagulation factors -> use INR

Question 9

decreased serum levels result from decreased hepatic synthesis (chronic liver disease or prolonged malnutrition), or excessive losses in urine or stool
- in chronic liver disease, degree of hypoalbuminemia correlates with severity of liver dysfunction

Answer 9

albumin

Question 10

elevated blood levels result fro deficiency of hepatic detoxification pathways and portal-systemic shunting, as in fulminant hepatitis, hepatotoxin exposure, and severe portal HTN

Answer 10

ammonia

Question 11

when would you see AST, ALT higher than alk phosphatase?

Answer 11

hepatocellular disease

Question 12

when would you see alk phos higher than AST/ALT?

Answer 12

cholestatic disease

Question 13

when would you see elevated alk phos levels and near-normal AST/ALT levels?

Answer 13

cholestatic disease

Question 14

what is the nonhepatic source of bilirubin?

Answer 14

red blood cells

Question 15

what is the nonhepatic source of AST?

Answer 15

skeletal muscle, cardiac muscle, RBC

Question 16

what is the nonhepatic source of ALT?

Answer 16

skeletal muscle, cardiac muscle, kidneys

Question 17

what is the nonhepatic source of LDH?

Answer 17

heart, RBC

Question 18

what is the nonhepatic source of alk phos?

Answer 18

bone, firm trimester placenta, intestines