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gastrointestinal system > EXAM #1: LIVER ENZYMES > Flashcards

EXAM #1: LIVER ENZYMES Flashcards

1
Q

What is the common term to refer to a elevation in the liver transaminases, AST and ALT?

A

Transaminitis

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2
Q

Which of the transaminases is LESS specific?

A

AST

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3
Q

What is AST?

A

Aspartate Aminotransferase

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4
Q

What are the primary sources of AST?

A

Liver

Skeletal muscle

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5
Q

When is AST released?

A

Liver and skeletal muscle damage

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6
Q

What is ALT?

A

Alanine Aminotransferase

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7
Q

What is the primary source of ALT?

A

Liver

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8
Q

Elevated ALT indicates damage to what organ?

A

Liver

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9
Q

What is the ratio of AST and ALT in alcohol use?

A

2:1

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10
Q

What is an alternative etiology to AST and ALT elevations?

A

Rhabdomyolysis

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11
Q

How do you evaluate for Rhabdomyolysis?

A

Creatinine Kinase

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12
Q

What markers indicate cholestatic injury?

A

Alkaline Phosphatase

Bilirubin

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13
Q

When is there a build-up of direct bilirubin?

A

If biliary drainage is inadequate

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14
Q

When is there a build-up of Indirect bilirubin?

A

Liver failing to process as quickly as RBCs are lysing

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15
Q

What is the source of Total Bilirubin?

A

Breakdown of Hemoglobin

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16
Q

What are the major sources of Alkaline Phosphatase?

A

Liver
Bone
Placenta

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17
Q

What causes an elevation of Alkaline Phosphatase?

A

1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester of pregnancy

18
Q

What are two examples of classic diseases that will cause an increase in Alkaline Phosphatase related to bone abnormalities?

A
  • Metastatic prostate cancer

- Paget Disease

19
Q

What cardiac related disease can cause an increase in Alkaline Phosphatase?

A

CHF

20
Q

How do you test for the specific etiology of an elevated ALP?

A

Gamma Glutamyl Transferase (GGT)

21
Q

Is a GGT part of a normal CMP?

A

NO

22
Q

What does an elevated GGT tell you?

A

GGT elevation indicates ALP is increased from liver disease

23
Q

What does a GGT that is NOT elevated tell you?

A

ALP elevation is from bony etiology

24
Q

What are three indications that liver synthetic function is normal?

A

Normal labs:

1) Bilirubin
2) Albumin
3) INR

25
Q

What is Alcoholic Hepatitis?

A

Acute inflammation of the liver (due to alcohol consumption)

26
Q

What lab test is associated with Alcoholic Hepatitis?

A

Extremely high bilirubin

27
Q

What is the source of ammonia in the body?

A

Protein metabolism

28
Q

What is ammonia converted to? Where?

A

Urea in the liver

29
Q

What causes an elevated ammonia?

A

Severe liver disease

30
Q

What is hyperammonia associated with?

A

Hepatic Encephalopathy

This is a big predictor of mortality*

31
Q

What is ANA?

A

Antinuclear antibody

32
Q

What is AMA?

A

Antimitochondrial antibody

33
Q

What is ASMA?

A

Antismooth muscle antibody

34
Q

What is LKM?

A

Anti liver-kidney microsomal antibody

35
Q

What are the two major labs associated with Primary Biliary Cirrhosis?

A

1) Disproprotionate increase in alkaline phosphatase (APL)

1) Positive AMA (antimitochondiral antibody)

36
Q

What patient population in Primary Biliary Cirrhosis associated with?

A

Middle aged females

37
Q

What is Primary Sclerosing Cholangitis?

A

Inflammation and obliterative fibrosis of the bile ducts

38
Q

What is Primary Sclerosing Cholangitis associated with?

A

Ulcerative Colitis

39
Q

What are the red flags for Primary Sclerosing Cholangitis?

A

1) Disproportionate increase in APL
2) “Beads on a string” in bile ducts
3) Onion skinning of bile ducts on biopsy

40
Q

What antibodies are associated with Autoimmune Hepatitis?

A

ANA

ASMA

41
Q

What age groups is Autoimmune Hepatitis seen in?

A

Young females

gastrointestinal system (42 decks)

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