EXAM #1: LIVER ENZYMES Flashcards
What is the common term to refer to a elevation in the liver transaminases, AST and ALT?
Transaminitis
Which of the transaminases is LESS specific?
AST
What is AST?
Aspartate Aminotransferase
What are the primary sources of AST?
Liver
Skeletal muscle
When is AST released?
Liver and skeletal muscle damage
What is ALT?
Alanine Aminotransferase
What is the primary source of ALT?
Liver
Elevated ALT indicates damage to what organ?
Liver
What is the ratio of AST and ALT in alcohol use?
2:1
What is an alternative etiology to AST and ALT elevations?
Rhabdomyolysis
How do you evaluate for Rhabdomyolysis?
Creatinine Kinase
What markers indicate cholestatic injury?
Alkaline Phosphatase
Bilirubin
When is there a build-up of direct bilirubin?
If biliary drainage is inadequate
When is there a build-up of Indirect bilirubin?
Liver failing to process as quickly as RBCs are lysing
What is the source of Total Bilirubin?
Breakdown of Hemoglobin
What are the major sources of Alkaline Phosphatase?
Liver
Bone
Placenta
What causes an elevation of Alkaline Phosphatase?
1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester of pregnancy
What are two examples of classic diseases that will cause an increase in Alkaline Phosphatase related to bone abnormalities?
- Metastatic prostate cancer
- Paget Disease
What cardiac related disease can cause an increase in Alkaline Phosphatase?
CHF
How do you test for the specific etiology of an elevated ALP?
Gamma Glutamyl Transferase (GGT)
Is a GGT part of a normal CMP?
NO
What does an elevated GGT tell you?
GGT elevation indicates ALP is increased from liver disease
What does a GGT that is NOT elevated tell you?
ALP elevation is from bony etiology
What are three indications that liver synthetic function is normal?
Normal labs:
1) Bilirubin
2) Albumin
3) INR
What is Alcoholic Hepatitis?
Acute inflammation of the liver (due to alcohol consumption)
What lab test is associated with Alcoholic Hepatitis?
Extremely high bilirubin
What is the source of ammonia in the body?
Protein metabolism
What is ammonia converted to? Where?
Urea in the liver
What causes an elevated ammonia?
Severe liver disease
What is hyperammonia associated with?
Hepatic Encephalopathy
This is a big predictor of mortality*
What is ANA?
Antinuclear antibody
What is AMA?
Antimitochondrial antibody
What is ASMA?
Antismooth muscle antibody
What is LKM?
Anti liver-kidney microsomal antibody
What are the two major labs associated with Primary Biliary Cirrhosis?
1) Disproprotionate increase in alkaline phosphatase (APL)
1) Positive AMA (antimitochondiral antibody)
What patient population in Primary Biliary Cirrhosis associated with?
Middle aged females
What is Primary Sclerosing Cholangitis?
Inflammation and obliterative fibrosis of the bile ducts
What is Primary Sclerosing Cholangitis associated with?
Ulcerative Colitis
What are the red flags for Primary Sclerosing Cholangitis?
1) Disproportionate increase in APL
2) “Beads on a string” in bile ducts
3) Onion skinning of bile ducts on biopsy
What antibodies are associated with Autoimmune Hepatitis?
ANA
ASMA
What age groups is Autoimmune Hepatitis seen in?
Young females
