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Clin Med Lab Med > Exam #1: Liver Function/Hepatic Serology > Flashcards

Exam #1: Liver Function/Hepatic Serology Flashcards

1
Q

What two tests are used to determine liver disease specifically from other pathology?

A
  • GGT

- 5NP

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2
Q

Under what two scenarios would GGT be useful?

A
  • ALP elevated (liver specific)

- AST/ALT >2 = ALD

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3
Q

If direct bili is elevated, indirect bili is normal and AST/ALT is elevated, what does this indicate?

A

Liver disease

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4
Q

If direct bili is normal, indirect bili is elevated and and AST/ALT is normal + ANEMIA, what does this indicate?

A

Hemolysis (Hemolytic Anemia)

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5
Q

If direct bili is normal, indirect bili is elevated and AST/ALT is normal WITHOUT Anemia, what does this indicate?

A

Gilbert’s Syndrome

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6
Q

If ONLY Bili is elevated, what other source should you consider?

A

RBCs

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7
Q

If ONLY AST is elevated, what other sources should you consider (4)?

A

Skeletal muscle, cardiac muscle, kidney, brain

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8
Q

If ONLY ALT is elevated, what other sources should you consider (3)?

A

Skeletal muscle, cardiac muscle, kidney

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9
Q

If ONLY ALP is elevated, what other source should you consider?

A

Bone

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10
Q

What two medication groups are often associated with risk factor of liver disease and AST/ALT elevation?

A
  • HTN

- Other chronic disease meds

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11
Q

What two medication groups are often associated with risk factor of liver disease and ALP elevation?

A
  • Abx

- Steroids

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12
Q

If ALT is VERY elevated, what two causes should you consider?

A
  • Liver ischemia

- Liver toxicity

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13
Q

If AST/ALT is >2, what disease should be considered?

A

ALD (Alcoholic Liver Disease)

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14
Q

If AST/ALT is >1, what disease should be considered?

A

Cirrhosis

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15
Q

If AST/ALT is <1 but still elevated, what two diseases should be considered?

A
  • Fatty liver

- Viral etiology

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16
Q

What risk factor of NAFLD is a strong predictor of NASH?

A

Metabolic Syndrome

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17
Q

What is Non-Alcoholic Steatohepatitis (NASH), and what does it create an increased risk for?

A

Fatty liver + inflammation

- High risk for significant fibrosis (scarring)

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18
Q

What is Hereditary Hemochromatosis and what two conditions can it lead to?

What other condition are you at increased risk for?

A

Hereditary disorder of iron metabolism (high iron absorption = too much iron)

  • Can progress to fibrosis or cirrhosis
  • Increased risk for Hepatocellular Carcinoma (HCC)
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19
Q

What two diagnostic tests should be ordered to screen for Hepatocellular Carcinoma (HCC)?

A
  • AFP

- Liver US

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20
Q

To diagnose Hereditary Hemochromatosis, what two labs should be ordered/screened for?

A
  • Transferrin saturation

- Ferritin

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21
Q

What genotype test should be ordered to test for Hereditary Hemochromatosis?

A

HFE genotype

NOTE: should also screen all 1st degree relatives for HFE genotype/iron testing

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22
Q

Which two autoimmune liver diseases are more common in women?

A
  • Primary Biliary Cholangitis (PBC)

- Autoimmune Hepatitis (AIH)

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23
Q

Which autoimmune liver disease is more common in men?

A

Primary Sclerosing Cholangitis (PSC)

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24
Q

What test will be positive if Primary Biliary Cholangitis (PBC) is present? Is this more common in men or women?

A

AMA will be positive (also elevated AST/ALT

- PBC is more common in women

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25
Q

What condition is strongly associated with Primary Sclerosing Cholangitis (PSC)?

A

IBD (Inflammatory Bowel Disease) - UC and Crohn’s

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26
Q

If you are concerned about Autoimmune Hepatitis, what four tests should you order?

A
  • ANA
  • ASMA
  • LKMA-1
  • LC-1
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27
Q

What condition can Alpha-1 Antitrypsin Deficiency cause in adults?

A

Early onset emphysema

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28
Q

To diagnose Alpha-1 Antitrypsin Deficiency, what two labs should be ordered?

A
  • Serum alpha-1 antitrypsin (LOW)

- Alpha-1 antitrypsin phenotype

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29
Q

What condition involves neurologic/psychiatric problems (ages 5-35 most common) – tremor, dysarthria, muscle spasticity or rigidity, personality/behavior changes?

A

Wilson’s Disease

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30
Q

What disease are Kayser-Fleisher rings in cornea associated with?

A

Wilson’s Disease

31
Q

What condition do these labs indicate is present?

  • Elevated AST/ALT
  • Low ALP
  • Low serum ceruloplasmin
  • 24-hour urinary copper test
A

Wilson’s Disease

32
Q

What condition involves testing with serum ceruloplasmin?

A

Wilson’s Disease

33
Q

What condition involves testing with 24-hour urinary copper test?

A

Wilson’s Disease

34
Q

Can Hep A be chronic?

A

NEVER

35
Q

What does a positive Anti-HAV IgM indicate?

A

Acute Hep A

36
Q

Is it more common for Hep B or Hep C to progress to chronic?

A 
Hep C (75-85% of time)
- Hep B only 5% of time
37
Q

If HbsAg is positive, what does this indicate?

A

Active Hepatitis B

- Acute OR chronic

38
Q

If IgM anti-HBc is positive, what does this indicate?

A

Acute Hepatitis B

- Negative would mean chronic

39
Q

If anti-HBs is present, what does this indicate?

A

Immunity for Hepatitis B

40
Q

If IgG anti-HBc or Total anti-HBc are positive, what does this indicate?

A

Previous exposure to Hepatitis B

41
Q

If HCV RNA is present, what does this indicate?

A

Hepatitis C (current?)

42
Q

Which type of Hepatitis involves fecal-oral spread; common in homeless population?

A

Hepatitis A

43
Q

Which type of Hepatitis involves spread by sexual contact, parenteral/percutaneous, person-to-person, perinatal from mother?

A

Hepatitis B

44
Q

Which type of Hepatitis involves born 1945-1965, transfusion before 1992, tattoos/piercing, intra-nasal drug use, incarceration, high-risk sex, HIV?

A

Hepatitis C

45
Q

What three co-existing diseases are associated with Hereditary Hemochromatosis?

A
  • Impotence
  • DM
  • Arthralgia
46
Q

What four co-existing diseases are associated with NASH?

A
  • DM
  • Hyperlipidemia
  • Obesity
  • HTN
47
Q

Is NAFLD associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

48
Q

Is chronic viral Hepatitis associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

49
Q

Is Hereditary Hemochromatosis associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

50
Q

Is ALD associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

51
Q

Is medication toxicity associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

52
Q

Is Wilson’s Disease associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

53
Q

Is Alpha-1 Antitrypsin Deficiency associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

54
Q

Is autoimmune hepatitis associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated AST/ALT

55
Q

Is PBC associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

56
Q

Is PSC associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

57
Q

Is neoplasm associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

58
Q

Is drug hepatotoxicity associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

59
Q

Is autoimmune cholangiopathy associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

60
Q

Is sarcoidosis associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

61
Q

Is biliary atresia associated more with an elevated AST/ALT or an elevated ALP?

A

Elevated ALP

62
Q

Is Epstein Barr Virus associated with acute or chronic hepatitis?

A

ACUTE Hepatitis

63
Q

Is Cytomegalovirus associated with acute or chronic hepatitis?

A

ACUTE Hepatitis

64
Q

Which two conditions are seen with both acute AND chronic hepatitis?

A
  • Wilson’s Disease

- DILI (drug-induced liver disease)

65
Q

Is Celiac disease associated with acute or chronic hepatitis?

A

CHRONIC Hepatitis

66
Q

Is fatty liver associated with acute or chronic hepatitis?

A

CHRONIC Hepatitis

67
Q

Is Celiac disease associated with acute or chronic hepatitis?

A

CHRONIC Hepatitis

68
Q

Is Hereditary Hemochromatosis associated with acute or chronic hepatitis?

A

CHRONIC Hepatitis

69
Q

Is Alpha-1 Antitrypsin Deficiency associated with acute or chronic hepatitis?

A

CHRONIC Hepatitis

70
Q

What are three potential causes of Shock Liver?

A
  • Cardiac failure
  • Respiratory failure
  • Septic shock
71
Q

What three diagnostic findings/conditions may present with Liver Cirrhosis/End-Stage Liver Disease?

A
  • Anemia
  • Thrombocytopenia
  • Elevated PT/INR
72
Q

What is the hallmark ALT level associated with ACUTE Hep B infection?

A

1000-2000

73
Q

In what age group is CHRONIC Hep B most often seen?

A

Newborns/children

Clin Med Lab Med (13 decks)

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