Exam 1: Liver Test And Hepatitis Flashcards
What is 5NP?
A liver enzyme that is elevated in diseases affecting the biliary tree. 5NP can help distinguish liver as the origin
When GGT elevated simultaneously with ALP, what does this indicate?
It confirms liver origin
What is the first step in evaluation of a patient with elevated LFTs but no symptoms?
Repeat the test (fasting)
When is GGT useful?
1) when ALP is elevated, it confirms liver specificity
2) When AST/ALT is >2 it further supports alcoholic liver disease (ALD)
What liver tests assess liver function?
Bilirubin, albumin, and PT/INR
What labs are going to be elevated with hepatocellular damage?
ALT and AST
What labs will be elevated with a cholestatic process?
Total bilirubin, ALP, and GGT
What does elevated ALP suggest?
Cholestasis
What is fractionated bilirubin and when is its useful?
Fraction of total bilirubin that is direct vs indirect.
Useful when standard liver tests are normal and total bilirubin is elevated (hemolysis and Gilbert syndrome)
What happens to UDP glucoronyl transferase in Gilbert syndrome?
Activity is reduced by 30% so unconjugated bilirubin is not being conjugated and there is decreased bilirubin secretion
What lab findings are consistent with liver disease?
Elevated direct bilirubin and elevated ALT and AST
What lab findings are consistent with hemolysis?
Elevated indirect bili, anemia, normal AST and ALT
What lab findings are consistent with Gilbert syndrome?
Elevated total bili, elevated indirect bili, normal ALT and AST, no anemia
Do normal liver tests mean that the liver is normal?
NO
Is there a relationship between severity of liver disease and transaminase levels?
NO
Where is GGT found?
Hepatocytes and biliary epithelial cells
What herbals/vitamins can cause drug induced liver injury (DILI)?
Ephedra, Kava, VItamin A, and Garcinia Cambogia
What are the medications that can cause DILI?
Acetaminophen, Statins, antifungals, antibiotics, Anti TB drugs, NSAIDs, tegretol
What are causes other than liver injury/damage that can cause elevated LFTs?
Muscle injury, cholelithiasis, masses, hemodynamics disorders, celiac, hypothyroid and adrenal insufficiency
What labs can be elevated in muscle disorders?
CPK and aldolase
What conditions are associated with mildly elevated AST and ALT?
Fatty liver, EtOH, chronic viral hepatitis, and medication effects
What conditions are associated with AST> ALT?
Alcoholic hepatitis, rhabdo, cardiac, and cirrhosis