Exam 1 thera hepatic Flashcards
Non specific symptoms
Anorexia
Nausea and vomiting
Fatigue
Mental confusion
Late disease symptoms
Jaudince
Dark urine
ascites
peripheral edema
Hepatocellular injury
Injury to the liver cells
Cholestatic injury
Damage to the billiary tract
Hepatobiliary
damage to the hepatocytes and the biliary tract
Aminotransferases ALT and AST
represent what?
What are they?
Hepatocellular injury
They are intracellular enzyme inside of the cell
Aminotransferases ALT and AST reference value?
<35 units/L
AST is in the
Liver, muscle, brain, kidney and red cells
ALT is in the
Mainly in the liver, muscled and kidney
Ischemic injury
Less blood flow to the liver
Liver cirrhosis Compensated cirrhosis
The liver has some function
The liver can metabolize at some extent
Liver cirrhosis decompensated cirrhosis
The liver loss the ability to metabolize
-Can see ALT and AST in normal level because it needs cell to cause the damage and the cell that are damage are replace by scar tissue
AST / ALT and alcoholism
-AST to ALT ratio is greater than 2
-When the pt is chronic alcoholic user see elevated AST
-because the AST is in the mitochondria and when the mitochondria is damage is going to release the AST
-Also because the pt has poor diet and doesn’t have Vitamin B6 that is needed for ALT activit
Lactate Dehydrogenase LDH what does it represents?
Hepatocellular injury
-Is in the liver, RBC, kidney, heart, skeletal muscle, brain and lungs
-It shows a injury but need isoenzymes to determine where the injury is at
Alkaline Phosphatase ALP what does it represents?
Cholestatic injury
-It shows injury to the liver and to the bone
What does it means to have high ALP?
It indicates that the billie cannot be excreted because the biliary tract is occluted and the billie will get back up
As a result it stimulated the release of ALP
Pregnant woman and childrens have high ALP
Gamma-Glutamyl transferase GGT represents what?
Cholestatic injury
-Is mainly in the liver, biliary tract and pancreas
If high GGT represents chronic alcohol use
-Can increase by enzyme inducers
Bilirubin is made how?
Breakdown of RBC the bilirubin is going to be conjugated to albumin but when it gets to the liver is not going to be conjugated by albumin it will get conjugated by the liver
Bilirubin reference number
1
Pt with hepatitis A shows high what?
High AST, High ALT and high bilirubin
Hyperbilirubinemia
High levels of bilirubin greater than 2 will show symptoms of jaundice and ictus (itchy)
Conjugated bilirubin = direct
Conjugated bilirubin reference value
0-0.2mg/dl
If conjugated bilirubin is high what does it means?
Indicates there is a liver injury
Get dark urine because the conjugated bilirubin is not being excreted because of hepatobiliary injury and the conjugated bilirubin will go throw blood circulation and then back to urine
Unconjugated bilirubin reference value?
0.2-0.9
What does high unconjugated bilirubin reflects?
It shows that the pt has anemia, receives blood transfusion or also a genetic disorder
Pt with Hepatitis A has high what?
High ALT
High AST
High bilirubin
Albumin reference
3.5-5
Low Albumin
-It represents the liver function
-Because albumin is made by the liver so if the pt has low albumin the liver is not working well
-Also if the pt has low protein intake the albumin will be low
-Over hydration
-If low albumin the fluids start leaking so get edema
-Nephrotic syndrome- edema, weight gain and protein in urine
High albumin
Dehydration and steroids
Prothrombim time (PT)
-It shows the liver function because factor VII is made by the liver
-Is how fast blood clots can form in a result of a injury
-If high PT –>increases the risk of bleeding and 80% of the liver is not working
INR reference value
1
if high INR pt is bleeding
Pt on warfarin INR
2.5-3.5
Ammonia
-Ammonia is metabolized by the liver and excreted by the kidneys
-If high ammonia indicates the liver is not working well and is not metabolizing properly
Ammonia reference value
40-80mcg
