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ADV DIAG > EXAM 3 Hepato-biliary and pancreas > Flashcards

EXAM 3 Hepato-biliary and pancreas Flashcards

1
Q

abdominal US

A
  1. gall stones
  2. biliary obstruction
  3. liver abscess
  4. liver mass, masses, or metastases
  5. pancreatic enlargement
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2
Q

test preferred for gall bladder

A

us

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3
Q

what will be seen in CT of gall bladder

A

only stones with significant calcium content

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4
Q

advantages of US of gall bladder

A

noninvasive, good for stones of all kinds, no radiation

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5
Q

LFTs that give info for cellular integrity

A

ALT- liver
AST- liver
gamma-glutamyl transpeptidase - liver and bile ducts

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6
Q

lfts that give info for cellular fx

A

protein, blood
bilirubin, indirect (unconjugated)
cholesterol
protime (INR)

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7
Q

LFT that give info for biliary obstruction

A

bilirubin, direct (conjugated) excretion obstruction
AP , cellular integrity
gamma-glutmyl transpeptidase- cellular activity

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8
Q

what happens if liver cells become ischemic or die (alcoholic hepatitis, viral hepatitis, drugs such as Tylenol, anticonvulsants, etc)

A

enzymes contained within the cell are freed and enter circulation and increase in concentration

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9
Q

what happens if liver cell fx is reduced (ie cirrhosis)

A

usual products of the liver (clotting factors, albumin, indirect or unconjugated bilirubin) are reduced and decreased concentrations may be detected

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10
Q

what happens if there is a biliary blockage

A

conjugated bilirubin is not eliminated

concentration builds up in blood and urine

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11
Q

if cells lining biliary ducts are stretched and irritated what can happen

A

leakage of alkaline phosphatase and gamma-glutamyl transpeptidase into blood

concentrations rise

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12
Q

common liver fx tests

A

cmp, albumin, AST, ALT, bilirubin, AP

used to detect asymptomatic liver disease and follow progression of disease after dx

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13
Q

AST can increase in what

A

liver disease

also heart attacks

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14
Q

ALT increases in what

A

increases up to x10 in cirrhosis, infections, or tumors

up to 100x in viral or toxic hepatitis

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15
Q

gamma glutamyl transferase used for what

A

monitors pt recovering from hepatitis and cirrhosis

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16
Q

lactate dehydrogenase is increased when

A

liver disease

and following heart attacks

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17
Q

alkaline phosphatase increases when

A

greatly increased in liver tumors and lesions (and metastasis)

moderately increased in disease like hepatitis

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18
Q

if pt has LFTs WNL but increase in AP consider what

A

maybe problem in liver, bones, kidneys, intestinal lining or placenta

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19
Q

ALT range

A

7 - 55 u/l

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20
Q

AST range

A

8 - 48 u/l

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21
Q

ALP range

A

45-115 u/l

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22
Q

albumin range

A

3.5 - 5.0 g/dl

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23
Q

total protein range

A

6.3 - 7.9 g/dl

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24
Q

bilirubin range

A

0.1 - 1.2 mg/dl

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25
Q

ggt aka gamma-glutamyl transferase range

A

9 - 48 u/l

26
Q

ld range

A

122 - 222 u/l

27
Q

what is bilirubin

A

breakdown of hemoglobin

28
Q

unconjugated bilirubin

A

it hasn’t been through the liver yet – so a ton of heme being broken down (and it’s exceeding the pace of liver conjugation) or there’s something wrong with the conjugating capacity of the liver (like a congenital disorder where you’re missing an enzyme necessary for conjugation – for example, Gilbert syndrome)

29
Q

conjugated bilirubin

A

means it’s been through the conjugation process in the liver – so there’s something preventing the secretion of bilirubin into the bile (likehepatitis or biliary obstruction), and the bilirubin is backing up into the blood.

30
Q

what labs look like with acute liver damage (ie d/t infection, toxins, drugs, etc)

A
  1. bilirubin - normal or increased usually after ALT and AST already increased
  2. ALT and AST - usually greatly increased, ALT > AST
  3. ALP - normal or only moderately increased
  4. albumin wnl
  5. pt - usually wnl
31
Q

chronic forms of various liver disorders

A
  1. bilirubin - normal or increased
  2. ALT and AST- moderately increased
  3. ALP - normal to slightly increased
  4. albumin wnl
  5. pt wnl
32
Q

alcoholic hepatitis

A
  1. bilirubin - normal or increased
  2. AST usually x2 of ALT
  3. ALP - normal or moderately increased
  4. albumin wnl
  5. pt - wnl
33
Q

cirrhosis

A
  1. bilirubin- may be increased but usually occurs later in disease
  2. AST usually higher than ALT but levels are usually lower than in alcoholic disease
  3. ALP - normal or increased
  4. albumin - usually decreased
  5. PT usually prolonged
34
Q

bile duct obstruction, cholestasis

A
  1. bilirubin- normal or increased; increased in complete obstruction
  2. alt and ast - normal or moderately increased
  3. alp - increased, often 4x normal
  4. albumin - usually normal, but if disease is chronic levels may decrease
  5. pt - usually normal
35
Q

cancer that has spread to liver - metastasized

A
  1. bilirubin - usually normal
  2. alt and ast - normal or slightly increased
  3. alp usually greatly increased
  4. albumin wnl
  5. pt wnl
36
Q

cancer originating in liver- hepatocellular carcinoma, hcc

A
  1. bilirubin - may be increased, esp if disease has progressed
  2. AST higher than ALT but levels lower than see in alcoholic disease
  3. alp - normal or increased
  4. albumin usually decreased
  5. pt usually prolonged
37
Q

autoimmune

A
  1. bilirubin- normal or increased
  2. alt and ast - moderately increased
  3. alp - normal or slightly increased
  4. albumin - normal or decreased
  5. pt wnl
38
Q

Which of the following is a characteristic of acute alcoholic liver disease?

A

AST/ALT > 2

39
Q

what is greatly increased in metastatic ca

A

alkaline phosphatase

40
Q

true or false, Direct or conjugated bilirubin is expected to rise more that the unconjugated fraction in patients with biliary obstruction.

A

True
Conjugated bilirubin has been metabolized in the liver to make it water soluble so it can be excreted. When the bile ducts are obstructed, conjugated bilirubin backs up, and its concentration rises in the blood.

41
Q

true or false, A patient with right upper quadrant pain exacerbated by a fatty meal can safely be said to not have gall bladder disease if the GGT, bilirubin and alkaline phosphatase are normal

A

false

When there is a high suspicion of gall bladder disease, patients should have an ultrasound examination of the gall blabber and biliary tract regardless of the results of the GGT, bilirubin and alkaline phosphatase

42
Q

with biliary obstruction or inflammation you would expect to see elevation in what labs

A

bilirubin
alkaline phosphatase
GGT

43
Q

what is test of cellular integrity of bile duct lining cells

A

alkaline phosphatase

44
Q

what is test of liver cell integrity?

A

ast

45
Q

what are amylase and lipase

A

enzymes released from pancreatic parenchymal cells when pancreas is inflamed or ischemic

46
Q

when is blood amylase and lipase levels increased

A

with inflammation or ischemia

47
Q

signs of acute pancreatitis

A

pt presents with acute onset of mid-abdominal or back pain (in lumbar area) “ band radiating to back”, fever, vomiting, and malaise

48
Q

causes of pancreatitis

A

excess alcohol ingestion
gall stones in the pancreatic portion of the common bile duct
medications
highly elevated triglycerides

49
Q

amylase timing

A

rises before lipase

rise within 12 hours of insult, decrease 48 - 72 hrs after insult

50
Q

lipase timing

A

rise 24- 48 hrs and remain elevated 5 - 7 days

elevated longer than amylase

51
Q

what is the test to rule in acute pancreatitis

A

lipase

24 hr urine amylase almost as good

52
Q

other than pancreatitis, when else can lipase be elevated

A

renal impairment or intestinal infarction

53
Q

clinical picture of hepatitis

A

abnormal LFTs, and s/s of acute viral infection- n/v/f, malaise, yellowing of skin

54
Q

positive HAV ab IgM means what

A

acute infection

contagious

55
Q

HAV Ab IgG means what

A

previous infection when HAV IgM is negative

immune

56
Q

how does body respond to hep a with antibodies

A

body first responds with IgM antibody and secondarily with IgG antibody as a preventative against future infection

57
Q

Hepatitis B antigen (HBsAg):

A

protein on surface of hep B virus

seen increased in serum during acute or chronic hep b infection

presence means pt is infectious

58
Q

Hepatitis B surface antibody (anti-HBs):

A

generally indicates recovery and immunity from hep B infection

also seen in pts who have been successfully vaccinated against hep b

59
Q

Total hepatitis B core antibody (anti-HBc):

A

Appears at the onset of symptoms in acute hepatitis B and persists for life.

The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame

60
Q

IgM antibody to hepatitis B core antigen (IgM anti-HBc):

A

Positivity indicates recent infection with hepatitis B virus (<6 mos). Its presence indicates acute infection`

61
Q

Anti-HCV (Antibody Hepatitis C Virus)

A

+ result does not always means pt has recovered from infection & developed immunity

may indicate current infection, 85% become carriers

62
Q

if anti-HCV + order what to confirm dx

A

HCV RNA
HCV Viral Load
HCV Genotype –done after HCV dx confirmed
Refer to GI for liver biopsy/treatment if +

Marked increase risk for liver cancer or failure- will need to be followed at least yearly

often asymptomatic

ADV DIAG (23 decks)

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