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Clinical Chemistry (CC 1) > (F) L3: Liver Function Tests (Liver Diseases) > Flashcards

(F) L3: Liver Function Tests (Liver Diseases) Flashcards

1
Q
  • Refers to elevated bilirubin in the blood
  • A yellowish discoloration of skin and sclera
A

Jaundice/Hyperbilirubinemia

Note: Jaundice is NOT a disease, just a manifestation

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2
Q

Hyperbilirubinemia

Jaundice will only start manifesting once the level of bilirubin in the blood reaches what?

A

3-5mg/dL or GREATER

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3
Q

Hyperbilirubinemia

TOF: Jaundice is always associated with hyperbilirubinemia

A

False (some people can be diagnosed with hyperbilirubinemia but manifest no signs of jaundice yet)

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4
Q

Hyperbilirubinemia

Refers to a serum/plasma specimen with increased bilirubin/yellowish discoloration

A

Icterus/Icteric

Note: Jaundice is for describing the person, icteric is for the sample

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5
Q

Hyperbilirubinemia

Refers to hyperbilirubinemia in newborns/infants wherein the BBB is not yet intact leading to bilirubin deposition in the brain

A

Kernicterus

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6
Q

Hyperbilirubinemia

Kernicterus level according to Henry’s?

A

> 20mg/dL (15-20mg/dL is borderline)

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7
Q

Classifications of Hyperbilirubinemia

  • Happens when there is hemolysis/hemolytic disease, malaria, and autoimmune disease
  • There is elevated B1
  • There is no problem with the liver
A

Pre-hepatic

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8
Q

Classifications of Hyperbilirubinemia

  • There is elevated bilirubin due to liver disease
  • May be secondary to intrinsic defects due to disorders of bilirubin metabolism and transport defects
  • Diseases resulting to hepatocellular injury/destruction (e.g. hepatitis)
A

Hepatic

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9
Q

Classifications of Hyperbilirubinemia

  • There is a problem with bilirubin excretion (biliary obstruction)
  • May be due to gallstones (cholelithiasis) and tumors
  • There is elevated B2
A

Post-hepatic

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10
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • Due to immaturity of the liver (deficient UDPGT)
  • Elevated B1 levels are observed
  • Patient will undergo phototherapy until the liver matures (bilirubin is light sensitive)
A

Physiologic Jaundice of the Newborn

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11
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • A genetic disorder wherein the UGT1A1 gene (for UDPGT) is mutated
  • B1 is elevated while B2 is decreased
A

Crigler-Najjar Syndrome

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12
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

Types of Crigler-Najjar Syndrome (answer all):
1. A complete deficiency of UDPGT (elevated B1 and absent B2)
2. A partial deficiency of UDPGT (elevated B1 and decreased B2)

A
  1. Type 1
  2. Type 2
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13
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • An impaired cellular uptake of bilirubin due to a defect in bilirubin transport
  • Can be secondary to a benign deficiency of UDPGT
  • Elevated B1
A

Gilbert Syndrome

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14
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • There is a circulating inhibitor of bilirubin conjugation
  • Elevated B1 and decreased B2
  • A familial form of unconjugated hyperbilirubinemia (inherited disorder)
A

Lucey-Driscoll Syndrome

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15
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • A genetic disorder wherein there is a deficiency of MDR2/cMOAT (Canalicular Multi-Specific Organic Anion Transporter) which is important for the excretion of bilirubin
  • Elevated B2 (no problem with the conjugation, only transport)
  • Risk for developing delta-bilirubin
  • There is a deposition of lipofucsin in the liver (dark pigmentation)
A

Dubin-Johnson

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16
Q

Hyperbilirubinemia (Instrinsic Liver Defects)

  • A genetic defect in the excretion of bilirubin but with unknown etiology
  • Elevated B2
  • There is no dark pigmentation of the liver
A

Rotor Syndrome

17
Q
  • Usually occurs secondary to chronic hepatocellular damage
  • Scar tissues replace normal healthy tissue
  • Conjugation and excretion functions are affected
  • Both B1 and B2 are elevated
  • Secondary to viral hepatitis, autoimmune hepatitis, inherited disorders, non-alcoholic steatohepatitis, blocked bile ducts, drugs, toxins, and infections
18
Q
  • Includes viral, bacterial, and parasitic infections
  • Also includes non-infections (radiation, drugs, chemical, and autoimmune diseases and toxins)
  • Refers to the inflammation of the liver
  • There is elevated B1 and B2
19
Q

In hepatitis, bilirubin is increased in what percent of cases for the following?

  1. Hepatitis A
  2. Hepatitis B
  3. Acute Hepatitis C

A. 20%
B. 30%
C. 70%

A
  1. Hep. A - 70%
  2. Hep. B - 30%
  3. Acute Hep. C - 20%
20
Q
  • Refers to gallstones, cholelithiasis, and pancreatic tumors
  • There is post-hepatic jaundice caused by elevated B2
A

Biliary Obstruction

21
Q

Benign or Malignant Tumor?
1. Hepatocellular adenoma and hemangiomas
2. Hepatocellular and bile duct carcinoma

A
  1. Benign
  2. Malignant
22
Q
  • An acute illness characterized by non-inflammatory encephalopathy
  • Neurologic functions are affected
  • There is fatty degeneration of the liver (hyperbilirubinemia)
  • A threefold increase of ammonia in blood due to the insufficient conversion of ammonia to urea
  • More common in children with unknown etiology

Note: Doctors suspect the etiology to be the ingestion of aspirin

A

Reye’s Syndrome

23
Q

Alcohol and Drug Related Diseases

  • Slight elevation in AST, ALT, and GGT
  • Fatty infiltrates are noted with vacuoles on liver biopsy
  • Affects young to middle-aged people with a history of moderate alcohol consumption
A

Alcoholic Fatty Liver

24
Q

Alcohol and Drug Related Diseases

  • Presents with fever, ascites, and proximal damage
  • Moderately elevated AST, ALT, GGT, ALP
  • Total bilirubin is greater than 5mg/dL
A

Alcoholic Hepatitis

25
Q

Alcohol and Drug Related Diseases

  • Most severe form (all functions are affected)
  • More common in males than in females
  • Increased liver function tests (AST, ALT, GGT, ALP, and Total Bilirubin)
  • There is decreased albumin and prolonged prothrombin time
  • A biopsy is the only method for definitive diagnosis
A

Alcoholic Cirrhosis

26
Q

This enzyme is the marker for occult and chronic alcoholism

A

Gamma-Glutamyl Transferase (GGT)

27
Q

TOF: Intrinsic liver defects are inherited

28
Q

Give the intrinsic liver defects that present with elevated B1

A
  1. Physiologic Jaundice of Newborn
  2. Crigler-Najjar Syndrome
  3. Gilbert Syndrome
  4. Lucey-Driscoll Syndrome
29
Q

Give the intrinsic liver defects that present with elevated B2

A
  1. Dubin-Johnson
  2. Rotor Syndrome
30
Q

Unknown etiology?
A. Rotor Syndrome
B. Reye’s Syndrome
C. Both
D. Neither

31
Q

B1 is elevated while B2 is decreased

A. Crigler-Najjar Type 1
B. Crigler-Najjar Type 2
C. Lucey-Driscoll Syndrome
D. A and B
E. B and C

A

E. LD Syndrome and Type 2 only (Type 1 has absent B2)

32
Q

Elevated B1 only
A. Cirrhosis
B. Hepatitis
C. Both
D. Neither

A

D. Neither (both B1 and B2 are elevated)

Clinical Chemistry (CC 1) (33 decks)

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