Functional Liver Tests and Treatment of Chronic Hepatitis

Question 1

AST and ALT

Answer 1

amino transferases,
hepatocellular damage
AST found in cytosol and mitochondria- heart liver, muscle RBC
ALT found in cytosol- ALT liver only

Question 2

Alkaline phosphatase

Answer 2

cholestasis, infiltrative disease, biliary obstruction

present in nearly all tissues–>can look at isozyjmes to determine tissue origin

Question 3

Bilirubin

Answer 3

cholestasis, impaired conjugation or biliary obstruction

normal heme degradation product, excreted from body via secretion into bile
insoluble in water
requires conjugation for excretion

Question 4

Characterize patterns of liver chemistry test abnormalities
Hepatocellular
Cholestatic

Answer 4

Cholestatic-

Question 5

Conjugated bilirubin

Answer 5

canaliculus- will be elevated in cholestais

Question 6

Unconjugated bilirubin

Answer 6

will be higher with liver cell damage or hemolytic anemia

Question 7

Elevated AST and ALT (

Answer 7

many things

Question 8

Elevated alkaline phosphatase

Answer 8

often causes pain
Hepatobiliary-bile duct obstruction, PBC, PSC, meds, Hep, Cirrhosis, inflitrative disease

Nonhepatic- bone disease, pregnancy, CKD, Lymphoma and other malignancies, CHF, infection and inflammation

do ultrasound –> ERCP or MRCP

Question 9

AST/ALT ratio

Answer 9

greater than 2:1 etoh liver disease

greater than 1 is seen in cirrhosis

Question 10

AST and ALT > 15x normal

Answer 10

acute viral hep
meds/toxins
ischemic hep
autoimmune hep
wilsons
acute budd-Chiari
hep artery ligation or thrombosis

Question 11

GGT

Answer 11

not very specific
used to determine source of elevated alkaline phosphatase
elevated in any liver problem and after etoh consumption, not present in bone

Question 12

5’-nucleotidease

Answer 12

significantly elevatedonly in liver disease highest levels in cholestatic diseases

Question 13

what conjugates bilirubin?

Answer 13

UDP glucoronyl transferase

Question 14

Gilberts disease

Answer 14

very common
decreased bilirubin uptake,
mutation in promoter of UDPGT, reduced activity

increase in unconjugated bilirubin

Question 15

Grigler-Najjar Syndrome

Answer 15

rare AR, UDP-GT deficiency
type 1 is severe jaundice and neurologic impairment
type 2 lower serum bilirubin, no neurologic impairement

increase in unconjugated bilirubin

Question 16

*Dubin Johnson Syndrome

Answer 16

defective secretion of conjugated bilirubin
rare
mutation of MRP-2
benign
jaundice
no Rx