Functional Liver Tests and Treatment of Chronic Hepatitis Flashcards
ALT and AST elevation indicates ______________.
hepatocellular damage
Elevation of bilirubin and alkaline phosphatase indicates _____________.
bile duct obstruction
The most common causes of chronic liver disease are ____________.
alcohol abuse and viral hepatitis
ASTs and ALTs are _____________.
aminotransferases
Which is found only in the liver, ALT or AST?
ALT (L for Liver)
AST is also found in the ______________.
heart, muscle, and blood
Where are AST and ALT in hepatocytes (what organelles)?
AST: mitochondria and cytosol
ALT: cytosol
The AST:ALT ratio should be less than ____. If it’s greater than 1, that could indicate __________; greater than 2 indicates __________.
1; cirrhosis; alcohol abuse
Now that we have effective treatment for HCV, ___________ will become the leading reason for liver transplant.
steatohepatitis (non-alcoholic fatty liver)
What is the first step in evaluating someone with abnormal LFTs? The second? The third?
First: conduct a thorough history and physical
Second: recommend discontinuation of hepatotoxic medications
Third: test for virus, ANA, iron, albumin, bilirubin, and alkaline phosphatase
There are only a few causes of extremely high (greater than 15x normal) levels of ALT and AST. List them.
- acute viral hepatitis (HAV, HEV, HSV)
- ischemic hepatitis (e.g., cardiac arrest)
- Budd-Chiari syndrome
- medications and toxins (e.g., amphetamines, acetaminophen)
- autoimmune hepatitis
- hepatic artery ligation or thrombosis
- Wilson’s disease
____________ uniformly requires a liver transplant.
Wilson’s disease
What is the general purpose of alkaline phosphatase?
It removes phosphate groups from nucleotides, protein, and alkaloids.
Which liver enzyme is also present in nearly all tissues?
Alkaline phosphatase
True or false: acute choledocholithiasis leads to a rapid rise in alkaline phosphatase.
False. It takes time for alkaline phosphatase to accumulate.
Other than the traditional liver enzymes, what other enzymes can be tested for specific indications of liver failure?
GGT (gamma-glutamyltransferase)
5-nucleotidease
If either of these is elevated, then liver disease is highly likely.
Those with primary biliary cirrhosis will have elevated levels of ______________.
anti-mitochondrial antibodies (absolutely positive –no other diseases have this)
Why does bilirubin need to be conjugated?
Because it is normally insoluble in water
After conjugation, direct bilirubin is __________________. Why is it elevated in bile duct obstruction?
actively secreted in the bile duct; because it can’t leave through the bile duct and so gets absorbed by the blood
There is a disorder in which people express less UDP-GT than normal. What happens when they are triggered by illness, stress, or hemolysis?
They develop high indirect bilirubin –this is Gilbert’s disease.
The extreme form of Gilbert’s (in which there is no or almost no UDP-GT) is called ____________.
Crigler-Najjar syndrome
Those with Dubin-Johnson syndrome have elevated ___________ bilirubin.
conjugated
Why do people with cirrhosis develop jaundice?
Because they cannot get bilirubin into cells as easily (because of the desmoplastic changes in the liver)
What are the two main reasons to treat chronic hepatitis?
It prevents cirrhosis (and the consequences thereof) and prevents risk of hepatocellular carcinoma.
Presence of _______________ indicates active hepatitis B infection.
hepatitis B surface antigen
Presence of ______________ indicates past infection with recovery with or vaccination to hepatitis B.
antibody to hepatitis B surface antigen
Presence of ________________ indicates past or active infection with hepatitis B infection.
antibody to hepatitis B core
Presence of _______________ indicates high viral load of hepatitis B, while antibody to this indicates lower viral load.
hepatitis B e antigen
What are the indications for chronic hepatitis treatment?
- High serum DNA load
- Elevated ALTs/ASTs
- Persistent (greater than 6 months) elevated antibody to HBV surface antigen
- If a patient has cirrhosis, treat regardless of whether or not the three things above are met.
Normal ALT level predicts poor possibility of ____________ in chronic hepatitis B.
seroconversion (from HBeAg to HBeAb); only treat in cases of cirrhosis
Sofosbuvir (Solvadi) can cure up to _______ percent of people with hepatitis C with no symptoms.
95
Why did Colorado medicare and medicaid stop paying for sofosbuvir?
Because providers in Colorado prescribed 13 million dollars in one month, when the entire yearly budget is 78 million.
Hereditary hemochromatosis results from ____________ and is treated with ____________.
increased intestinal absorption of iron; phlebotomy
Although the gold standard for diagnosing Wilson’s disease is liver biopsy, low levels of ____________ also indicate Wilson’s.
ceruloplasmin (a copper-binding enzyme)
In addition to phlebotomy, those with hereditary hemochromatosis should stop consuming _____________
excess vitamin C
The best treatment for autoimmune hepatitis is ______________.
azathioprine and corticosteroids
Compare and contrast primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC).
PSC: primarily affects men; large bile duct involvement; associated with UC
PBC: primarily affects women; small bile duct involvement; associated with AMA
Prolonged PT/INR that corrects with vitamin K suggests _______________ rather than _____________.
malabsorption; defective liver enzyme production
How is non-alcoholic steatohepatitis (NASH) treated?
Lifestyle modification: weight loss, diabetes control, and management of blood lipids
AST is important in forming ___________, while ALT is important in forming ______________.
pyruvate; oxaloacetate
If someone has an elevated alkaline phosphatase, be sure to check _____________ levels. If those are elevated, too, then the alkaline phosphatase almost certainly came from the liver.
5-nucleotidease and gamma-glutamyltransferase
What treatments help HBV?
Tenofovir and interferon
What is SVR?
Sustained virological response
For those with HH, perform one phlebotomy per ________ for ___________. After this period, one phlebotomy every 2 to 4 months should suffice.
week; one year
True or false: once someone with AIH has normal transaminases, you can cease treatment.
False. It is a chronic disease and is likely to flair if treatment is abruptly stopped.
True or false: steroids can prevent the dysfunction seen in PSC.
False. There are no successful medical treatments of PSC.
How does ursodiol work?
It helps remove bile and protects cells from effects of too much bile.
How much copper should you have in 24 hours of urine?
Less than 40 ug
