Functional Liver Tests and Treatment of Chronic Hepatitis

Question 1

ALT and AST elevation indicates ______________.

Answer 1

hepatocellular damage

Question 2

Elevation of bilirubin and alkaline phosphatase indicates _____________.

Answer 2

bile duct obstruction

Question 3

The most common causes of chronic liver disease are ____________.

Answer 3

alcohol abuse and viral hepatitis

Question 4

ASTs and ALTs are _____________.

Answer 4

aminotransferases

Question 5

Which is found only in the liver, ALT or AST?

Answer 5

ALT (L for Liver)

Question 6

AST is also found in the ______________.

Answer 6

heart, muscle, and blood

Question 7

Where are AST and ALT in hepatocytes (what organelles)?

Answer 7

AST: mitochondria and cytosol
ALT: cytosol

Question 8

The AST:ALT ratio should be less than ____. If it’s greater than 1, that could indicate __________; greater than 2 indicates __________.

Answer 8

1; cirrhosis; alcohol abuse

Question 9

Now that we have effective treatment for HCV, ___________ will become the leading reason for liver transplant.

Answer 9

steatohepatitis (non-alcoholic fatty liver)

Question 10

What is the first step in evaluating someone with abnormal LFTs? The second? The third?

Answer 10

First: conduct a thorough history and physical
Second: recommend discontinuation of hepatotoxic medications
Third: test for virus, ANA, iron, albumin, bilirubin, and alkaline phosphatase

Question 11

There are only a few causes of extremely high (greater than 15x normal) levels of ALT and AST. List them.

Answer 11

• 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

Question 12

____________ uniformly requires a liver transplant.

Answer 12

Wilson’s disease

Question 13

What is the general purpose of alkaline phosphatase?

Answer 13

It removes phosphate groups from nucleotides, protein, and alkaloids.

Question 14

Which liver enzyme is also present in nearly all tissues?

Answer 14

Alkaline phosphatase

Question 15

True or false: acute choledocholithiasis leads to a rapid rise in alkaline phosphatase.

Answer 15

False. It takes time for alkaline phosphatase to accumulate.

Question 16

Other than the traditional liver enzymes, what other enzymes can be tested for specific indications of liver failure?

Answer 16

GGT (gamma-glutamyltransferase)
5-nucleotidease

If either of these is elevated, then liver disease is highly likely.

Question 17

Those with primary biliary cirrhosis will have elevated levels of ______________.

Answer 17

anti-mitochondrial antibodies (absolutely positive –no other diseases have this)

Question 18

Why does bilirubin need to be conjugated?

Answer 18

Because it is normally insoluble in water

Question 19

After conjugation, direct bilirubin is __________________. Why is it elevated in bile duct obstruction?

Answer 19

actively secreted in the bile duct; because it can’t leave through the bile duct and so gets absorbed by the blood

Question 20

There is a disorder in which people express less UDP-GT than normal. What happens when they are triggered by illness, stress, or hemolysis?

Answer 20

They develop high indirect bilirubin –this is Gilbert’s disease.

Question 21

The extreme form of Gilbert’s (in which there is no or almost no UDP-GT) is called ____________.

Answer 21

Crigler-Najjar syndrome

Question 22

Those with Dubin-Johnson syndrome have elevated ___________ bilirubin.

Answer 22

conjugated

Question 23

Why do people with cirrhosis develop jaundice?

Answer 23

Because they cannot get bilirubin into cells as easily (because of the desmoplastic changes in the liver)

Question 24

What are the two main reasons to treat chronic hepatitis?

Answer 24

It prevents cirrhosis (and the consequences thereof) and prevents risk of hepatocellular carcinoma.

Question 25

Presence of _______________ indicates active hepatitis B infection.

Answer 25

hepatitis B surface antigen

Question 26

Presence of ______________ indicates past infection with recovery with or vaccination to hepatitis B.

Answer 26

antibody to hepatitis B surface antigen

Question 27

Presence of ________________ indicates past or active infection with hepatitis B infection.

Answer 27

antibody to hepatitis B core

Question 28

Presence of _______________ indicates high viral load of hepatitis B, while antibody to this indicates lower viral load.

Answer 28

hepatitis B e antigen

Question 29

What are the indications for chronic hepatitis treatment?

Answer 29

• 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.

Question 30

Normal ALT level predicts poor possibility of ____________ in chronic hepatitis B.

Answer 30

seroconversion (from HBeAg to HBeAb); only treat in cases of cirrhosis

Question 31

Sofosbuvir (Solvadi) can cure up to _______ percent of people with hepatitis C with no symptoms.

Answer 31

95

Question 32

Why did Colorado medicare and medicaid stop paying for sofosbuvir?

Answer 32

Because providers in Colorado prescribed 13 million dollars in one month, when the entire yearly budget is 78 million.

Question 33

Hereditary hemochromatosis results from ____________ and is treated with ____________.

Answer 33

increased intestinal absorption of iron; phlebotomy

Question 34

Although the gold standard for diagnosing Wilson’s disease is liver biopsy, low levels of ____________ also indicate Wilson’s.

Answer 34

ceruloplasmin (a copper-binding enzyme)

Question 35

In addition to phlebotomy, those with hereditary hemochromatosis should stop consuming _____________

Answer 35

excess vitamin C

Question 36

The best treatment for autoimmune hepatitis is ______________.

Answer 36

azathioprine and corticosteroids

Question 37

Compare and contrast primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC).

Answer 37

PSC: primarily affects men; large bile duct involvement; associated with UC

PBC: primarily affects women; small bile duct involvement; associated with AMA

Question 38

Prolonged PT/INR that corrects with vitamin K suggests _______________ rather than _____________.

Answer 38

malabsorption; defective liver enzyme production

Question 39

How is non-alcoholic steatohepatitis (NASH) treated?

Answer 39

Lifestyle modification: weight loss, diabetes control, and management of blood lipids

Question 40

AST is important in forming ___________, while ALT is important in forming ______________.

Answer 40

pyruvate; oxaloacetate

Question 41

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.

Answer 41

5-nucleotidease and gamma-glutamyltransferase

Question 42

What treatments help HBV?

Answer 42

Tenofovir and interferon

Question 43

What is SVR?

Answer 43

Sustained virological response

Question 44

For those with HH, perform one phlebotomy per ________ for ___________. After this period, one phlebotomy every 2 to 4 months should suffice.

Answer 44

week; one year

Question 45

True or false: once someone with AIH has normal transaminases, you can cease treatment.

Answer 45

False. It is a chronic disease and is likely to flair if treatment is abruptly stopped.

Question 46

True or false: steroids can prevent the dysfunction seen in PSC.

Answer 46

False. There are no successful medical treatments of PSC.

Question 47

How does ursodiol work?

Answer 47

It helps remove bile and protects cells from effects of too much bile.

Question 48

How much copper should you have in 24 hours of urine?

Answer 48

Less than 40 ug