Fxnl Liver tests (5)

Question 1

AST is a hepatocellular dmg marker, where else is it located?

Answer 1

Liver
heart
muscle
blood

(ALT is liver only)

Question 2

Typical AST:ALT ratio is ____
___ is cirrhosis
___ is alcoholic liver disease

Answer 2

1

>2

Question 3

Alkaline phosphatase

Answer 3

present in nearly all tissue

Elevated in:

• Cholestatic or infiltrative dis of liver
• obstruction of biliary system
• bone disease
• pregnancy

Question 4

Prothrombin time

prolongation is significant for?

Answer 4

assess extrinsic clotting pathway

• prolonged jaundice
• malabsorption

Question 5

what liver chemistry test elevation is seen with:
hepatocellular
cholestatic

Answer 5

hepatocellular: AST/ALT elevation
Cholestatic: alk phos elevation

Question 6

Conjugated bilirubin (\_\_\_\_\_)
Unconjugated bilirubin (\_\_\_\_\_)

Answer 6

• Conjugated bilirubin (indirect)

* Unconjugated bilirubin (direct)

Question 7

Etiology of Mild (

Answer 7

1. Acute viral hepatitis (A-E, herpes)
2. Meds/toxins
3. Ischemic hepatitis
4. Autoimmune hepatitis
5. Wilson’s disease
6. Budd-chiari syndrome
7. hepatic artery ligation or thrombosis

Question 8

If pt has ↑ AST & ALT

Answer 8

1. Hx and Physical →
2. discontinue hepatotoxic meds→
3. alk phos, albumin, bili, INR, viral hep serologies, iron →

NEGATIVE SERO + SYMPTOMATIC

4a. US, ANA, ASMA, ceruloplasmin, a1-antitrypsin
5a. Liver biopsy

NEG SERO + ASYMPTOMATIC

4. Lifestyle mod
5. 3-6 mo repeat liver chem
6. if abnl run step 4a

Question 9

How can you tell if the problem is from the liver (hepatobiliary) or not from the liver (nonhepatobiliary)?

Answer 9

5’ nucleotidease
- elevated only in liver disease

GGT

• not in bone
• elevated after -oh consumption

Question 10

Hemolytic jaundice

Answer 10

[overwhelmed conjugation]

Hemolytic anemia → 
lyse RBC →
lots of UNCONJUGATED bili →
liver tries to get rid of as much as poss →
lots of CONJUGATED bili

Question 11

Gilbert’s disease

Answer 11

[decreased unconjugated bilirubin uptake]

Mut in gene encoding for UDP-GT → reduced activity → elevated total bilirubin that is mainly composed of unconjugated bilirubin

Question 12

Crigler-Najjar syndrome

Answer 12

[Impaired bilirubin conjugation]

rare - AR
UDP-GT deficiency/low levels (cant conj bili)

Type I: severe jaundice, neuro impairment
Type II: lower serum bili, no neurologic impairment

Question 13

HBcAb

Answer 13

marker of active or prior infection. If you have this you were previously infected

Question 14

Goal of Treatment for Hep B

Answer 14

HBeAg seroconversion, Interferon,
*Nucleoside analog (Tenofovir) - majority

[loss of HBeAg and development of HBeAb associated with negative HBV DNA when treatment is stopped]

Question 15

Chronic HBV infection: indications for treatment

Answer 15

(1) HBsAg (+) [surface antigen] in blood for >6 months
(2) serum HBV DNA > 105 copies/mL
(3) persistent or intermittent elevation in ALT and AST levels [likelihood of HBeAg seroconversion with normal ALT is very low]
- if elevated serum ALT is high, they respond better to tx

IF PT HAS CIRRHOSIS WITH LIVER BIOPSY TX WITH NUCLEOSIDE/TIDE ANALOG (TENOFOVIR!)

Question 16

Hep C infxn

• chronic HCV?
• Goal of tx?

Answer 16

Chronic HCV is presence of HCV RNA in blood >6 mo after infxn

Goal: clear HCV RNA so that remain HCV RNA negative 12 weeks after stopping therapy
- sustained virological response (SVR) = cure

TX: 1 pill

Question 17

If pt has hereditary hemochromatosis and they have increased intestinal iron absorption. You would normally suggest therapeutic phlebotomy (to keep ferritin 50-100ng/mL). But you find out the pt is anemic, what do you do?

Answer 17

Anemic pts do not tolerate phlebotomy well.

Chelation therapy instead with desfuroxamide

Question 18

Tx for primary biliary cirrhosis

Answer 18

Ursodeoxycolic acid (UDCA)

• improves bile acid transport
• detoxifies bile and provides cytoprotection
• reduce need for liver transplant

Question 19

AMA + (anti mitochondrial ab) is strongly indicative of?

Answer 19

primary biliary cirrhosis