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Clinical Lab > Gastroenterology and Hepatobilliary > Flashcards

Gastroenterology and Hepatobilliary Flashcards

1
Q

What are the types of tests for a Synthetic Liver Function? HINT: 3 types

A

Albumin, Pre-albumin, and Prothrombin time (PT) w/ Internationalized Ratio (INR)

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2
Q

What is albumin?

What happens to albumin after the onset of hepatic dysfunction?

A

Albumin is a major plasma protein involved in maintaining plasma oncotic pressure AND the binding and transportations of hormones, fatty acids, anions, and drugs
Albumin decreases

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3
Q

What are some causes for hypoalbuminemia? HINT: 3 things

A

Malnutrition/malabsorption, protein loss from the kidneys/gut/skin, increased blood volume

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4
Q

What are the some clinical outcomes of hypoalbuminemia? HINT: 5 things

A

It could cause ascites, pulmonary or peripheral edema, could affect the interpretations of total serum calcium and concentrations of drugs that are highly protein bound?

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5
Q

What are some causes of hyperalbuminemia? HINT: some (two) causes are false accusations of hyperalbuminemia

A

Severe dehydration, anabolic steroids; ampicillin and heparin may cause false elevated results

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6
Q

What are some clinical significance of hyperalbuminemia? HINT: 2 things

A

Evaluate for dehydration (BUN and Hct levels)

Assess for medication causes

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7
Q

Which of the following would be result of hypoalbuminemia?

a. Increased drug binding
b. Ascites development
c. Falsely high calcium
d. Increased bleed risk

A

b. Ascites development

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8
Q

What is pre-albumin? What is pre-albumin affected by more

A
  • It’s just like albumin but instead it’s rapidly responsive than albumin
  • Pre-albumin is affected more by protein nutrition and less affected by hepatic dysfunction and dehydration compared to albumin
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9
Q

What are some causes of pre-albumin to be low?

A

Malnutrition/malabsorption

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10
Q

What are the clinical significance for low levels of pre-albumin? HINT: 2 things

A
  • Monitored routinely in patients receiving IV or tube feeding
  • Helpful to determine acute vs. chronic malnutrition
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11
Q

What is INR and PT?

A

It’s a measurement of speed for a set of reactions in the extrinsic pathway of the coagulation cascade

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12
Q

What are some causes for INR and PT to become abnormal? HINT: 5 things

A
  • Hepatic impairment
  • Only a substantial (huge) hepatic impairment would cause clotting abnormalities and decreased synthesis of clotting factors
  • Medications
  • Vitamin K deficiency (malnutrition/malabsorption)
  • Inherited clotting factor diseases
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13
Q

What are some clinical significance in INR and PT? HINT: 2 things

A
  • Increased bleeding risk

- Assess other lab/signs of liver disease

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14
Q

What is cholestasis?

A

It’s a deficiency of liver excretory function

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15
Q

Failure of excretory functions could lead to what patient symptoms? HINT: 3 things

A

Jaundice (bilirubin build up)
Pruritus (bile salts build up)
Xanthoma (lipid deposits in skin)

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16
Q

What tests are done to detect Excretory Liver Function and Cholestasis? HINT: 4 tests

A
  • Alkaline Phosphatase (ALP)
  • 5’ nucleotidase
  • Gamma-glutamyl transpeptidase (GGT)
  • Bilirubin
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17
Q

When will cholestatic disorder be suggested in ALP? Will it be elevated or decreased?

A

Elevated

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18
Q

What are some non-hepatic causes of elevated ALP? HINT: 8 things

A

Healing fractures, osteomalacia, paget disease, tumors, hyperthyroidism, anticonvulsants (phenytoin, phenobarbital), lithium, and oral contraceptives

19
Q

5’ nucleotidase is helpful for what?

A

To differentiate cholestatic and hepatocellular disease

20
Q

What is the clinical significance of 5’ nucleotidase?

A

Helps in differential diagnosis coupled with elevated ALP to determine the source of the problem
- However, if ALP is increased and 5’ nucleotidase is normal it could indicate as a non-hepatic cause for ALP

21
Q

Would GGT elevate or decrease in liver disease?

A

It would elevate

- Usually high concentrations are in patients who abuse alcohol or have alcoholic liver disease

22
Q

What is the clinical significance of GGT?

A

Helps in differential diagnosis coupled with elevated ALP to determine the source of the problem

23
Q

What is the function of bilirubin?

A

Breakdown product from red blood cells

24
Q

When bilirubin is elevated and Liver Function Tests (LFTs) are normal that could indicate what?

A

Could indicate hemolysis and congenital syndrome

25
Q

When bilirubin is elevated and LFTs are elevated too that could indicate what?

A

Could indicate hepatobiliary disease

26
Q

What test(s) help assess hepatocellular injury?

A

Aminotransferases

27
Q

What are aminotransferases & what are the two common types?

A

These are located inside hepatocytes

- AST & ALT

28
Q

What is the purpose for aminotransferases?

A

The purpose is to reflect damage in ACTIVE hepatocytes (not in hepatocytes that have been damaged for awhile now)

29
Q

What is the interpretation of aminotransferases? HINT: 3 interpretations

A
  • Highly elevated (> 1000 U/L) concentrations could indicate acute viral hepatitis, severe drug or toxic reactions, or ischemic hepatitis (inadequate blood flow to the liver)
  • AST: ALT ratio > 2 could signify alcoholic hepatitis
  • AST elevation but ALT remains normal could signify muscle or heart disease
30
Q

What is aspartate aminotransferase (AST)?

A

A type of aminotransferase that is NOT solely located in the hepatocytes
- So, can be elevated to other type of conditions

31
Q

What is alanine aminotransferase (ALT)?

A

A type of aminotransferase that is MORE localized in the liver than AST
- So, can be specific to liver injury

32
Q

What test is associated with detoxification? HINT: There’s only one

A

Ammonia

33
Q

What are the 5 common types of viral hepatits?

A

Hepatitis A, B, C, D, and E

34
Q

What is hepatitis A (HAV) and how is it transmitted?

A

It’s primarily transmitted by fecal-oral route by contaminated food or water OR by person-to-person contact

35
Q

What are two types of tests that measure HAV antibodies?

A

Immunoglobulin M (IgM) or total antibodies

36
Q

How is IgM interpreted for HAV?

A

Anti-HAV IgM reveals acute or recent infection

37
Q

How are total antibodies interpreted for HAV?

A

Total Anti-HAV indicates present, previous infection, or immunization (this is composed of antibodies from all isotypes of HAV)

38
Q

What is hepatitis B (HBV) and how is it transmitted?

A

It’s primarily transmitted by bodily fluids, such as:

  • most commonly through sexual activities
  • Others: contaminated needles, nonsterile tattooing/piercing, or vertical transmission (mother to baby)
39
Q

What four tests help to interpret HBC?

A
  • Hepatitis B surface antigen (HBsAg)
  • Hepatitis B surface antibody (anti-HBs)
  • Total hepatitis B core antibody (anti-HBc)
  • IgM antibody to hepatitis B core antigen (IgM anti-HBc)
40
Q

What is the interpretation of HBsAg?

A

High levels could indicate chronic or acute infection OR presence could indicate the person is infectious

41
Q

What is the interpretation of anti-HBs?

A

Generally interpreted as indicating recovery or immunity from HBV infection OR is developed in a person who has been successfully vaccinated

42
Q

What is the interpretation of anti-HBc?

A

Appears at the onset of symptoms in acute HBV and persists for life OR it could indicate previous or ongoing infections

43
Q

What is the interpretation of IgM anti-HBc?

A

Indicates recent infection of HBV (in less than or equal to 6 months) [acute infection NOT chronic infection]

44
Q

What four tests help to screen/diagnose HCV?

A
  • ELISA
  • RT-PCR
  • RIBA
  • Quantitative viral load molecular assays

Clinical Lab (7 decks)

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