Gastroenterology and Hepatobilliary Flashcards by Leslie Najera

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

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

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What is albumin?

What happens to albumin after the onset of hepatic dysfunction?

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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What are some causes for hypoalbuminemia? HINT: 3 things

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

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

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

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

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

Evaluate for dehydration (BUN and Hct levels)

Assess for medication causes

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Which of the following would be result of hypoalbuminemia?

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

b. Ascites development

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

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

Malnutrition/malabsorption

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

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

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What is INR and PT?

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

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

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

Increased bleeding risk

- Assess other lab/signs of liver disease

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What is cholestasis?

It’s a deficiency of liver excretory function

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

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

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

Alkaline Phosphatase (ALP)
5’ nucleotidase
Gamma-glutamyl transpeptidase (GGT)
Bilirubin

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

Elevated

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

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

5’ nucleotidase is helpful for what?

To differentiate cholestatic and hepatocellular disease

What is the clinical significance of 5’ nucleotidase?

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

Would GGT elevate or decrease in liver disease?

It would elevate

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

What is the clinical significance of GGT?

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

What is the function of bilirubin?

Breakdown product from red blood cells

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

Could indicate hemolysis and congenital syndrome

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

Could indicate hepatobiliary disease

What test(s) help assess hepatocellular injury?

Aminotransferases

What are aminotransferases & what are the two common types?

These are located inside hepatocytes | - AST & ALT

What is the purpose for aminotransferases?

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

What is the interpretation of aminotransferases? HINT: 3 interpretations

- 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

What is aspartate aminotransferase (AST)?

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

What is alanine aminotransferase (ALT)?

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

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

Ammonia

What are the 5 common types of viral hepatits?

Hepatitis A, B, C, D, and E

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

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

What are two types of tests that measure HAV antibodies?

Immunoglobulin M (IgM) or total antibodies

How is IgM interpreted for HAV?

Anti-HAV IgM reveals acute or recent infection

How are total antibodies interpreted for HAV?

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

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

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)

What four tests help to interpret HBC?

- 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)

What is the interpretation of HBsAg?

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

What is the interpretation of anti-HBs?

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

What is the interpretation of anti-HBc?

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

What is the interpretation of IgM anti-HBc?

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

What four tests help to screen/diagnose HCV?

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