Gastroenterology and Hepatobilliary Flashcards
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)
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
What are some causes for hypoalbuminemia? HINT: 3 things
Malnutrition/malabsorption, protein loss from the kidneys/gut/skin, increased blood volume
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?
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
What are some clinical significance of hyperalbuminemia? HINT: 2 things
Evaluate for dehydration (BUN and Hct levels)
Assess for medication causes
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
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
What are some causes of pre-albumin to be low?
Malnutrition/malabsorption
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
What is INR and PT?
It’s a measurement of speed for a set of reactions in the extrinsic pathway of the coagulation cascade
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
What are some clinical significance in INR and PT? HINT: 2 things
- Increased bleeding risk
- Assess other lab/signs of liver disease
What is cholestasis?
It’s a deficiency of liver excretory function
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)
What tests are done to detect Excretory Liver Function and Cholestasis? HINT: 4 tests
- Alkaline Phosphatase (ALP)
- 5’ nucleotidase
- Gamma-glutamyl transpeptidase (GGT)
- Bilirubin
When will cholestatic disorder be suggested in ALP? Will it be elevated or decreased?
Elevated
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
