intro to liver dz

Question 1

3 main tests that assess liver function & what you order to get them

Answer 1

LFT: albumin & total bilirubin
Coags: PT/INR

albumin & PT/INR are for general liver function

Question 2

why do we care about which labs are elevated?

Answer 2

tells you where the damage could be coming from

Question 3

which 3 labs (not in LFTs) that change in presence of liver failure? do they increase or decrease?

Answer 3

Glucose, cholesterol, BUN
all decrease in liver failure

Question 4

list 7 causes of low albumin

Answer 4

• cirrhosis or liver failure
• alcohol ingestion
• malnutrition
• sepsis
• cancer
• burns
• nephrotic syndrome
• protein-losing enteropathy

Question 5

which 3 clotting factors are NOT made by the liver

Answer 5

3,4 and vWF

Question 6

2 conditions and 1 medication that affect PT/INR

Answer 6

Vit K deficiency (cholestasis, etc)
coumadin
DIC

Question 7

3 things that DIC and liver dz have in common. 1 thing that is different

Answer 7

Same: thrombocytopenia, hypofibrinogenemia and increased INR
Different: Factor 8 is increased in liver dz & decreased in DIC

Question 8

when is alpha fetoprotein typically ordered? when is it high?

Answer 8

• ordered q 6 months in cirrhotic patients to screen for cancer
• hepatocellular carcinoma

Question 9

when is ammonia typically ordered? when is it high?

Answer 9

• ordered to look for hepatic encephalopathy
• hepatic dysfunction and portosystemic shunting

Question 10

top 3 ordans with the most AST & ALT

Answer 10

1. liver
2. muscle
3. heart

Question 11

what does AST>ALT mean? how about AST < ALT?

Answer 11

• AST is greater if its alcohol hepatitis
• ALT is greater in most liver diseases

Question 12

when aminotransferase levels are above 1K IU/L, what two conditions are you thinking?

Answer 12

acute viral hep.
ischemic or toxic liver injury (close to 10K)

Question 13

which bilirubin is water solube and excreted or stored?

Answer 13

conjugated

Question 14

what two lab studies should you get for hyperbilirubinemia

Answer 14

total bilirubin & direct bilirubin

Question 15

• if most of the elevated bilirubin is direct, what does this mean?
• if its indirect, what does that mean?
• which condition can have either elevated direct or indirect?

Answer 15

• direct: something blocking bile from coming out (liver problem); ex:cholestasis or cancer
• indirect: too much being made; ex:hemolysis, transfusion, hematoma, Gilbert’s
• hepatic dysfunction can be either

Question 16

4 general causes of elevated liver ALP

Answer 16

• infiltrative processes (malignancy)
• intra-abdominal infections
• osteomyelitis
• cholestatic issues

Question 17

• membrane bound enzyme found in proximal renal tubule, liver, pancreas and intestine; serum activity is primarily from liver
• more sensitive than ALP in obstructive liver disease

Answer 17

GGT

Question 18

4 causes of elevated GGT

Answer 18

• cholestasis and biliary obstruction
• alcohol ingestion
• DM, hyperthyroid, R.A, COPD, MI
• drugs

Question 19

how is GGT typically used (3)

Answer 19

• more sensitive for cholestasis
• if theres high AP, GGT can exclude bone disease as cause
• Marker for significant alcohol ingestion

Question 20

what 3 labs if elevated are indicative of a cholestatic cause?

Answer 20

alkaline phosphatase
GGT
bilirubin

Question 21

5 most common single drugs that cause liver toxicity

Answer 21

1. Acetominophen by far!
2. augmentin
3. NTF
4. INH
5. TMP-SMX

Question 22

what should you if working up a symptomatic patient and alk phos is elevated? (2)

Answer 22

determine if its caused by liver– GGT, fractionated AP
evaluate for chronic choleastis or infiltrative liver dz

Question 23

what is this? treatment?

hereditary mild isolated indirect hyperbilirubinemia d/t reduced UGT1A1 activity & decreased bilirubin uptake by liver causing episodic jaundice. Normal LFTs.

Answer 23

gilbert’s syndrome
no treatment needed (but phenobarbital can normalize the bilirubin concentration)