intro to liver dz Flashcards
3 main tests that assess liver function & what you order to get them
LFT: albumin & total bilirubin
Coags: PT/INR
albumin & PT/INR are for general liver function
why do we care about which labs are elevated?
tells you where the damage could be coming from
which 3 labs (not in LFTs) that change in presence of liver failure? do they increase or decrease?
Glucose, cholesterol, BUN
all decrease in liver failure
list 7 causes of low albumin
- cirrhosis or liver failure
- alcohol ingestion
- malnutrition
- sepsis
- cancer
- burns
- nephrotic syndrome
- protein-losing enteropathy
which 3 clotting factors are NOT made by the liver
3,4 and vWF
2 conditions and 1 medication that affect PT/INR
Vit K deficiency (cholestasis, etc)
coumadin
DIC
3 things that DIC and liver dz have in common. 1 thing that is different
Same: thrombocytopenia, hypofibrinogenemia and increased INR
Different: Factor 8 is increased in liver dz & decreased in DIC
when is alpha fetoprotein typically ordered? when is it high?
- ordered q 6 months in cirrhotic patients to screen for cancer
- hepatocellular carcinoma
when is ammonia typically ordered? when is it high?
- ordered to look for hepatic encephalopathy
- hepatic dysfunction and portosystemic shunting
top 3 ordans with the most AST & ALT
- liver
- muscle
- heart
what does AST>ALT mean? how about AST < ALT?
- AST is greater if its alcohol hepatitis
- ALT is greater in most liver diseases
when aminotransferase levels are above 1K IU/L, what two conditions are you thinking?
acute viral hep.
ischemic or toxic liver injury (close to 10K)
which bilirubin is water solube and excreted or stored?
conjugated
what two lab studies should you get for hyperbilirubinemia
total bilirubin & direct bilirubin
- 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?
- 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
4 general causes of elevated liver ALP
- infiltrative processes (malignancy)
- intra-abdominal infections
- osteomyelitis
- cholestatic issues
- 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
GGT
4 causes of elevated GGT
- cholestasis and biliary obstruction
- alcohol ingestion
- DM, hyperthyroid, R.A, COPD, MI
- drugs
how is GGT typically used (3)
- more sensitive for cholestasis
- if theres high AP, GGT can exclude bone disease as cause
- Marker for significant alcohol ingestion
what 3 labs if elevated are indicative of a cholestatic cause?
alkaline phosphatase
GGT
bilirubin
5 most common single drugs that cause liver toxicity
- Acetominophen by far!
- augmentin
- NTF
- INH
- TMP-SMX
what should you if working up a symptomatic patient and alk phos is elevated? (2)
determine if its caused by liver– GGT, fractionated AP
evaluate for chronic choleastis or infiltrative liver dz
what is this? treatment?
hereditary mild isolated indirect hyperbilirubinemia d/t reduced UGT1A1 activity & decreased bilirubin uptake by liver causing episodic jaundice. Normal LFTs.
gilbert’s syndrome
no treatment needed (but phenobarbital can normalize the bilirubin concentration)
