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Clin LAB Med > L3: Liver Tests and Hepatic Serology > Flashcards

L3: Liver Tests and Hepatic Serology Flashcards

1
Q

What are the tests involved in the liver panel?

A 
ALT
AST
Total bilirubin
Albumin
Alk phosph
GGT
Total protein
PT/INR
Lactate dehydrogenase
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2
Q

What are the 3 types of liver disease categories?

A
  1. Hepatocellular (injury to hepatocytes)
  2. Cholestatic (injury of bile ducts or bile flow obstruction)
  3. Infiltrative (liver invaded by non-hepatic substances)
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3
Q

Which 3 of the liver tests assess liver function?

A

PT/INR
Total bilirubin
Albumin

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4
Q

What 2 tests will be elevated if there is damage to the hepatocytes?

A

ALT

AST

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5
Q

What 3 tests will be affected with a cholestatic process?

A

Total bili
Alk phosph
GGT

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6
Q

What does elevated alk phosph suggest?

A

Cholestasis

  • ALP isoenzymes (bone vs. liver disease)
  • 5NP (enzyme elevated if problem in biliary tree, distinguishes liver as the origin)
  • GGT when simultaneously elevated can confirm liver origin
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7
Q

What is the “equation” for total bilirubin?

A

Total = sum of direct + indirect

If direct elevated = inside liver
If indirect elevated= outside liver

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8
Q

What is the equation of fractionated bilirubin

A

Fraction of total bilirubin that is direct vs indirect

*useful when standard liver tests are normal and total bilirubin is elevated

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9
Q

Elevated direct bilirubin, elevated or normal indirect bilirubin, + an elevated AST/ALT is indicative of

A

liver disease

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10
Q

Describe direct, indirect, and other labs affected by liver disease

A

Elevated direct bilirubin, elevated or normal indirect bilirubin, + an elevated AST/ALT

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11
Q

Elevated (90% of total bili) indirect bili + anemia and normal AST/ALT is indicative of

A

hemolysis

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12
Q

Describe the direct, indirect, and other labs affected with hemolysis

A

Direct: normal
Indirect: elevated
Other: Anemia, increased retic count, abnormal peripheral smear, normal AST and ALT

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13
Q

Elevated (>90% of total bili), normal AST and ALT, with no anemia is indicative of

A

Gilbert’s syndrome

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14
Q

What is Gilbert’s syndrome?

A

Inherited decrease in ability to conjugate bili

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15
Q

true/false: elevated liver tests mean liver is normal

A

False

Pts with normal ALT and AST can have significant liver disease chronically

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16
Q

The first step in eval of a patient with elevated liver tests but no sxs is:

A

repeat the test (fasting)

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17
Q

Is AST or ALT more specific to the liver?

A

ALT

highest level found in kidney, AST found other places, ALT gender specific

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18
Q

GGT is present in:

A

hepatocytes and epithelial cells

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19
Q

GGT is useful when:

A

1) ALP IS ELEVATED = confers liver specificity
2) When AST/ALT >2 it further supports alcoholic liver disease

Know these!

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20
Q

What is a nonhepatic source of an elevated bilirubin?

A

RBC (hemolysis, etc.)

21
Q

What is a nonhepatic source of an elevated AST?

A

SM, cardiac muscle, kidney, and brain

22
Q

What is a nonhepatic source of an elevated ALT?

A

SM, cardiac muscle, kidneys

23
Q

What is a nonhepatic source of an elevated LDH?

A

Enzyme present in tissues all throughout the body

24
Q

What is a nonhepatic source of an elevated ALP?

A

Bone, 1st trimester placenta, intestines

25
Q

List 4 herbals/vitamins that can cause DILI.

A

Ephedra
Kava
Vit A
Garcinia cambogia

26
Q

List some meds that can cause DILI

A 
Acetaminophen
Statins
Antifungals/azoles
Abx
Anti-tb drugs
NSAIDs
27
Q

What is the best way to see if a med is responsible for DILI

A

Stop tx and see if lab values return to normal

28
Q

What are some non-liver causes of elevated liver tests (5)

A
  • Muscle (cardiac, skeletal)
  • Cholethiasis
  • Masses (tumors)
  • Hemodynamic disorders (CHF)
  • Celiac, hypothyroidism, adrenal insufficiency
29
Q

List a primary cause of mildly elevated AST and ALT

A

Fatty liver (chronic rather than acute condition)

30
Q

What condition can cause an elevated AST > ALT

A

Alcoholic hepatitis

31
Q

A pt with an AST:ALT ratio of >/= 2 is suggestive of

A

alcoholic liver disease (present in both mild and severe cases)

32
Q

A pt with an AST:ALT ratio of <2 is suggestive of

A

Acute or chronic viral hepatitis (AST:ALT <1)

33
Q

If AST, ALT higher than ALP, think

A

hepatocellular

34
Q

If ALP higher than AST, ALT, think

A

cholestasis

35
Q

If elevated ALP with AST, ALT nearly normal think

A

cholestasis or infiltrative (differentiate with imaging)

36
Q

There is ______ cause for fat accumulation in the liver.

A

NO secondary

37
Q

What is non-alcoholic fatty liver disease?

A

Fatty liver WITHOUT INFLAMMATION

Low risk of developing significant fibrosis

38
Q

What is non-alcoholic steatohepatitis (NASH)?

A

Fatty liver + inflammation of hepatocyte injury +/- fibrosis

-HIGH RISK DEVELOPING SIGNIFICANT FIBROSIS, cirrhosis, liver failure, and liver cancer

39
Q

What are risk factors for NAFLD?

A 
Abdominal obesity
DM
Hyperlipidemia
Metabolic syndrome ***strongest precursor for NASH!
Polycystic ovarian syndrome
40
Q

Are patients with NASH usually symptomatic?

A

No, majority asymptomatic (will have RUQ pain if sx)

41
Q

What will be elevated with NASH?

A

Mildly elevated AST (2-4 x ULN)

42
Q

What will imaging show in a patient with NASH?

A

Fatty infiltration on imaging or biospy

43
Q

What will a liver biopsy show in a patient with NASH

A
  • steatosis (fat accumulation)
  • inflammation +/- fibrosis
  • Liver bx w/ metabolic syndrome helps with dx and prognosis
44
Q

What are 4 lifestyle recommendations for NASH tx?

A

Caloric intake reduction
Weight loss
Exercise
No heavy alcohol consumption

45
Q

When would you consider liver transplant in a pt with NASH?

A

If it progresses to cirrhossi

46
Q

What is hereditary hemochromatosis?

A

Hereditary disorder of iron metabolism (increased intestinal absorption of Fe = too much iron)

47
Q

Hereditary hemochromatosis can lead to what 2 disorders?

A

Fibrosis/cirrhosis

Hepatocellular carcinoma

48
Q

What are the typical signs and sxs of hereditary hemochromatosis?

A
  • Usually asymptomatic
  • If symptomatic: fatigue/malaise, arthralgia, loss of libido
  • Late manifestations: hepatomegaly, cirrhosis, DM, impotence, bronze skin, cardiomegaly +/- CHF
49
Q

What are the lab findings of hereditary hemochromatosis?

A
  • Elevated AST and ALT

- slide 37….

Clin LAB Med (4 decks)

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