Lab diagnosis in hepatobiliary disease

Question 1

_________ are lab tests that are more indicative of liver injury than liver function

Answer 1

ALT/AST

Question 2

List causes that will result in ALT/AST elevated above 2000

Answer 2

viral
toxin
ischemia

Question 3

_____ is present in the cytosol and mitochondria of liver and other tissues.
_____ elevation is more specific for liver damage and is found only in the cytosol

Answer 3

AST

ALT

Question 4

Interpret the following lab findings: AST/ALT ratio >2

Answer 4

alcoholic hepatitis

due to pyridoxine deficiency in alcoholism, affects ALT more

Question 5

_____ is not specific for liver injury and is elevated in MI and hemolysis

Answer 5

LDH

Question 6

What is the likely cause of markedly elevated LDH and alkaline phosphatase?

Answer 6

Malignant infiltration of liver

Question 7

Elevated alkaline phosphatase suggests damage to the _______

Answer 7

biliary tree

also found in placenta, bone, etc

Question 8

_______ is absent in bone so it is helpful in distinguishing between liver and bone as the cause of elevated ALKP

Answer 8

GGT

Question 9

______ can be induced by alcohol and drugs so it lacks specificity for liver damage

Answer 9

GGT

Question 10

_____ and _____ elevation together suggests cholestasis due to biliary obstruction of infilatrative disorders

Answer 10

ALKP and GGT

Question 11

_________ bilirubin ins lipophilic, transported in plasma bound to albumin, and internalized by the liver

Answer 11

Unconjugated

Question 12

_____ bilirubin is hydrophilic and excreted into the bile

Answer 12

conjugated

Question 13

Bilirubin hydrolysis by bacterial enzymes produce:

Answer 13

urobilinogens and urobilin

Question 14

Elevated unconjugated bilirubin and no bilirubin in the urine suggets a _____ cause

Answer 14

pre-hepatic: ex hemolysis

Question 15

Increases in both conjugated and unconjugated bilirubin suggests a ______ cause

Answer 15

hepatic: ex reduced efficiency of bilirubin excretion in bile, conjugated bilirubin reflux into circulation and is found in urine

Question 16

Pale stools, dark urine, and pruritis are suggestive of a ______ pathology

Answer 16

cholestatic: failure of adequate amounts of bile to reach duodenum, failure of canalicular secretion, ductulra disease, bile duct obstruction

Question 17

Bile acids are elevated in _______

Answer 17

cholestasis- specific for hepatobililary disease

Question 18

What tests are indicative of liver failure?

Answer 18

Prolonged PT/INR, low albumin

indicative of synthetic dysfunction

Question 19

The hepatocyte is the principle site of synthesis of all coagulation factors except ______

Answer 19

vWF/ factor VIII

Question 20

In liver disease, INR does not correct with administration of _________

Answer 20

vitamin K

Question 21

_______ is a negative acute phase reactant

Answer 21

Albumin

Question 22

________ is increased in liver dysfunction and portal-systemic shunting and contributes to hepatic encephalopathy

Answer 22

ammonia

Question 23

Spider angioma is a sign of ________

Answer 23

portal hypertension