[LEC] Liver Enzymes Flashcards
5 MAJOR LIVER ENZYMES
AST
ALT
GGT
ALP
5’ NTP
RECOMMENDED NAME OF AST
ASPARTATE AMINO TRANSFERASE
ENZYME CLASS OF AST
TRANSFERASE
EC CODE OF AST
2.6.1.1
SYSTEMATIC NAME OF AST
L-ASPARTATE-2-OXOGLUTARATE AMINOTRANSFERASE
FORMER NAME OF AST
SGOT
SERUM GLUTAMIC OXALOACETIC TRANSAMINASE
COENZYME OF AST
PYRIDOXAL PHOSPHATE
CHEMICAL REACTION OF AST
ASPARTATE + ALPHA-KTOGLUTARATE <—AST—> OXALOACETATE + GLUTAMATE
WHICH ENZYME HAS A SHORTER HALF LIFE
AST OR ALT
AST
IN AST, ALPHA KETO ACIDS ARE OXIDIZED BY WHAT REACTION
TCA CYCLE
TRICARBOXYLIC ACID CYCLE
WHAT DOES THE TCA CYCLE PRODUCE
ENERGY
MAJOR TISSUE SOURCES OF AST
CARDIAC TISSUE
LIVER
SKELETAL MUSCLE
MINOR TISSUE SOURCES OF AST
KIDNEY
PANCREAS
ERYTHROCYTES
ISOENZYME FRACTIONS OF AST
CYTOPLASM — Predominant form; found in healthy sera
MITOCHONDRIA — Abnormal; found in cellular necrosis
IS AST ISOENZYME ANALYSIS ROUTINELY DONE
NO
CLINICAL SIGNIFICANCES OF AST
HEPATOCELLULAR DISORDERS
SKELETAL MUSCLE INVOLVEMENT
ANGINA PECTORIS
AST IS USED TO FOLLOW THE COURSE OF WHAT CLINICAL CONDITION
MYOCARDIAL INFARCTION
— But is not used to diagnose
PREDOMINANT AST ISOENZYME FORM
CYTOPLASMIC AST
ISOENZYME OF AST THAT APPEARS WHEN CELLULAR NECROSIS OCCURS
MITOCHONDRIAL AST
PATIENT IS DIAGNOSED WITH CHRONIC ALCOHOLISM,
WHAT AST ISOENZYME IS INCREASED
MITOCHONDRIAL AST
CYTOPLASMIC AST IS FOUND IN PATIENT X’S SERUM SAMPLE.
IS THE PATIENT SUFFERING FROM ANY CLINICAL CONDITION
NO
CYTOPLASMIC AST IS FOUND IN HEALTHY HUMAN SERA
EFFECT OF ALCOHOL ON HEPATOCYTES
ALCOHOL DESTROYS HEPATOCYTES
MITOCHONDRIAL AST INCREASES
THE TWO MAIN ENZYMES USED TO MONITOR HEPATOCELLULAR DISORDERS
AST
ALT
TRUE OR FALSE
AST IS USED IN THE DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION
FALSE
WHAT ARE THE TIME ACTIVITY OF AST IN ANGINA PECTORIS
RISE — 6 TO 8 HRS AFTER ONSET
PEAK — 24 HRS
RETURNS — WITHIN 3-5 DAYS (OR WITHIN 5 DAYS)
HIGHEST ELEVATION OF AST
5X ULN
CLINICAL CONDITIONS OF AST WHEN ELEVATIONS REACH 5 OR MORE X ULN
ACUTE HEPATOCELLULAR DISORDERS
MYOCARDIAL INFARCTION
CIRCULATORY COLLAPSE (SHOCK)
ACUTE PANCREATITIS
INFECTIOUS MONONUCLEOSIS
KEY TAKEAWAYS:
ACUTE, SUDDEN
CLINICAL CONDITIONS OF AST WHEN ELEVATIONS ARE MODERATE
BILIARY TRACT OBSTRUCTION
CARDIAC ARRYTHMIAS
CONGESTIVE FAILURE
METASTATIC OR PRIMARY TUMOR IN LIVER
MUSCULAR DYSTROPHY
KEY TAKEAWAYS: OBSTRUCTION, FAILURE TO FUNCTION
CLINICAL CONDITIONS OF AST WHEN ELEVATION IS SLIGHT
PERICARDITIS
CIRRHOSIS
PULMONARY INFARCTION
DELIRIUM TREMENS
CEREBROVASCULAR ACCIDENT
HEPATOTOXIC DRUG INTAKE
KEY TAKEAWAYS: INFLAMMATION, INJURY, DRUGS
WHAT ENZYME IS USED TO MONITOR HEPATOTOXIC DRUGS
AST
LIMIT AT WHICH THE PHYSICIAN STOPS THE PATIENT’S THERAPY WITH HEPATOTOXIC DRUGS
UP TO 3X ULN
[RATIO SUMMARY]
HALF LIFE OF AST AND ALT
AST < ALT
[RATIO SUMMARY]
LEVELS OF AST AND ALT IN LIVER DISEASES
AST < ALT
[RATIO SUMMARY]
DE RITIS RATIO
ALT:AST > 1 — ACUTE HEPATITIS
AST > ALT — ALCOHOLIC HEPATITIS
[RATIO SUMMARY]
AST AND ALT LEVELS IN HEPATOCELLULAR CIRRHOSIS
AST > ALT
[RATIO SUMMARY]
AST AND ALT LEVELS IN LIVER NEOPLASIA
AST > ALT
WHY IS AST HIGHER THAN ALT IN CASES OF HEPATOCELLULAR CIRRHOSIS AND LIVER NEOPLASIA
BECAUSE HEPATOCYTES ARE SEVERELY DAMAGED
HEPATOCYTES HAVE HIGH AST ACTIVITY
[RATIO SUMMARY]
AST AND ALT LEVELS IN LIVER SPECIFICITY
AST < ALT
ENZYME CLASSIFICATION OF ALT
TRANSFERASE
EC CODE OF ALT
2.6.1.2
SYSTEMATIC NAME OF ALT
L-ALANINE-2-OXIDOGLUTARATE AMINOTRANSFERASE
RECOMMENDED NAME OF ALT
ALANINE AMINOTRANSFERASE
COENZYME OF ALT
PYRIDOXAL PHOSPHATE
HALF LIFE OF AST
16 HRS
HALF LIFE OF ALT
24 HRS
PYRIDOXAL PHOSPHATE IS THE COENZYME OF WHICH LIVER ENZYMES
AST AND ALT
MAJOR TISSUE SOURCE OF ALT
LIVER (More specific than AST)
KIDNEY
MINOR TISSUE SOURCES OF ALT
HEART
SKELETAL MUSCLE
IN WHAT CLINICAL CONDITION IS AST MORE ELEVATED THAN ALT AND WHY
ACUTE HEPATOCELLULAR CIRRHOSIS
LIVER NEOPLASIA
HEPATOCYTES ARE SEVERELY DAMAGED
HEPATOCYTES HAVE HIGHER AST ACTIVITY
ARE ALT ELEVATIONS OBSERVED IN PATIENTS WHO ARE NON ALCOHOLIC AND ASYMPTOMATIC
YES
WHAT SCREENING PROCEDURE IS ALT USED IN
SCREENING FOR BLOOD DONORS
SCREENING POST TRANSFUSION (FOR POST TRANSFUSION HEPATITIS)
MILD ALT ELEVATIONS ARE FOUND IN WHAT CLINICAL CONDITIONS
HEPATITIS C INFECTIONS
WHAT ENZYME IS MORE SPECIFIC FOR THE LIVER
ALT
CHEMICAL REACTION OF ALT
ALANINE + A-KETOGLUTARATE <—ALT—> PYRUVATE + GLUTAMATE
[RATIO SUMMARY]
ENZYME ACTIVITY IN HEPATOCYTES
AST > ALT
ENZYME CLASSIFICATION OF ALP
HYDROLASE
EC CODE OF ALP
3.1.3.1
RECOMMENDED NAME OF ALP
ALKALINE PHOSPHATE
SYSTEMATIC NAME OF ALP
ALKALINE ORTHOPHOSPHERIC MONOESTER PHOSPHOHYDROLASE
OPTIMUM PH AT WHICH ALP FUNCTIONS
pH 9-10
MAJOR TISSUE SOURCES OF ALP
CANALICULAR MEMBRANE OF THE LIVER
OSTEOBLASTS IN THE BONE
MINOR TISSUE SOURCES OF ALP
MUCOSA OF THE SMALL INTESTINE
PROXIMAL CONVOLUTED TUBE OF THE KIDNEYS
PLACENTA
ISOFORMS OF ALP BASED ON GENETIC LOCUS
CHR 1 — KIDNEY, LIVER, BONE
CHR 2 — PLACENTA, INTESTINE
WHAT ALP TISSUE SOURCE IS CODED FOR BY CHROMOSOME 1
KIDNEY
LIVER
BONE
WHAT ALP TISSUE SOURCE IS CODED FOR BY CHROMOSOME 2
PLACENTA
INTESTINES
WHAT ARE THE NORMAL ISOENZYMES OF ALP
INTESTINAL
PLACENTAL
BONE AND LIVER
MOST PREDOMINANT ISOENZYME FRACTION OF ALP
BONE AND LIVER ALP
WHAT ARE THE ABNORMAL ISOENZYME FRACTIONS OF ALP
REGAN
NAGAO
KASHARA
WHAT ISOENZYME FRACTION RESULTS WHEN THERE IS AN ECTOPIC PRODUCTION OF ALP
REGAN
IN WHAT CONDITIONS IS THE REGAN FRACTION FOUND IN
LUNG, BREAST, COLON CANCERS
OVARIAN AND GYNECOLOGICAL CANCERS (HIGH INCIDENCE)
IN WHAT CONDITIONS DOES THE REGAN ISOENZYME FRACTION HAVE THE HIGHEST INCIDENCE IN
OVARIAN AND GYNECOLOGICAL CANCERS
MOST HEAT STABLE ALP ISOENZYME FORM
REGAN