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clin lab med exam 2 > LFT > Flashcards

LFT Flashcards

1
Q

Cholestatic liver disease

A

injury to bile ducts and/or bile flow obstruction

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2
Q

infiltrative liver disease

A

liver is invaded or replaced by non-hepatic substances

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3
Q

What liver function tests reflect hepatocellular damage

A
  • ALT: Alanine aminotransferase
  • AST: aspartate transaminase
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4
Q

Which liver function tests reflect a cholestatic process

A
  • total biliruben
  • alkaline phosphatase
  • GGT
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5
Q

What does an elevated alkaline phosphatase suggest

A
  • cholestasis: bile cannot flow
    • liver, bone, intestine, placenta origin
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6
Q

What can be used to distinguish between liver and bone disease when there is an elevated alk phosph

A

ALP isoenzyme

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7
Q

What is an enzyme in the liver and is elevated in diseases affecting the biliary tree and can help distinguish liver as the origin.

A

5NP (5’-Nucleotidase)

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8
Q

fractionated biliruben

A

tells the fraction of total bilirubin that is direct vs indirect

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9
Q

What condition presents with these lab results

  • direct (conjugated) biliruben: elevated
  • indirect biliruben: elevated or normal
  • AST/ALT: elevated
A

liver disease

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10
Q

What condition presents with these lab results

  • direct (conjugated) biliruben: normal
  • indirect biliruben: elevated (90% of TB)
  • AST/ALT: normal
  • anemia, increased reticulocyte count
A

hemolysis

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11
Q

What condition presents with these lab results

  • direct (conjugated) biliruben: normal
  • indirect biliruben: elevated (90% TB)
  • AST/ALT: normal
  • no anemia
A

gilbert syndrome: inherited decrease in ability to conjugate biliruben

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12
Q

GGT is present in

A
  • hepatocytes
  • biliary epithelial cells
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13
Q

When is GGT useful

A
  1. when ALP is elevated, it confers liver specificity
    • _​​_elevated with biliary tract obstruction or cholestasis
  2. when AST/ALT > 2, it further supports Alcoholic liver disease when elevated
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14
Q

Which liver function tests reflext liver function

A
  • albumin
  • PT/INR
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15
Q

Which is more specific to the liver, ALT or AST

A

ALT

  • AST found in liver, skeletal and cardiac muscle, RBC
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16
Q

The first step in the evaluation of a patient with elevated LFTs but no symptoms is to

A

repeat the test

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17
Q

Non hepatic source of biliruben

A

RBC

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18
Q

Non hepatic source of AST

A
  • skeletal muscle
  • cardiac muscle
  • RBC
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19
Q

Medications that are common examples to cause harm to the liver

A
  • acetaminophen
  • statins
  • azoles
  • NSAIDs
  • Isoniazid
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20
Q

Mildly elevated AST and ALT (2-5 x nml) generally indicates what conditions

A
  • fatty liver
  • ETOH related
  • chronic viral hepatitis
  • medication effect
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21
Q

Elevated AST generally indicates what conditions

A
  • alcoholic hepatitis
  • skeletal
  • cardiac
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22
Q

AST: ALT ratio > 2 indicates

A
  • alcoholic liver disease
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23
Q

AST: ALT ratio < 2 indicates

A
  • acute or chronic viral hepatitis
  • chrolestatic disease (ALP elevated)
  • NASH (ration usually < 1)
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24
Q

If AST and ALT are higher than ALP, this is typical of

A

hepatocellular injury

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25
Q

If ALP is higher than AST and ALT, this is typical of

A

Cholestatic

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26
Q

If ALP is elevated with near normal AST and ALT, this is indicative of

A
  • cholestatic or infiltrative
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27
Q

Nonalcoholic fatty liver disease has what spectrum of disease

A
  • simple steatosis (NAFL)
  • non-alcoholic steatohepatitis (NASH)
  • cirrhosis
28
Q

simple steatosis or Non-alcoholic fatty liver means what

A
  • fatty liver without injury of hepatocytes on liver bx
  • risk of progression to cirrhosis is minimal
29
Q

Non alcoholic steatohepatitis (NASH) means

A
  • fatty liver + inflammation + hepatocyte injury on liver bx +/- fibrosis
  • risk of progression of fribrosis, cirrhosis, liver failure and liver cancer is significant
30
Q

risk factors for Non alcoholic steatohepatitis (NASH)

A
  • metabolic syndrome
  • abdominal obesity
  • hyperlipidemia (high TG or low HDL)
  • DM (insulin resistance)
31
Q

how is Non alcoholic steatohepatitis (NASH) diagnosed

A
  • mildly elevated aminotransferases (AST, ALT)
  • fatty infiltration on imagina
  • confirmed by liver bx
    • fat accumulation and inflammation
32
Q

managment for Non alcoholic steatohepatitis (NASH)

A
  • exercise
  • weight loss
  • discontinue ALL ETOH
  • control diabetes and hyperlipidemia
33
Q

Which two autoimmune liver diseases affect women: men 9:1

A
  • primary biliary cirrhosis
  • autoimmune chronic hepatitis
34
Q

What is primary biliary cirrhosis

A
  • immunologic attack on the intrahepatic bile ducts that eventually leads to cirrhosis and liver failure
35
Q

AMA (anti-mitochondrial antibodies) is positive in which condition

A

primary biliary cirrhosis

36
Q

What is autoimmune chronic hepatitis

A
  • hepatocellular inflammation secondary to presumed T cell mediated immune attack of liver antigens
37
Q

Which autoimmune liver disease affects men: women 5:1

A

primary sclerosing cholangitis

38
Q

what is primary sclerosing cholangitis

A
  • inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts
  • strong association with IBD
  • can lead to cirrhosis and liver failure
39
Q

What antibody tests are available when assessing for autoimmune hepatitis

A
  • antinuclear antibodies (ANA)
  • smooth muscle antibodies (SMA)
  • liver kidney microsomial antibody (LKMA)
  • antibody to liver cytosol (Anti-LC1)
40
Q

which condition presents with

  • AST/ALT 7-10 x ULN
  • ASMA 90% positive
  • IgG: high titer
A

autoimmune hepatitis

41
Q

which condition presents as

  • ALP 2-10 x ULN
  • biliruben elevated in later disease
  • AMA positive
  • IgM (high titer)
A

primary biliary cirrhosis

42
Q

What is Hereditary hemochromatosis

A
  • autosomal recessive
  • genetic mutation results in increased GI absorption of iron -> iron accumulation
43
Q

Hereditary hemochromatosis can lead to what 2 liver conditions

A
  • cirrhosis
    • esp in patients who drink ETOH
  • hepatocellular carcinoma
44
Q

how is hepatocellular carcinoma screened for

A
  • AFP (alpha fetoprotein)
  • US
45
Q

Lab findings in hereditary hemochromatosis

  • LFTs
  • serum Fe
  • TIBC
  • ferritin
A
  • elevated LFTs: AST, ALT, Alk Phos
  • Fe/TIBC = transferrin saturation
    • transferrin sat > 45 and/or
    • ferritin > 250 in men or > 200 in women
      • proceed to HFE mutation analysis
46
Q

how is hereditary hemochromatosis diagnosed

A
  • genetic testing
  • liver bx
47
Q

treatment for hereditary hemochromatosis

A
  • avoid vit c and iron supplements
  • avoid ETOH
  • regular phlebotomy
48
Q

What disease should be suspected in a patient with COPD/emphysema at a young age (30-40s)

A

alpha-1 antitrypsin defciency

49
Q

how is alpha-1 antitrypsin defciency diagnosed

A
  • absence of alpha 1 peak on SPEP
  • serum a-1 antitrypsin decreases
  • a-1 antitrypsin phenotype
50
Q

alpha 1 antitrypsin is synthesized where

A

liver

51
Q

What is Wilson’s disease

A
  • autosomal recessive
  • accumulation of copper in liver and decreased excretion of copper into bile
  • presents between ages 5-35
52
Q

in Wilson’s disease, serum ceruloplasmin is

A
  • low
  • serum ceruloplasmin is the plasma copper-carrying protein
    • < 5 is strong evidence for WD
53
Q

clinical manifestations of Wilson’s disease affect what systems

A
  • hepatic
  • neurologic
  • psychiatric
54
Q

Kayser-Fleischer ring is pathognomonic for

A

Wilson’s disease

  • Kayser-Fleischer ring: fine pigmented granular deposits in cornea
55
Q

how is Wilsons disease diagnosed

A
  • liver biopsy
56
Q

How is Acute Hepatitis A spread

A
  • fecal oral route
  • consumption of shellfish or uncooked fruits, vegetables
57
Q

what lab value is diagnostic for Acute Hepatitis A

A
  • positive Anti-HAV IgM
  • AST/ALT > 15 x
  • elevated ALP and bilirubin
58
Q

can Hepatitis A become chronic

A

no

59
Q

main symptoms of Acute Hepatitis A

A
  • fever
  • jaundice
    • 90% childhood infection and 50% adult infections asymptomatic
    • 99% recover completely
60
Q

How is Hepatitis B transmitted

A
  • blood
  • sexual contact
  • parenteral contact
  • peri-natal transmission
61
Q

clinical presentation

  • arthralgia, rash
  • jaundice
  • elevated biliruben, ALP, ALT > 15x
A

Hepatitis B

62
Q

75% of chronic HBV carriers are

A

Asian

63
Q

What antigen tests are elevated in hepatitis B

A
  • Hepatitis B surface antigen (HBsAg)
    • active disease
  • Antibody to surgace antigen (Anti-HBs)
      • immunity (vaccine or resolved infection)
  • Antibody to hepatitis B core antigen
    • IgM anti-HBc: acute exposure
64
Q

what percentage of patients whi Hep B develop a chronic infection

A

1-10%

65
Q

what percentage of patients whi Hep C develop a chronic infection

A

70-80%

66
Q

Hep C testing

A
  1. HCV antibody -> if reactive
  2. HCV RNA -> detected -> current infection

clin lab med exam 2 (5 decks)

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