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clin lab med exam 2 > LFT > Flashcards

LFT Flashcards

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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
If ALP is higher than AST and ALT, this is typical of
Cholestatic
26
If ALP is elevated with near normal AST and ALT, this is indicative of
* cholestatic or infiltrative
27
Nonalcoholic fatty liver disease has what spectrum of disease
* simple steatosis (NAFL) * non-alcoholic steatohepatitis (NASH) * cirrhosis
28
simple steatosis or Non-alcoholic fatty liver means what
* fatty liver without injury of hepatocytes on liver bx * risk of progression to cirrhosis _is minimal_
29
Non alcoholic steatohepatitis (NASH) means
* fatty liver + inflammation + hepatocyte injury on liver bx +/- fibrosis * risk of progression of fribrosis, cirrhosis, liver failure and liver cancer is significant
30
risk factors for Non alcoholic steatohepatitis (NASH)
* **metabolic syndrome** * abdominal obesity * hyperlipidemia (high TG or low HDL) * DM (insulin resistance)
31
how is Non alcoholic steatohepatitis (NASH) diagnosed
* mildly elevated aminotransferases (AST, ALT) * fatty infiltration on imagina * confirmed by liver bx * fat accumulation and inflammation
32
managment for Non alcoholic steatohepatitis (NASH)
* exercise * weight loss * discontinue ALL ETOH * control diabetes and hyperlipidemia
33
Which two autoimmune liver diseases affect women: men 9:1
* primary biliary cirrhosis * autoimmune chronic hepatitis
34
What is primary biliary cirrhosis
* immunologic attack on the intrahepatic bile ducts that eventually leads to cirrhosis and liver failure
35
AMA (anti-mitochondrial antibodies) is positive in which condition
primary biliary cirrhosis
36
What is autoimmune chronic hepatitis
* hepatocellular inflammation secondary to presumed T cell mediated immune attack of liver antigens
37
Which autoimmune liver disease affects men: women 5:1
primary sclerosing cholangitis
38
what is primary sclerosing cholangitis
* inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts * strong association with IBD * can lead to cirrhosis and liver failure
39
What antibody tests are available when assessing for autoimmune hepatitis
* antinuclear antibodies (ANA) * smooth muscle antibodies (SMA) * liver kidney microsomial antibody (LKMA) * antibody to liver cytosol (Anti-LC1)
40
which condition presents with * AST/ALT 7-10 x ULN * ASMA 90% positive * IgG: high titer
autoimmune hepatitis
41
which condition presents as * ALP 2-10 x ULN * biliruben elevated in later disease * AMA positive * IgM (high titer)
primary biliary cirrhosis
42
What is Hereditary hemochromatosis
* autosomal recessive * genetic mutation results in increased GI absorption of iron -\> iron accumulation
43
Hereditary hemochromatosis can lead to what 2 liver conditions
* cirrhosis * esp in patients who drink ETOH * hepatocellular carcinoma
44
how is hepatocellular carcinoma screened for
* AFP (alpha fetoprotein) * US
45
Lab findings in hereditary hemochromatosis * LFTs * serum Fe * TIBC * ferritin
* 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
how is hereditary hemochromatosis diagnosed
* genetic testing * liver bx
47
treatment for hereditary hemochromatosis
* avoid vit c and iron supplements * avoid ETOH * regular phlebotomy
48
What disease should be suspected in a patient with COPD/emphysema at a young age (30-40s)
alpha-1 antitrypsin defciency
49
how is alpha-1 antitrypsin defciency diagnosed
* absence of alpha 1 peak on SPEP * serum a-1 antitrypsin decreases * a-1 antitrypsin phenotype
50
alpha 1 antitrypsin is synthesized where
liver
51
What is Wilson's disease
* autosomal recessive * accumulation of copper in liver and decreased excretion of copper into bile * presents between ages 5-35
52
in Wilson's disease, serum ceruloplasmin is
* low * serum ceruloplasmin is the plasma copper-carrying protein * \< 5 is strong evidence for WD
53
clinical manifestations of Wilson's disease affect what systems
* hepatic * neurologic * psychiatric
54
Kayser-Fleischer ring is pathognomonic for
Wilson's disease * Kayser-Fleischer ring: fine pigmented granular deposits in cornea
55
how is Wilsons disease diagnosed
* liver biopsy
56
How is Acute Hepatitis A spread
* fecal oral route * consumption of shellfish or uncooked fruits, vegetables
57
what lab value is diagnostic for Acute Hepatitis A
* positive Anti-HAV IgM * AST/ALT \> 15 x * elevated ALP and bilirubin
58
can Hepatitis A become chronic
no
59
main symptoms of Acute Hepatitis A
* fever * jaundice * 90% childhood infection and 50% adult infections asymptomatic * 99% recover completely
60
How is Hepatitis B transmitted
* blood * sexual contact * parenteral contact * peri-natal transmission
61
clinical presentation * arthralgia, rash * jaundice * elevated biliruben, ALP, ALT \> 15x
Hepatitis B
62
75% of chronic HBV carriers are
Asian
63
What antigen tests are elevated in hepatitis B
* **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
what percentage of patients whi Hep B develop a chronic infection
1-10%
65
what percentage of patients whi Hep C develop a chronic infection
70-80%
66
Hep C testing
1. **HCV antibody** -\> if reactive 2. **HCV RNA** -\> detected -\> current infection

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