LFT and Coag

Question 1

What tests are markers of acute hepatocyte injury or death?

Answer 1

• AST
• ALT
• Alkaline phosphotase

Question 2

What tests measure hepatocyte synthetic function?

Answer 2

• PT/INR

- Albumin

Question 3

What tests are indicators of hepatocyte catabolic activity?

Answer 3

Direct and indirect bilirubin

Question 4

What tests diagnose specific disease entities?

Answer 4

GGT

Question 5

What do ALT and AST stand for?

Answer 5

ALT = Alanine Aminotransferase
AST = Aspartate Aminotransferase

Question 6

What are some causes of an elevated ALT?

Answer 6

• Hepatitis (viral, alcoholic, autoimmune, ischemic)
• Biliary tract disease
• Fatty liver disease
• Medication related
• Infiltrative disease

Question 7

What is ALT > AST indicative of?

Answer 7

Viral hepatitis

Question 8

Which is more specific for liver disease, ALT or AST?

Answer 8

ALT (typically a 2:1 ratio)

Question 9

What are some causes of an elevated AST?

Answer 9

• Hepatitis (viral, alcoholic, autoimmune, ischemic)
• Biliary tract disease
• Fatty liver disease
• MYOCARDIAL INFARCT
• Medication related
• Infiltrative disease

Question 10

What is AST > ALT indicative of?

Answer 10

Alcohol hepatitis (S in AST –> think they were SHITTY to their liver, so now they have alcohol hepatitis, vs ALT is viral hepatitis)

Question 11

What is the function of Alkaline Phosphatase?

Answer 11

• Removes phosphate groups from molecules

- Growth and development of bones and teeth

Question 12

What are some causes of an elevated alkaline phosphatase?

Answer 12

• Hepatitis
• Biliary tract disease
• Fatty liver disease
• BONE DISEASE (paget’s, primary, metastatic bone malignancy)
• Pregnancy
• Medication related

Question 13

Which test is more specific for biliary tract disease?

Answer 13

Alkaline phosphatase

Question 14

What is normal AST and ALT but elevated alkaline phosphatase indicative of?

Answer 14

Bone issues

Question 15

What is GGT?

Answer 15

Gamma Glutamyl Transpeptidase

*Typically used as adjunct test if elevated AST, ALT, + alkaline phosphatase

Question 16

What are some causes of elevated GGT?

Answer 16

• Hepatitis (alcoholic)
• Biliary tract disease
• Pancreatic disease
• Cardiovascular disease
• Diabetes

Question 17

AST > ALT ratio 2:1, GGT elevated indicates….

Answer 17

Alcoholic liver disease

Question 18

Elevated alkaline phosphatase, elevated GGT indicates…..

Answer 18

Liver issue

Question 19

Elevated alkaline phosphatase, normal GGT indicates….

Answer 19

Not a liver issue

Question 20

What is the most common cause of elevated aminotransferases?

Answer 20

Fatty liver disease

Question 21

How do you determine INDIRECT bilirubin?

Answer 21

Total bilirubin - Direct bilirubin

Question 22

What does bilirubin measure?

Answer 22

Live catabolic activity (component of bile & an antioxidant)

Question 23

What are some causes of an elevated indirect bilirubin?

Answer 23

• Hemolysis
• Impaired hepatic uptake or conjugation
• Neonates

Question 24

When would you order a direct bilirubin test?

Answer 24

If you have an elevated bilirubin (from this you can estimate indirect)

Question 25

What are some causes of an elevated direct bilirubin?

Answer 25

- Liver disease | - Biliary tract disease

Question 26

Which bilirubin is lipid soluble and which is water soluble?

Answer 26

- Indirect = lipid soluble | - Direct = water soluble

Question 27

What is the least useful test?

Answer 27

Total protein

Question 28

What can cause an increased total protein?

Answer 28

- Bone marrow disorders | - Inflammation

Question 29

What can cause a decreased total protein?

Answer 29

- Liver disease - Kidney disease - Malnutrition - Malabsorption

Question 30

What is the main constituent of total protein?

Answer 30

Albumin

Question 31

What does albumin measure?

Answer 31

Synthetic function of liver

Question 32

What is albumin not a good test for?

Answer 32

ACUTE liver issues (ie. aspirin overdose) | Why? Because it has a long half life (3 weeks)

Question 33

What can cause an increased albumin?

Answer 33

Dehydration

Question 34

What can cause a decreased albumin?

Answer 34

- Liver disease - Kidney disease - Malnutrition - Malabsorption - Severe burns

Question 35

What are the 3 pathways of the classic blood coagulation path?

Answer 35

1. Intrinsic 2. Extrinsic 3. Common

Question 36

What is important when approaching bleeding disorders?

Answer 36

HISTORY - Hx of bleeding with surgery or dental procedures - Menorrhagia (heavy periods) - Med list - Family hx - Dietary hx - Social hx (ETOH)

Question 37

What pathway is PT/INR?

Answer 37

EXTRINSIC and common pathway (clotting time)

Question 38

PT/INR reflects the plasma concentration of which clotting factors?

Answer 38

1, 2, 5, 7, 10

Question 39

What is prothrombin?

Answer 39

A protein produced by the liver for clotting of blood - depends on adequate vitamin K intake and absorption

Question 40

What do PT/INR and aPTT measure?

Answer 40

Synthetic liver function

Question 41

What are causes of prolonged INR?

Answer 41

- Liver disease - Vitamin K deficiency - Warfin use - Coagulation deficiencies - DIC

Question 42

What does a prolonged PT/INR indicate?

Answer 42

-Liver disease | acute chronic liver injury, chronic liver disease, monitoring course of liver diease

Question 43

What pathway is warfrin?

Answer 43

Extrinsic (PT/INR --> prolonged)

Question 44

aPTT reflects the plasma concentration of what clotting factors?

Answer 44

1, 2, 5, 8, 9, 10, 11, 12

Question 45

What pathway is aPTT?

Answer 45

INTRINSIC and common pathway

Question 46

What causes a prolonged aPTT?

Answer 46

- Liver disease - HEPARIN USE - Factor deficiencies - Sepsis - Factor antibodies - DIC

Question 47

What does a prolonged aPTT indicate?

Answer 47

- Liver disease (ADVANCED) - Heparin use - Factor deficiency --> specifically hemophilia

Question 48

What is bleeding time?

Answer 48

- Rarely ever ordered | - Measure of platelet interaction with vessel wall

Question 49

When is platelet aggregation ordered?

Answer 49

- Screen at risk presurgical patients | - Rarely ever ordered

Question 50

What is Von Willebrand Factor?

Answer 50

- A glycoprotein involved in hemostasis - Increases adhesiveness/aggregation of platelets - Binds factor VIII and prevents it from being inactivated

Question 51

What is Von Willebrand disease?

Answer 51

-Most common hereditary coagulation abnormality (deficiency of vWF - lack factor VIII)

Question 52

What are signs and symptoms of Von Willebrand Disease?

Answer 52

Bleeding gums, easy bruising, menorrhagia, nosebleeds

Question 53

How do you diagnosis Von Willebrand disease?

Answer 53

- Prolonged aPTT (intrinsic pathway) - Prolonged bleeding time - Decreased vWF - Decreased factor VIII

Question 54

What is the treatment for Von Willebrand Disease?

Answer 54

- Desmopressin before dental work or minor surgery | - Factor VIII before major surgery

Question 55

What is fibrinogen?

Answer 55

Glycoprotein precursor to fibrin in coagulation cascade * *Thrombin converts fibrinogen to fibrin * *Fibrin = main protein in a clot

Question 56

When are increased fibrinogen levels seen?

Answer 56

**More likely to clot** Inflammatory process (infection, malignancy)

Question 57

When are decreased fibrinogen levels seen?

Answer 57

- Rare disease (hypofibrinogenemia and afribogenemia) | - DIC

Question 58

What is Factor V Leiden?

Answer 58

Functions as a cofactor in the clotting cascade | activated by thrombin, inactivated by protein C

Question 59

What happens if there is a factor V leiden mutation?

Answer 59

Abnormal factor V --> unable to be inactivated by protein C --> hypercoagulability

Question 60

What is Antithrombin III?

Answer 60

A protease that lyses thrombin and Factor Xa and IXa

Question 61

What does a antithrombin III deficiency cause?

Answer 61

Inability to inhibit thrombin --> hypercoagulability

Question 62

What is antiphospholipid?

Answer 62

Normally functions as part of vessel wall | -Positive antibodies indicate DISEASE --> hypercoagulability

Question 63

What is protein C dependent on?

Answer 63

Vitamin K

Question 64

What does protein C do?

Answer 64

Cofactor that inactivates factors Va and VIII which are necessary for thrombin activation

Question 65

What does a deficiency in protein C cause?

Answer 65

Hypercoagulability

Question 66

What is protein S?

Answer 66

- Dependent on vitamin K - Cofactor to protein C in the inactivation of Va and VIIIa - Deficiency = hypercoagulability

Question 67

What is a D-dimer?

Answer 67

Byproduct of the degradation of a clot

Question 68

When would you have an elevated D-dimer?

Answer 68

If you have a clot.....but an elevated D-dimer doesn't always mean you have a blood clot

Question 69

When is a D-dimer test helpful?

Answer 69

When the probability of venous thromboembolism is LOW

Question 70

What can cause a D-dimer to be elevated?

Answer 70

- Thromboembolism - Cancer - Pregnancy - Trauma - Post surgery - Liver disease - Infection - DIC