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Medical Diagnostics > LFT and Coag > Flashcards

LFT and Coag Flashcards

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USMLE® Step 1 flashcards
1
Q

What tests are markers of acute hepatocyte injury or death?

A
  • AST
  • ALT
  • Alkaline phosphotase
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2
Q

What tests measure hepatocyte synthetic function?

A
  • PT/INR

- Albumin

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3
Q

What tests are indicators of hepatocyte catabolic activity?

A

Direct and indirect bilirubin

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4
Q

What tests diagnose specific disease entities?

A

GGT

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5
Q

What do ALT and AST stand for?

A 
ALT = Alanine Aminotransferase
AST = Aspartate Aminotransferase
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6
Q

What are some causes of an elevated ALT?

A
  • Hepatitis (viral, alcoholic, autoimmune, ischemic)
  • Biliary tract disease
  • Fatty liver disease
  • Medication related
  • Infiltrative disease
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7
Q

What is ALT > AST indicative of?

A

Viral hepatitis

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8
Q

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

A

ALT (typically a 2:1 ratio)

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9
Q

What are some causes of an elevated AST?

A
  • Hepatitis (viral, alcoholic, autoimmune, ischemic)
  • Biliary tract disease
  • Fatty liver disease
  • MYOCARDIAL INFARCT
  • Medication related
  • Infiltrative disease
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10
Q

What is AST > ALT indicative of?

A

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

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11
Q

What is the function of Alkaline Phosphatase?

A
  • Removes phosphate groups from molecules

- Growth and development of bones and teeth

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12
Q

What are some causes of an elevated alkaline phosphatase?

A
  • Hepatitis
  • Biliary tract disease
  • Fatty liver disease
  • BONE DISEASE (paget’s, primary, metastatic bone malignancy)
  • Pregnancy
  • Medication related
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13
Q

Which test is more specific for biliary tract disease?

A

Alkaline phosphatase

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14
Q

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

A

Bone issues

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15
Q

What is GGT?

A

Gamma Glutamyl Transpeptidase

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

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16
Q

What are some causes of elevated GGT?

A
  • Hepatitis (alcoholic)
  • Biliary tract disease
  • Pancreatic disease
  • Cardiovascular disease
  • Diabetes
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17
Q

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

A

Alcoholic liver disease

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18
Q

Elevated alkaline phosphatase, elevated GGT indicates…..

A

Liver issue

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19
Q

Elevated alkaline phosphatase, normal GGT indicates….

A

Not a liver issue

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20
Q

What is the most common cause of elevated aminotransferases?

A

Fatty liver disease

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21
Q

How do you determine INDIRECT bilirubin?

A

Total bilirubin - Direct bilirubin

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22
Q

What does bilirubin measure?

A

Live catabolic activity (component of bile & an antioxidant)

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23
Q

What are some causes of an elevated indirect bilirubin?

A
  • Hemolysis
  • Impaired hepatic uptake or conjugation
  • Neonates
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24
Q

When would you order a direct bilirubin test?

A

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

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25
Q

What are some causes of an elevated direct bilirubin?

A
  • Liver disease

- Biliary tract disease

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26
Q

Which bilirubin is lipid soluble and which is water soluble?

A
  • Indirect = lipid soluble

- Direct = water soluble

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27
Q

What is the least useful test?

A

Total protein

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28
Q

What can cause an increased total protein?

A
  • Bone marrow disorders

- Inflammation

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29
Q

What can cause a decreased total protein?

A
  • Liver disease
  • Kidney disease
  • Malnutrition
  • Malabsorption
30
Q

What is the main constituent of total protein?

A

Albumin

31
Q

What does albumin measure?

A

Synthetic function of liver

32
Q

What is albumin not a good test for?

A

ACUTE liver issues (ie. aspirin overdose)

Why? Because it has a long half life (3 weeks)

33
Q

What can cause an increased albumin?

A

Dehydration

34
Q

What can cause a decreased albumin?

A
  • Liver disease
  • Kidney disease
  • Malnutrition
  • Malabsorption
  • Severe burns
35
Q

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

A
  1. Intrinsic
  2. Extrinsic
  3. Common
36
Q

What is important when approaching bleeding disorders?

A

HISTORY

  • Hx of bleeding with surgery or dental procedures
  • Menorrhagia (heavy periods)
  • Med list
  • Family hx
  • Dietary hx
  • Social hx (ETOH)
37
Q

What pathway is PT/INR?

A

EXTRINSIC and common pathway (clotting time)

38
Q

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

A

1, 2, 5, 7, 10

39
Q

What is prothrombin?

A

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

40
Q

What do PT/INR and aPTT measure?

A

Synthetic liver function

41
Q

What are causes of prolonged INR?

A
  • Liver disease
  • Vitamin K deficiency
  • Warfin use
  • Coagulation deficiencies
  • DIC
42
Q

What does a prolonged PT/INR indicate?

A

-Liver disease

acute chronic liver injury, chronic liver disease, monitoring course of liver diease

43
Q

What pathway is warfrin?

A

Extrinsic (PT/INR –> prolonged)

44
Q

aPTT reflects the plasma concentration of what clotting factors?

A

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

45
Q

What pathway is aPTT?

A

INTRINSIC and common pathway

46
Q

What causes a prolonged aPTT?

A
  • Liver disease
  • HEPARIN USE
  • Factor deficiencies
  • Sepsis
  • Factor antibodies
  • DIC
47
Q

What does a prolonged aPTT indicate?

A
  • Liver disease (ADVANCED)
  • Heparin use
  • Factor deficiency –> specifically hemophilia
48
Q

What is bleeding time?

A
  • Rarely ever ordered

- Measure of platelet interaction with vessel wall

49
Q

When is platelet aggregation ordered?

A
  • Screen at risk presurgical patients

- Rarely ever ordered

50
Q

What is Von Willebrand Factor?

A
  • A glycoprotein involved in hemostasis
  • Increases adhesiveness/aggregation of platelets
  • Binds factor VIII and prevents it from being inactivated
51
Q

What is Von Willebrand disease?

A

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

52
Q

What are signs and symptoms of Von Willebrand Disease?

A

Bleeding gums, easy bruising, menorrhagia, nosebleeds

53
Q

How do you diagnosis Von Willebrand disease?

A
  • Prolonged aPTT (intrinsic pathway)
  • Prolonged bleeding time
  • Decreased vWF
  • Decreased factor VIII
54
Q

What is the treatment for Von Willebrand Disease?

A
  • Desmopressin before dental work or minor surgery

- Factor VIII before major surgery

55
Q

What is fibrinogen?

A

Glycoprotein precursor to fibrin in coagulation cascade

  • *Thrombin converts fibrinogen to fibrin
  • *Fibrin = main protein in a clot
56
Q

When are increased fibrinogen levels seen?

A

More likely to clot
Inflammatory process
(infection, malignancy)

57
Q

When are decreased fibrinogen levels seen?

A
  • Rare disease (hypofibrinogenemia and afribogenemia)

- DIC

58
Q

What is Factor V Leiden?

A

Functions as a cofactor in the clotting cascade

activated by thrombin, inactivated by protein C

59
Q

What happens if there is a factor V leiden mutation?

A

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

60
Q

What is Antithrombin III?

A

A protease that lyses thrombin and Factor Xa and IXa

61
Q

What does a antithrombin III deficiency cause?

A

Inability to inhibit thrombin –> hypercoagulability

62
Q

What is antiphospholipid?

A

Normally functions as part of vessel wall

-Positive antibodies indicate DISEASE –> hypercoagulability

63
Q

What is protein C dependent on?

A

Vitamin K

64
Q

What does protein C do?

A

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

65
Q

What does a deficiency in protein C cause?

A

Hypercoagulability

66
Q

What is protein S?

A
  • Dependent on vitamin K
  • Cofactor to protein C in the inactivation of Va and VIIIa
  • Deficiency = hypercoagulability
67
Q

What is a D-dimer?

A

Byproduct of the degradation of a clot

68
Q

When would you have an elevated D-dimer?

A

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

69
Q

When is a D-dimer test helpful?

A

When the probability of venous thromboembolism is LOW

70
Q

What can cause a D-dimer to be elevated?

A
  • Thromboembolism
  • Cancer
  • Pregnancy
  • Trauma
  • Post surgery
  • Liver disease
  • Infection
  • DIC

Medical Diagnostics (10 decks)

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