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GI Final > LFT Module (Quiz 3) > Flashcards

LFT Module (Quiz 3) Flashcards

1
Q

which LFTS are indicators of hepatocellular injury

another name for them

A
  • AST (SGOT)

- ALT (SGPT)

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2
Q

which LFTs are indicators of cholestasis or obstruction (bile duct injury or obstruction)

A
  • alkaline phosphatase
  • GGT
  • bilirubin
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3
Q

which LFTs are indicators of true liver function

A
  • bilirubin
  • albumin
  • PT/INR
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4
Q

when we talk about hepatocellular injury, we mean that what has been damaged

A
  • actual hepatocytes
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5
Q

what do we mean when cholestatic or biliary injury has occurred

A
  • cells that compose the wall of bile ducts have been damaged
  • impaired bile formation or impaired bile flow
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6
Q

AST and ALT play a role in what process

A
  • gluconeogenesis
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7
Q

AST produces

ALT produces

A
  • oxaloacetate

- pyruvate

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8
Q

between AST and ALT, which is more specific for liver disease

A
  • ALT

- AST is located in many places

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9
Q

highest levels of amino transferases are found with what

A
  • ischemic injury

- drug-induced liver injury

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10
Q

what is cholestasis

A
  • impairment of biliary flow
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11
Q

the elevation in alkaline phosphatase in cholestatic diseases is thought to be secondary to _______________ due to enhanced translation of the mRNA of alkaline phosphatase

A
  • increased synthesis
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12
Q

between GGT and alkaline phosphatase, which is more sensitive and has the best negative predictive value

A
  • GGT
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13
Q

GGT may become elevated due to enzyme induction from ________-

A
  • alcohol
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14
Q

what will albumin levels be during periods of liver injury or severe inflammation

A
  • decreased
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15
Q

what happens to the PT/INR during liver damage

A
  • prolonged
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16
Q

bilirubin is a toxic metabolite generated by what process

A
  • breakdown of hemoglobin from RBC
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17
Q

bilirubin circulates through the blood how

A
  • in an insoluble, unconjugated form

- complexed with albumin

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18
Q

once bilirubin is taken into hepatocytes, it gets conjugated with ____________ by which enzyme

purpose

A
  • glucouronic acid
  • UGT
  • make bilirubin soluble
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19
Q

what happens with conjugated bilirubin

via which protein

A
  • secreted from hepatocytes into bile

- cMOAT/MRP-2

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20
Q

bilirubin is broken down by gut bacteria into

fate of these products

A
  • sterocobilinogen - excreted in stool

- urobilinogen - reabsorbed by enterohepatic circulation

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21
Q

how do we synthesize bilirubin

A
  • heme -> biliverdin -> bilirubin
22
Q

how do we produce heme -> biliverdin

A
  • heme oxygenase opens heme ring
23
Q

how do we produce biliverdin -> bilirubin

A
  • bilirubin reductase reduces central methylene bridge of biliverdin
24
Q

classify the bilirubin formed in the reticuloendothelial cells

A
  • lipid soluble
  • insoluble in water
  • unconjugated bilirubin
25
Q

does the liver take up bilirubin and albumin?

A
  • no
26
Q

the ______ bilirubin is that which reacts within 1 minute, whereas the _______ bilirubin is the amount which reacts 30 minutes after the addition of alcohol

A
  • direct bilirubin

- total bilirubin

27
Q

how to calculate indirect fraction of bilirubin

A
  • total bilirubin minus direct bilirubin
28
Q

hemolytic disorders and ineffective erythropoiesis lead to (conjugated or unconjugated) hyperbilirubenemia

A
  • unconjugated
29
Q

what is a serious condition causes hyperbilirubinemia in infants called?

A
  • kernicterus
30
Q

hepatocellular dysfunction and intrahepatic cholestais cause (conjugated or unconjugated) hyperbilirubenemia

how

A
  • conjugated

- blocks transit of bilirubin from hepatocytes

31
Q

are LFTs normal with indirect hyperbilirubinemia?

what about with direct

A
  • yes

- no; elevated

32
Q

pre-hepatic jaundice leads to elevation of direct or indirect bilirubin

when does it occur

A
  • indirect

- prior to bilirubin uptake by the liver

33
Q

intra-hepatic jaundice leads to elevation of direct or indirect bilirubin

when does it occur?

A
  • direct and indirect
  • when hepatocytes are damaged
  • can’t conjugate bilirubin or leakage of conjugated bilirubin
34
Q

post-hepatic jaundice leads to elevation of direct or indirect bilirubin

when does it occur?

A
  • direct

- impaired excretion of bilirubin in the biliary tree

35
Q

which disorders of bilirubin metabolism are disorders of conjugation

caused by what

A
  • gilbert syndrome
  • crigler najjar syndrome
  • alterations in gene that produces UGT
36
Q

which disorders of bilirubin metabolism are disorders of excretion into bile

A
  • Dubin johnson syndrome
37
Q

which disorders of bilirubin metabolism are disorders of reuptake

A
  • rotor syndrome
38
Q

what is the most common hereditary hyperbilirubinemia syndrome that is associated with at least a 50% loss of UGT activity and results in a mild, intermittent, isolated unconjugated hyperbilirubinemia

A
  • gilbert syndrome
39
Q

which type of Crigler Najjar syndrome is characterized by absent or nearly absent UGT1A1 enzyme activity

which type is characterized by reduced by not absent UGT1A1 activity

A
  • Type I

- Type II

40
Q

which type of Crigler Najjar syndrome is caused by multiple deleterious mutations

which type of Crigler Najjar syndrome is caused by a point mutation in a single amino acid residue, which leads to reduced, and not absent enzyme activity

A
  • Type I

- Type II

41
Q

which type of Crigler Najjar syndrome is associated with bilirubin encephalopathy and death without administration of aggressive phototherapy and exchange transfusions

treatment

A
  • Type I

- liver transplantation

42
Q

which disorder of bilirubin metabolism results from absent or deficient expression of the gene ABCC2/MRP2 that leads to absent transcription of or failure of translocation of the bilirubin transporter to the canalicular membrane.

how do you diagnose it

what are their levels

will the liver be pigmented

A
  • Dubin-Johnson syndrome
  • measure coproporphyrin I levels
  • around 80%
  • yes, black
43
Q

which disorder of bilirubin metabolism is characterized by hepatic uptake and storage of bilirubin that results in the absence of OATP1B1 and OATP1B3 transporters

how do you diagnose it

what are their levels

will the liver be pigmented

A
  • rotor syndrome
  • measure coproporphyrin I levels
  • around 65%
  • no
44
Q

which is elevated in hepatocellular injury (AST/ALT or alkaline phosphatase)

A
  • AST/ALT elevated greater than alkaline phosphatase
45
Q

what is the AST/ALT ratio for alcoholic hepatitis

A

2-3:1

46
Q

which is elevated in cholestatic injury (AST/ALT or alkaline phosphatase)

what accompanies this

A
  • alkaline phosphatase is elevated more than the transaminases
  • direct hyperbilirubinemia
47
Q

intrahepatic cholestasis refers to

A
  • impaired excretion of conjugated bilirubin
48
Q

extrahepatic cholestasis refers to

A
  • bile duct obstruction
49
Q

which is elevated in infiltrative diseases like sarcoidosis, lymphoma, tuberculosis (AST/ALT or alkaline phosphatase)

A
  • alkaline phosphatase
50
Q

one of the more common places for bile duct stones to get stuck is where

A
  • common bile duct
51
Q

what is the most important aspect of liver imaging

A
  • evaluate for biliary ductal obstruction
52
Q

two types of liver biopsy

where are they performed

A
  • percutaneous - bedside

- transjugular - VIR suite

GI Final (27 decks)

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