LFT & Other GI Flashcards
why is PT and INR included in a liver function test?
liver makes the clotting factors
what 3 things does the liver metabolize/synthesize?
- protein
- carbohydrates
- lipids
what does the liver excrete? (5)
- bilirubin
- bile
- hormones
- cholesterol
- drugs
damage to the hepatocytes (liver cells)
hepatocellular disease
abnormality in hepatic synthesis or excretory function (bile excretion)
cholestatic disease
what type of cholestasis has defective liver cell function, damaged bile secretion, transport mechanism, or altered metabolism?
intrahepatic cholestasis
which type of cholestasis has a mechanical blockade in biliary tree, biliary atresia, or common duct stone?
extrahepatic cholestasis
an enzyme that comes from liver, bone, intestines, placenta, and neoplasms
alkaline phosphatase
What is an elevated level of alkaline phosphatase most likely associated with?
cholestatic disorders
what happens to the result if an ALP is heated?
decreased result
enzyme that comes from the liver, brain, heart, and blood vessels
5’-nucleotidase
What is 5’-nucleotidase highly sensitive and highly specific for?
hepatobiliary cholestatic disorders (liver disease)
if 5’-nucleotidase has _____ levels to ALP, this indicates _____
parallel; liver disease
enzyme that comes from liver (biliary tree ducts), kidneys, heart, spleen, pancreas, and brain
GGT
if GGT has _____ levels along with _____ and _____, this indicates liver disease
increased; ALP; 5’-nucleotidase
which enzyme is used to monitor long-term compliance to alcohol abstinence / hepatitis?
GGT
which enzyme comes from all body tissues? (liver, heart, kidneys, intestines, skeletal muscles, erythrocytes, etc.)
AST
AST is elevated after _____ _____, within ____ to ____ hours
active damage; 24-48
which 2 enzymes must be elevated together to indicate liver damage?
AST and ALT
which enzyme comes from hepatocytes, kidney, heart, and skeletal muscle?
ALT
which enzyme is both highly sensitive and highly specific for liver damage?
ALT
which enzyme rises before clinical symptoms appear?
ALT
a patient with mildly elevated ALP, WNL 5’-nucleotidase, GGT, AST/ALT indicates what differential diagnosis?
nonhepatic cause (pregnancy)
a patient with moderately elevated ALP, highly elevated 5’-nucleotidase, GGT, WNL AST, and minimally elevated ALT indicates what differential diagnosis?
cholestatic disease
a patient with mildly elevated ALP, 5’-nucleotidase, GGT, and highly elevated AST, and ALT indicates what differential diagnosis?
hepatocellular disease
yellowish pigment that is the breakdown product of RBCs
bilirubin
who should remove bilirubin from the body?
liver
what does an elevated total and indirect bilirubin indicate?
pre-hepatic problem
what does an elevated total and direct bilirubin indicate?
hepatic or post-hepatic problem
colorless end-product of bilirubin metabolism that is oxidized by intestinal flora to brown pigment called urobilin
urobilinogen
some urobilinogen is excreted in the urine as _____
urobilin
What will high levels in urobilinogen indicate?
hemolytic disease
What will low levels in urobilinogen indicate?
biliary obstruction
what 3 things will be elevated if there is blood in the urine?
- urobilinogen
- protein
- hemoglobin
if total and indirect bilirubin is moderately elevated, direct bilirubin is WNL, and ALT/AST/GGT is WNL, what is our differential diagnosis? (3)
- hemolysis
- gilbert syndrome
- neonatal jaundice
if total and direct bilirubin are moderately elevated, and indirect, ALT/AST/GGT are all WNL, what is our differential diagnosis?
congenital
if total and direct bilirubin is mildly elevated, and indirect, ALT/AST/GGT are all moderately elevated, what is our differential diagnosis?
hepatobiliary disease
yellow appearance due to deposition of bilirubin in the skin, mucous membranes, and sclera + tea-colored urine or tan-colored stools
jaundice
increased unconjugated bilirubin due to hemolytic anemia or in a new born
prehepatic jaundice
what is prehepatic jaundice also known as?
hemolytic icterus
why is neonatal hyperbilirubinemia so dangerous?
it can progress to kernicterus
brain damage that can result from high levels of bilirubin in a baby’s body
kernicterus
test that transmits light through infant’s skin and analyzes specific wavelengths that are reflected
transcutaneous bilirubinometry (TcB)
bilirubin is lipo-_____
lipophilic
what kind of jaundice is increased unconjugated and/or conjugated bilirubin present in?
hepatic jaundice
jaundice that presents with impaired cellular uptake and abnormal removal by hepatocytes that is present in gilbert’s disease
hepatic jaundice
what is hepatic jaundice also called?
toxic icterus
syndrome of defective conjugation, complete absence of UDPG-T, colorless bile, increased unconjugated bilirubin, and patients may die of kernicterus
crigler-najjar syndrome type I
syndrome of defective conjugation, deficiency of UDPG-T, and increased unconjugated bilirubin
crigler-nijjar syndrome type II
syndrome of defective excretion of bilirubin into the bile, pigment deposits that causes liver to turn black, increased total bilirubin (conjugated mostly), and AST/ALT is normal
dubin-johnson syndrome
jaundice that presents with impaired removal of bilirubin from blood, increased conjugated bilirubin, decreased urobilinogen in stool and urine, and clay-colored/chalky white stool
post-hepatic jaundice
what is post-hepatic jaundice also called?
obstructive icterus
since calcium is bound to albumin, what would a decrease in albumin cause?
decrease in calcium
what maintains oncotic pressure and binds/transports hormones, anions, drugs, and fatty acids?
albumin
what does a shift of albumin out of the intravascular compartment lead to?
peripheral/pulmonary edema/ascites
what 2 proteins do we test for total protein?
albumin
globulin
present in tissue cell mitochondria/cytoplasm, is a waste product and excreted by the liver, and is used to form urea eliminated by the kidneys
ammonia
what does build-up of ammonia metabolism in the blood lead to?
hepatic encephalopathy
inflammation of the liver
hepatitis
What will be increased in the acute/chronic markers when testing for hepatitis? (6)
AST
ALT
ALP
GGT
TBilirubin
DBilirubin
what is the De Ritis ratio?
AST/ALT
what can be used to determine if alcohol is the cause of hepatitis?
De Ritis ratio
what are some common symptoms of acute and chronic hepatitis? (8)
fatigue
jaundice
N/V
lack of appetite
bleeding/bruising
dark urine
light stools
abdominal tenderness
swelling in the liver and brain that presents as protracted vomiting that usually follows within a week of febrile viral illness
reye’s syndrome
which syndrome has symptoms of lethargy, vomiting, confusion, irritability, seizures, rapid deterioration into stupor / loss of consciousness?
reye’s syndrome
which syndrome shows labs of low glucose, increased AST/ALT/ammonia, and normal total bilirubin and amino acids?
reye’s syndrome
a disorder of copper metabolism characterized by copper deposition in the brain, liver, kidney, and cornea
wilson’s disease
which disorder presents as neurologic degeneration, cirrhosis/jaundice, hepatomegaly, kayser-fleischer rings (eyes), and fluid buildup?
wilson’s disease
What is the gold standard to check for liver copper levels?
liver biopsy
type of fatty liver disease that has fat but no liver damage
nonalcoholic fatty liver disease (NAFLD)
type of fatty liver disease that has fat and signs of liver damage
nonalcoholic steatohepatitis (NASH)
most cases of fatty liver disease are _____
asymptomatic
what is the treatment for fatty liver disease?
lifestyle changes
gradual progressive destruction of the bile ducts in the liver (cholestasis disease) that leads to cirrhosis and liver failure
primary biliary cholangitis (PBC)
which disorder has early symptoms of choleostasis that includes fatigue, pruritis, jaundice, and deficiencies in fat-soluble vitamins?
primary biliary cholangitis
which disorder has late symptoms of RUQ pain, splenomegaly, edema, bone/muscle/joint pain, xanthomas, osteoporosis, and high cholesterol?
primary biliary cholangitis
what 3 things must be elevated/positive to diagnose primary biliary cholangitis?
- LFTs
- cholesterol
- AMA
inflammation of the pancreas
pancreatitis
accessory gland that excretes and makes enzymes for digestion and makes hormones like insulin and glucagon to regulate glucose
pancreas
what is the most common cause of pancreatitis?
alcohol abuse
a patient the presents with mid-epigastric pain that radiates to midback, nausea, vomiting, ileus, and fever is most likely experiencing …
pancreatitis
what is in my differential for a patient with suspected pancreatitis?
- ulcers
- biliary disease
- MI
- intestinal ischemia
- abdominal aortic aneurysm
2 out of 3 of these criteria are required to diagnose a patient with acute pancreatitis. what are they?
- abdominal pain
- serum lipase or amylase more than 3x normal limit
- CT
enzyme made by the pancreas and some by the salivary glands, that helps digest carbohydrates
amylase
when does amylase return back to normal in acute pancreatitis?
in 3-5 days
enzyme secreted by the pancreas into the duodenum, and helps digest fats and catalyzes the hydrolysis of triglycerides into fatty acids
lipase
when does lipase return to normal in acute pancreatitis?
8-14 days
enzyme that comes from the liver, kidneys and heart, and catalyzes the interconversion of lactate and pyruvate to make the body’s energy
lactate dehydrogenase (LDH)
an enzyme that is used to check for tissue damage, monitor conditions, assess severity of pancreatitis, and monitor treatments such as chemotherapy
LDH
