LFTs

Question 1

AST is released when

Answer 1

• Damage to HEART, LIVER, SKELETAL MUSCLE, KIDNEY, BRAIN, PANCREAS, SPLEEN, LUNGS
• less specific to liver than ALT

Question 2

ALT

Answer 2

• more specific to liver

- acute viral hep/tylenol OD/ischemia/celiacs would raise

Question 3

ETOH abusers often show AST:ALT of

Answer 3

≥ 2:1

Question 4

AST:ALT <1 suggestive of most types of

Answer 4

liver injury

Question 5

MC hepatotoxins

Answer 5

• acetaminophen (MCC drug induced liver failure, then augmentin)
• etoh

Question 6

alk phos is associated with the

Answer 6

• biliary tree, increased in obstruction of biliary track

- would also be high in a growth spurt or 3rd trimester

Question 7

GGT is assoicated with

Answer 7

Etoh

also common in pts on anticonvulsants

Question 8

liver dysfunction would result in ( ) amounts of albumin

Answer 8

decreased

Question 9

PT measures the

Answer 9

extrinsic pathway

If liver is not synthesizing coag factors then PT will be decreased….sign of bad liver function/disease

Question 10

lactate dehydrogenase

Answer 10

• Marked increases may be found with hepatic neoplasms or in hemolysis
• Relatively insensitive index of hepatocellular injury

Question 11

Toxic to body tissues- particularly neurons, readily removed from the body and converted to urea by the liver, excreted by kidneys

Answer 11

ammonia
Poor liver function means decreased urea synthesis and therefore increased ammonia in the blood
Can lead to hepatic encephalopathy

Question 12

causes of elevated bilirubin

Answer 12

Prehepatic – increased production (  indirect)
Hepatic - deficiency in hepatic metabolism (  indirect)
Posthepatic - bile duct obstruction (  direct)

Question 13

overproduction of unconjugated bilirubin is caused by

decreased conjugation of bilirubin is caused by

Answer 13

not the liver

liver, Gilbert’s syndrome

Question 14

conjugated hyperbilirubinemia is MCC

Answer 14

Obstruction, may lead to pale stool or darker urine from excess that cant be excreted from colon

Question 15

dubin johnson

Answer 15

Don’t secrete conjugated bilirubin well

Question 16

primary biliary cirrhosis

Answer 16

Chronic progressive destruction of small lobular intrahepatic bile ducts  Portal inflammation and scarring  Cirrhosis
aka destroys ducts in liver “intrahepatic”
associated w/AI disorders (skogrens, RA)

Question 17

primary biliary cirrhosis tx

Answer 17

urodeoxycholic acid

Question 18

Approx 70% cases are male
75-90% associated with IBD (usually UC)
80% of pts have perinuclear antineutrophilic cytoplasmic Ab (pANCA)
Diagnosis by ERCP (“string of pearls”) or MRCP
Ursodeoxycholic acid

Answer 18

primary sclerosing cholangitis, ducts within and outside liver “intra and extra hepatic)

Question 19

if there is a lot more ALT than alk phos….

if there is a lot more AP than ALT…

Answer 19

it is probably a liver problem

it is probably a biliary problem

Question 20

≥10-fold increase in AST/ALT indicate

Answer 20

active hepatocellular necrosis

Question 21

Courvoisier’s sign (firm, palpable gallbladder and jaundice) suggests

Answer 21

pancreatic cancer