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Clin Lab Med Exam 1 (Shelby) > LFTs > Flashcards

LFTs Flashcards

1
Q

What were the four herbals/ vitamins listed that are common for drug induced liver injury

A

Ephedra
Kava
Vitamin A
Garcinia cambogia

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3
Q

Your worst nightmare has come true, and you are working in peds. A parent brings in their child and they have neonatal cholestasis. Obviously their ALT/AST is elevated because it’s liver stuff. What special test are you going to order for this tiny monster

A

Serum a-1 antitrypsin

Probably has alpha-1 antitrypsin deficiency due to having liver disease as a freakin baby

A-1 antitrypsin phenotype if their insurance will cover it

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5
Q

Name that stage of nonalcoholic fatty liver disease

Fibrosis of the liver

A

Cirrhosis

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6
Q

Your patient has signs of liver disease, low serum ceruloplasmin, but you don’t see any Kayser-Fleischer rings. You do a 24 hour urine copper test and it is normal.

Whatchu got?
Need more tests?

A

Obtain a liver biospy or genetic testing

Serum ceruloplasmin was low, still need to confirm

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7
Q

What enzyme would be elevated in diseases affecting the biliary tree

A

5NP

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8
Q

Tests that refelct liver FUNCTION

A

Albumin

PT/INR

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10
Q

What are the three progressions of Nonalcoholic Fatty Liver Disease

A
  1. Simple Steatosis (NAFL)
  2. Non-alcoholic steatohepatitis (NASH)
  3. Cirrhosis
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11
Q

Transmission method for Hep B

A

Blood
Sexual contact
Birth

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13
Q

What could be the cause of AST elevation on its own

A

Skeletal muscle
Cardiac muscle
Kidney
Brain

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15
Q

How does Hep C classically present

A

Aysymptomatic 85% of the time

Some people get jaundice and fatigue fever, etc

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17
Q

Most people with hereditary hemochromatosis are asymptommatic, maybe with some fatigue and decreased libido. However, if they reach later stages of the disease, what are some signs and symptoms:

A
  1. Cirrhosis of the liver
  2. Bronze skin
  3. Cardiomegaly —-> Heart failure
  4. Diabetes (pancreas)
  5. Impotence (gonads)

ALL OF THESE THINGS DUE TO IRON DEPOSITING IN THAT ORGAN

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19
Q

When you have a super high ALP and GGT and you know its liver origin, What can tell you if it is alcoholic liver disease

A

If AST:ALT ration is MORE THAN 2:1

More AST!!! Even though its liver!!!

All the youtube videos said this was ~HiGh YiElD~

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20
Q

Which Hep is associated with Baby boomers

A

Hep C

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21
Q

Wilsons disease:

ALT/AST:
ALP:
ceruloplasmin:
24 hour urinary copper:

A

ALT/AST: elevated
ALP: low
Cerulosplasmin: low
24 hour urinary copper: high

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22
Q

How do you diagnose non alcoholic steatohepatitis

A

Mildly elevated AST and ALT

Confirm fatty infiltration with fibroscan or liver biopsy

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24
Q

What could be the cause of ALP elevated on its own

A

Bone
Preggo
Intestines

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27
Q

Hep B testing interpretation:

HBsAg = -
Total anti-HB= -
Anti-HBs = -

A

Susceptible to Hep B infection- never had it, no vaccine

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28
Q 
ALT/AST = mild
ALP = very high
ANA = +
AMA = -

What disease?

A

Primary Sclerosing Cholangitis

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30
Q

Transmission method for Hep A

A

Fecal-oral

Say no to rim jobs, kids.

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31
Q

Hep B testing interpretation:

HBsAg = -
Total anti-HB= +
Anti-HBs = +

IgG anti-HBc= +

A

Immune due to natural infection

Had it and got better

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32
Q

Of the hepatitis category (A B and C) which one has the smallest increase in ALT/AST

A

Hep C

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33
Q

In suspected HCV, you test for HCV antibody and it was reactive, and then you test for HCV RNA and it was detected, what next?

A

They have current HCV infection — treatment

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34
Q

When would someone with wilsons disease present with symptoms

A

5-35

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37
Q

What could be the reason LDH is elevated on its own

A

Tissue necrosis

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38
Q

Hep B testing interpretation:

HBsAg = +
Total anti-HB= +
Anti-HBs = -

IgM anti-HBc = -

A

Chronically infected

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39
Q

You get a high ALP, but you know that could be either liver OR something else. What other test can you look at to confirm liver origin

A

GGT

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40
Q

You patient has signs of liver diease, serum ceruloplasmin is low, AND there are Kayser-Fleischer rings in their eyes. You decide to do a 24 hour urine copper test and it comes back HIGH AS HELLLLLL

Whatchu got?
Need more tests?

A

Wilsons, the diagnosis is established

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41
Q

What % of people who get acute Hep C get chronic Hep C?

A

70-80%

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44
Q

If a patient haws elevated LFTs but no symptoms, what next?

A

Repeat the test - fasting

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45
Q

Which stage of Nonalcoholic fatty liver disease:

Fatty liver without inflammation, low risk of developing significant fibrosis

A

Non-alcoholic fatty liver (NAFL)

Stage 1

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47
Q

What % of people who have acute Hep A get chronic hep A

A

Chronic Hep A doesn’t exist. So zero.

48
Q

Hep B testing interpretation:

HBsAg = -
Total anti-HB= -
Anti-HBs = +

A

Immune because you are smart and got a vaccine

51
Q

How long does it take to recover from Hep A?

A

6 months

53
Q

Hemochromatosis is _____ build up in the liver

A

Iron

56
Q

Hep B testing interpretation:

HBsAg = +
Total anti-HB= +
Anti-HBs = -

IgM anti-HBc= +

A

ACUTE ACUTE!

They got that ish right nowwwww

57
Q

Your patient has signs of liver disease, normal serum Ceruloplasmin and Kayser-Fleischer rings.

Whachu got?
Need more tests?

A

Go straight to the biopsy without the urine test. Even if the urine test came back positive, you can’t diagnose with normal serum and high copper urine for wilsons, you need the biopsy.

58
Q

What is the cause of 45% of deaths for people with hereditary hemochromatosis ??

How do you detect this?

A

Hepatocellular carcinoma

Screen using AFP (alpha fetoprotein) and ultrasound

59
Q

What are some things not fully discussed in the lecture that could end up on a differntial for elevated ALT/AST (but not super elevated like a chronic disease)

A

Cancer
Celiac disease
Chronic alcoholic hepatitis

Things we talked about:
Drug induced liver injury (also could be in the acute differential with high values!)
Fatty liver
Hemochromatosis
Autoimmune hepatitis
Alpha-1 anti-trypsin deficiency
Wilsons disease
62
Q

You test for HCV antibody and it is reactive, so you test for HCV RNA and it is not detected. What next?

A

No further action required, probably a false positive on the antibody

64
Q

Which labs reflect hepatocellular damage

A

ALT

AST

65
Q

Hep B testing interpretation:

HBsAg = -
Total anti-HB= +
Anti-HBs = -

A

~iNtErPrEtAtIoN uNcLeAr~

  1. Most likely a resolved infection even though the anti-HBs is negative
  2. Could be a false positive anti-HBc, which means they are susceptible (never had it or the vaccine)
  3. “Low level” chronic infection even though HBsAg is negative
  4. Resolving acute infection
66
Q

H/H: low
AST/ALT: normal
Indirect Bilirubin: elevated
Direct Bilirubin: normal

Whatchu got

A

Hemolysis

Also see an increased retic count and abnormal peripheral smear

67
Q

Which Hep is associated with drug use, tattoos, high risk sexual behavior, etc

(Just think like times square in the early 90’s that should cover all the risk factors)

A

Hep C

68
Q

Hepatomegaly, Tremors, dysarthria, incoordination, personality or behavioral changes in someone ages 5-35 makes you think of what tests to order? For what disease?

A

Serum ceruloplasmin
24 hour copper urine
Look in their eye for kayser-fleischer rings

WILSONS

69
Q

Hep B

ALT/AST:
ALP:
Bilirubin:

A

Hep B

ALT/AST: BIG INCREASE
ALP: increase
Bilirubin: increase

70
Q

Which labs refect cholestatic process

A

ALP
Total bilirubin
GGT

71
Q

Your patient has signs of liver disease, no Kayser-Fleischer rings, and a normal serum ceruloplasmin. You do a 24 hour urine copper test anyway even tho how would you even think to do that but whatever, and it comes back HIGH AS HELLLL

Whachu got?
Need more tests?

A

Obtain a liver biopsy or genetic test for Wilson’s disease

*can’t confirm with just the urine since serum ceruloplasmin was normal

72
Q

In suspected Hep C, you test for HCV antibody and it is nonreactive, what next?

A

No further action required but if recent exposure within the last 6 month or is suspected OR if they are immunocompromised, test for HCV RNA

74
Q

Which two antibodies do you test for with suspected Hep C

A 
HCV antibody
HCV RNA (not really an antibody tho)
77
Q

H/H: normal
AST/ALT: normal
Indirect Bilirubin: elevated
Direct Bilirubin: normal

Whatchu got

A

Gilbert’s syndrome

79
Q

In suspected HCV, you test HCV antibody and it is reactive, what next?

A

Test for HCV RNA

82
Q

When determing if an infection is acute or chronic, lab values would be ___x the normal amount for a cute, and less than that for chronic

A

5 times

84
Q

What % of adults who get acute Hep B end up with chronic Hep B

A

Only 5%

85
Q

LABS for hereditary hemochromatosis

Ferritin:
Transferrin:
TIBC:
ALT/AST:

A

Ferritin: INCREASED
Transferrin: INCREASED
TIBC: DECREASED
ALT/AST: ~MiLd~ increase

87
Q

Which autoimmune diseases are hepatocellular?

Which autoimmune diseases are cholestatic?

A

Hepatocellular = autoimmune liver disease

Cholestatic = primary biliary cirrhosis, primary sclerosing cholangitis

88
Q 
ALT/AST = very high
ALP = mild
ANA = +
ASMA = very high
LKMA = +

What disease?
What antibody titer would you find?

A

Autoimmune liver diease

IgG

89
Q

Your patient has signs of liver damage, low serum ceruloplasmin, and Kayser-Fleisher rings, so you do a 24 hour urine copper test that comes back normal.

Whachu got?
Need more tests?

A

Liver biopsy or genetic testing to establish wilsons disease

*can’t confirm without the biopsy or genetic test because urine test was normal
Kayser-Fleischer rings are NOT enough for diagnosis!

90
Q

If you get a value that is SUPER HIGH for ALT/AST, other than the obvious acute hepatitis that you should be thinking of… what else is on the differential

A 
Epstein-Barr virus
Cytomegalovirus 
Acute Alcoholic Hepatitis (not chronic!) 
Drug Induced Liver Injury 
Mushroom ingestion
Acute Hepatitis of pregnancy (????)
Shock liver (hepatic ischemia)
91
Q

Primary Sclerosing Cholangitis

Men or women

A

Men

93
Q

How long is someone with Hep A contagious?

A

Thru the entire incubation period which averages 28 days + 1 week after symptoms of JAUNDICE

94
Q

What is unique about Hep B’s presenting symptoms

A

Usually without jaundice!

(Anicteric) even though bilirubin is increased

96
Q

Autoimmune Liver disease:

Men or women

A

Women

97
Q

Your patient has signs of liver disease, low serum ceruloplasmin, but you don’t see any kayser-fleischer rings. You do a 24 hour urine copper test and it comes back SKY HIGH

Whachu got?
Need more tets?

A

Wilson’s diagnosis is established

YOU DO NOT NEED THOSE DAMN RINGS TO ESTABLISH DX! If you have low serum ceruloplasmin, and high urine copper that is enough

98
Q

What percent of small children who get hep B end up with chronic hep B

A

25-50%

102
Q

What % of infants who get hep B end up with chronic hep B

A

90%

That SUCKS

103
Q 
ALT/AST = mild
ALP = very high
ANA = +
ASMA = mild
AMA = very high
LKMA = -

What disease?
What antibody would you find?

A

Primary Biliary Cirrhosis

IgM

105
Q

Hep A

ALT/AST:
ALP:
Bilirubin:

A

Hep A

ALT/AST: VERY MUCH INCREASED
ALP: increased
Bilirubin: increased

106
Q

Your patient has signs of liver disease, no Kayser-Fleischer rings, and a normal serum ceruloplasmin. You do a 24 hour urine copper test anyway because i dunno you felt like it, and it comes back normal

Whachu got?
Need more tests?

A

Wilson disease is excluded

All that ish was negative so you need to get off this wilsons thing and start thinking of other stuff it could be

107
Q

How long is the anti-HAV IgM that is diagnostic for Hep A positive in the serum?

A

4 months after symptoms appear

Symptoms usually appear a month after infection, due to incubation period

111
Q

What is the treatment for Hereditary hemochromatosis

A

AVOID GETTING CIRRHOSIS!!!!!!!!

  1. Don’t take vitamin C (for whatever fucking reason) 🍊🍊
  2. Don’t take iron supps (ok that makes sense) 🥩
  3. Don’t eat raw seafood (??????? What the actual fuck) ;🍣🍣🍣
  4. Don’t drink alcohol (also makes sense) 🥃🍸🍺
  5. BLOOD LETTING 💉💉
  6. Get immunizations for Hep A and B
122
Q

Primary Biliary Cirrhosis

Men or women

A

Women

126
Q

A patient comes in with emphysema and they are 44 years old. You start to judge them for being a chain smoker because why else would they have emphysema at 44 years old.

Then they tell you they have never smoked a cigarette in their entire life.

What test do you order STAT

…maybe not STAT. It can wait a few days whatever

A

AST/ALT = mild elevation
Serum a-1 antitrypsin = decreased

A-1 antitrypsin phenotype if their insurnace will pay for genetic testing (they wont)

Because they have alpha-1 antitrypsin deficiency

134
Q

Which stage of nonalcoholic fatty liver disease:

Fatty liver + inflammation with hepatocyte injury
High risk of developing significant fibrosis

A

Non alcoholish steatohepatitis (NASH)

135
Q

Management of nonalcoholic fatty liver disease includes:

A

Weight loss
No alcohol
Control diabetes and cholesterol

If cirrhosis = transplant

141
Q

What are the 4 risk factors for nonalcoholic fatty liver disease

A
  1. Abdominal obesity (big ole beer belly)
  2. Insulin resistance DM
  3. Hyperlipidemia
  4. Metabolic syndrome
145
Q

What is the strongest predictor of nonalcoholic steatohepatitis (NASH)

A

Metabolic syndrome

Clin Lab Med Exam 1 (Shelby) (1 decks)

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