LFTs and Hepatitis

Question 1

Liver inflammation/hepatocellular damage

Answer 1

Elevated ALT (more specific), AST, &GGT (worry if associated with other elevations or if elevated 3-5fold)
Most common in primary care
Any vitamins (esp. ephedra, kava, vit A) can cause elevations, many prescription meds too
Hepatitis, alcoholic liver disease, fatty liver/NASH, meds, hemochromatosis

Question 2

Elevations in cholestasis

Answer 2

bilirubin, bilirubin direct (conjugated), alkaline phosphatase, GGT, LOW urobilinogen (white poop)
common cause-choledocholithiasis

Question 3

Gamma-Glutamyl Transpeptidase (GGT)

Answer 3

used to determine source of ALP (alkaline phosphate) elevation (bone or liver), if GGT also elevated its likely liver
alcohol consumption makes it unclear

Question 4

Reduced Liver function

Answer 4

Low albumin, low total protein, high/prolonged PT (more important than ALT/AST levels)
Common cause-cirrhosis or severe acute injury

Question 5

Choledocholithiasis

Answer 5

gallstones in common bile duct from gall bladder

present with pain, jaundice, clay-colored stool, cola urine

Question 6

Painless jaundice

Answer 6

pancreatic cancer/tumor until proven otherwise

Question 7

Hepatic Obstruction

Answer 7

Elevated ALT/bilirubin, high/normal ALP, normal urobilinogen with bilirubin

Question 8

Post-hepatic obstruction

Answer 8

normal/high ALT, high ALP/bilirubin, no urobilinogen, bilirubin in urine

Question 9

Gilbert Syndrome

Answer 9

elevated Indirect (unconjugated) bilirubin
Benign, defect of gene usually only in homozygotes
jaundice episodes in times of stress, diagnosis made by ruling out other causes of ^indirect bilirubin

Question 10

Alkaline phosphatase elevation

Answer 10

if GGT elevated-source is liver

if GGT not elevated-source is bone

Question 11

Cirrhosis

Answer 11

Scarred liver (can’t be repaired)
Fatigue, portal hypertension, ascites, jaundice, easy bruising/bleeding
Definitive diagnosis/staging requires liver biopsy

Question 12

High AST, normal ALT

Answer 12

ETOH liver disease, esp if GGT >2x normal

Question 13

High ALT, normal AST

Answer 13

Acute/chronic viral hepatitis (normal GGT)

NASH

Question 14

High Alk Phos with High ALT/AST

Answer 14

Cholestatic disease (choledocolithiasis)

Question 15

Fatty Liver (NAFLD/NASH)

Answer 15

fatty infiltration with inflammation-NASH
Can lead to cirrhosis/liver failure
75% of liver disease
Most asymptomatic/fatigue
Hepatomegaly
Low albumin, high PT/ALT/AST, may have high Alkphos; can have normal labs
Ultrasound first test, definitive diagnosis needs hepatic steatosis by image/biopsy, exclusion of alcohol/other causes

Question 16

Hereditary Hemochromatosis

Answer 16

Hereditary disorder of iron metabolism, autosomal recessive, HFE gene
Increased iron absorption in gut>accumulation of iron in liver, kidney, pancreas, heart, adrenals, testes, pituitary
Mostly caucasians (0.5%homozygotes, 10%hetero)
Symptoms in 50’s, earlier in men (periods dump iron)
Classic triad-cirrhosis, DM, bronze skin
High ALT/AST, poss alkphos, symptoms, 1st degree relative; TS >45 check for HFE
Managed with phlebotomy, avoid iron/alcohol
Major cause of death cirrhosis, HCC, D, cardiomyopathy

Question 17

Autoimmune Hapatitis

Answer 17

Rare, more common in females
Low albumin, high PT/ALT/AST/IgG, antibodies
Diagnose with blood and liver biopsy to confirm
Manage with corticosteroids (pred)

Question 18

Wilson Disease

Answer 18

Hereditary, autosomal recessive
impaired biliary copper excretion>accumulation of copper in organs
1/30,000
Children present with liver disease/hepatitis
Adults present with dysarthria, gait, dystonia, tremor, Parkinson’s, drooling
Kayser-fleischer rings in 1/2 pst
High ALT/AST/PT, low albumin/platelets/ceruloplasmin
Refer to specialist for diagnosis

Question 19

Approach to asymptomatic with high ALT/AST

Answer 19

Risk factors, labs (TS/Iron>specialist)
Consider other causes (celiac, hypothyroid, adrenal insufficiency)
Screen for rare liver conditions (autoimmune/wilson)
Refer to specialist

Question 20

Hepatitis A

Answer 20

Causes infectious/endemic
fecal-oral
10-15 day incubation
Excreted in feces 2 weeks before clinical illnessdaycares/sex/high risk areas
>90% childhood infections asymptomatic, 25-50% adults asymptomatic
99% recover
Treat symptoms
Prevent with hygiene/vaccinations
High ALT/AST/bilirubin, antibodies

Question 21

Hepatitis B

Answer 21

Transmitted through blood/sex/injection
Leading cause of cirrhosis/hepatocellular carcinoma
Acute-fever, jaundice, rarely fatal; high ALT/AST/bilirubin
Chronic-asymptomatic until late, 90% infected as babies
Premature death due to cirrhosis or HCC, treat with antivirals; High ALT/AST, no other abnormals until late

Question 22

Hep B surface antigen

Answer 22

present if currently infected

Question 23

Hey B Surface antibody

Answer 23

appears during recovery; if present pt immune due to vaccine or infection (if core is present)

Question 24

Total Hep B Core antibody

Answer 24

appears at onset of symptoms and stays forever-current or previous infection

Question 25

IgM antibody to Hep B core antigen

Answer 25

acute or recent infection (<6 months)

Question 26

Hepatitis C

Answer 26

Transmitted through exposure to infected blood (injection drugs, blood/organ donation, birth) Leading cause for liver transplants Acute-20-30% become symptomatic (fever, jaundice), 75% will develop chronic Chronic-asymptomatic until late, fever/malasie, ascites, jaundice Prevention-avoid high risk behavior SCREEN BABY BOOMERS Labs-start with antibody, if + check for HCV RNA, if + they have infection, otherwise cleared or else positive