LFTs for Biliary Dz

Question 1

Which LFT components tell us about Cholestatic Process (Bile flow)?

Answer 1

Total Bilirubin
Alk Phos
GGT

Question 2

Which LFT components tell us about Hepatocellular Damage?

Answer 2

ALT

AST

Question 3

Which LFT components tell us about Liver Fxn?

Answer 3

Bilirubin
Albumin
PT

Question 4

Bile purpose? (2)

Answer 4

Digest/Absorb fats

Carries bilirubin, cholesterol and metabolic products

Question 5

Bile Salts (Acids) fxn? (2)

Reabsorption?

Answer 5

Emulsify fats
Transport FA and fat-soluble vitamins into intest mucosa

Distal ileum reab and returns to liver via portal circulation

Question 6

Alk Phosphate: Product of?

Tells us?

Answer 6

Liver, biliary tract, bone

Biliary flow (Cholestatic Process)

Question 7

Alk Phos: If high, next steps?

Answer 7

Determine if biliary or non-biliary cause:

Run Alk Phos isoenzymes:
Alk Phos 1 = liver issue
Alk Phos 2 = bone issue

Run 5-Nucleotidase:
High = hepatic isssue

Question 8

GGT is?

Tells us?

Answer 8

Product of liver/biliary tract

Liver dysf, cholestasis (VERY sensitive)

Question 9

Total Bilirubin includes?

Tells us?

Answer 9

Conjug and unconj

Defect in bilirubin metab or excretion
Doesn’t tell us if pre-, intra-, or posthepatic

Question 10

Unconjugated Bilirubin tells us?

Besides bilirubin metab defect, what are other causes?

Answer 10

Issue is Pre- or Intrahepatic

Prehepatic: ↑RBC metab

Intrahepatic: drug rxn, immature liver, cirrhosis, hepatitis

Question 11

Conjugated Bilirubin tells us?

What happens to Conj Bilirubin post liver?

Signs of issues with this?

Answer 11

Issue is Extrahepatic: Obstruction or Impaired excretion

Gut bacteria ∆s it to urobilingen -> makes pee yellow and poop brown

Pale poop, tea-colored pee

Question 12

Amylase is?

Presence of Amylase in blood tells us?

Answer 12

Pancreatic enzyme from acinar cells into duodenum to digest starch

Pancreatic duct obstruction or
Acinar cell damage

Question 13

Why is Amylase U not present w/ chronic pancreatitis?

Answer 13

Acinar cells are destroyed so no amylase is produced

Question 14

Lipse is?

Presence of lipase tells us? (3)

Answer 14

Pancrestic enzymes into duodenum to digest trigly to FA

Pancreatice dz, renal fail, intest obstruction

Question 15

SUMMARY: ↑Alk Phos/Bilirubin a/w that conditions? (5)

Answer 15

Choledocholithiasis
Ascending cholangitis
Biliary cirro
Sclerosing Cholangitis
CA

Question 16

Choledocholithiasis is?

Presentation? (4)

Tests? (5)

Tx?

Answer 16

Stone in common bile duct

RUQ pain
N/V
Jaundice
Dark pee, light poop

CBC, LFT, amylase, lipase
US

ERCP for extraction

Question 17

Ascending cholangitis is?

Presentation?

Tests? (6)

Tx?

Answer 17

Infected bile duct

Charcot’s Triad:
RUQ pain
Fever
Jaundice

CBC, LFT, amylase, lipase, Blood cx
US

Emergent ERCP

Question 18

Primary Biliary Cirrhosis is?

Presentation? (6)

Tests? (5)

Answer 18

Autoimm dz of small intrahepatic bile ducts

RUQ pain
Fatigue
Pruritis
Hyperpig
Xanthomas
CREST sxs

LFT (↑alk phos, GGT, 5-NT)
AMA  +
ANA  +
IgM  ↑
Bx confirmation

Question 19

Primary Sclerosing Cholangitis is?

a/w? (3)

Presentation? (5)

Answer 19

Inflam/Fibrosis of med/large intra/extra hepatic ducts

a/w biliary stricture, cholangitis, cholangiocarcinoma

Fatigue
Pruritis
Jaundice
Steatorr
Osteoporosis

Question 20

Primary Sclerosing Cholangitis tests? (6)

Answer 20

ANA +
IgM ↑
ASMA  +
P-ANCA  +
MRCP
ERCP

Question 21

Cholangiocarcinoma is?

a/w? (2)

Presentation? (4)

Tests? (3)

Answer 21

Adenocarcinoma of bile ducts
a/w PSC and choledochal cyst

Jaundice
Wgt loss/Anorexia
Abd pain
Pruritis

LFT (↑alk phos, ↑conj bili)
↑CA 19-9
US

Question 22

Pancreatic CA is?

Presentation? (3)

Tests? (3)

Answer 22

U adenoCA in head

Wgt loss/Anorexia
Epigast pain
Jaundice

LFT (↑alk phos, ↑conj bili)
↑CA 19-9
US

Question 23

Cholestatis Pattern is?

Answer 23

Test results of:
↑alk phos
↑conj bili