LFTs for Biliary Dz Flashcards
Which LFT components tell us about Cholestatic Process (Bile flow)?
Total Bilirubin
Alk Phos
GGT
Which LFT components tell us about Hepatocellular Damage?
ALT
AST
Which LFT components tell us about Liver Fxn?
Bilirubin
Albumin
PT
Bile purpose? (2)
Digest/Absorb fats
Carries bilirubin, cholesterol and metabolic products
Bile Salts (Acids) fxn? (2)
Reabsorption?
Emulsify fats
Transport FA and fat-soluble vitamins into intest mucosa
Distal ileum reab and returns to liver via portal circulation
Alk Phosphate: Product of?
Tells us?
Liver, biliary tract, bone
Biliary flow (Cholestatic Process)
Alk Phos: If high, next steps?
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
GGT is?
Tells us?
Product of liver/biliary tract
Liver dysf, cholestasis (VERY sensitive)
Total Bilirubin includes?
Tells us?
Conjug and unconj
Defect in bilirubin metab or excretion
Doesn’t tell us if pre-, intra-, or posthepatic
Unconjugated Bilirubin tells us?
Besides bilirubin metab defect, what are other causes?
Issue is Pre- or Intrahepatic
Prehepatic: ↑RBC metab
Intrahepatic: drug rxn, immature liver, cirrhosis, hepatitis
Conjugated Bilirubin tells us?
What happens to Conj Bilirubin post liver?
Signs of issues with this?
Issue is Extrahepatic: Obstruction or Impaired excretion
Gut bacteria ∆s it to urobilingen -> makes pee yellow and poop brown
Pale poop, tea-colored pee
Amylase is?
Presence of Amylase in blood tells us?
Pancreatic enzyme from acinar cells into duodenum to digest starch
Pancreatic duct obstruction or
Acinar cell damage
Why is Amylase U not present w/ chronic pancreatitis?
Acinar cells are destroyed so no amylase is produced
Lipse is?
Presence of lipase tells us? (3)
Pancrestic enzymes into duodenum to digest trigly to FA
Pancreatice dz, renal fail, intest obstruction
SUMMARY: ↑Alk Phos/Bilirubin a/w that conditions? (5)
Choledocholithiasis Ascending cholangitis Biliary cirro Sclerosing Cholangitis CA
Choledocholithiasis is?
Presentation? (4)
Tests? (5)
Tx?
Stone in common bile duct
RUQ pain
N/V
Jaundice
Dark pee, light poop
CBC, LFT, amylase, lipase
US
ERCP for extraction
Ascending cholangitis is?
Presentation?
Tests? (6)
Tx?
Infected bile duct
Charcot’s Triad:
RUQ pain
Fever
Jaundice
CBC, LFT, amylase, lipase, Blood cx
US
Emergent ERCP
Primary Biliary Cirrhosis is?
Presentation? (6)
Tests? (5)
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
Primary Sclerosing Cholangitis is?
a/w? (3)
Presentation? (5)
Inflam/Fibrosis of med/large intra/extra hepatic ducts
a/w biliary stricture, cholangitis, cholangiocarcinoma
Fatigue Pruritis Jaundice Steatorr Osteoporosis
Primary Sclerosing Cholangitis tests? (6)
ANA + IgM ↑ ASMA + P-ANCA + MRCP ERCP
Cholangiocarcinoma is?
a/w? (2)
Presentation? (4)
Tests? (3)
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
Pancreatic CA is?
Presentation? (3)
Tests? (3)
U adenoCA in head
Wgt loss/Anorexia
Epigast pain
Jaundice
LFT (↑alk phos, ↑conj bili)
↑CA 19-9
US
Cholestatis Pattern is?
Test results of:
↑alk phos
↑conj bili
