liver (1) Flashcards
what are the 4 main liver tests and what are the abnormal results you will see
serum ALT (increased in hepatocellular damage) serum bilirubin (increased in cholestasis) Serum ALP (increased in cholestasis) Serum albumin (decreased in chronic disease)
ALT increases in liver diseases (2x + 10x increase)
in all liver diseases this increases (sensitive not spec)
2x increase= block likely
10x increase= indicates hepatitis
if ALT> AST what does it indicate
If AST>ALT what does it indicate
if ALT>AST= likely due to drug induced hepatitis/obstruction
if AST>ALT= likely due to alcoholic cirrhosis, metastatic cancer
when is serum bilirubin increased and what to take into consideration when doing it
increased in cholestasis
- normal serum bilirubin is <17 but jaundice is only seen when >40
- this means liver disease may be missed by only measuring bilirubin
When is serum bilirubin increased (2)
increased din cholestasis
increased in cancers/cirhosis
when is serum albumin decreased
levels decreased in chronic liver disease, kidney disease, starvation
summary for first line tests for cell damage, bile blockage
cell damage- serum ALT
bile blockage- serum bilirubin, ALP increase, Serum GGT increase
when will serum gGT, PT and serum cuerulosplasmin change
serum gGT- Increase in all liver diseases, marker for alcoholism
PT- may be first sign of liver damage
Serum cueruloplasmin- increase in inflammation, decrease in wilsons (juv cirrhosis)
hepatocellular disease prodrome (5)
- anorexia
- nausea
- malaise
- abdominal pain
- liver tenderness
hemolytic (pre liver) lab findings
serum bilirubin increased
blood reticulocytes present
blood hemoglobin decreased
hepatocellular liver diseaase lab results
serum ALT always elevated (ALP later)
Serum billlirubin later
Cholestatis lab markers
- serum ALP elevated
- Serum bilirubin elevated
- serum ALT, AST slightly increased
pre hepatic jaundice causes (4)
- unconjugated hyperbilirubin
- glu-6-phospatase def
- spherocytosis
- gilberts disease
What is hepatic jaundice due to and lab markers
caused by poisoning/virus
-serum bilrubin, ALP, ALT increased
Hepatitis prodrome lab
serum ALT, urineblinogen increase
-when jaundice appears, serum ALP increases
Hep A- type, trans, dx, `
single stand RNA
trans: fecal-oral due to contaminated drinking water (disease of children)
dx: Serum IgM against hep A
Heb B: type, dx, symptoms, long term
DNA virus
Trans: body fluids
Jt pain/itchy hives
-can lead to chronic hep, cirrhosis
3 serologies for Hep B
HBsAg- acute/present inf
HBc- core antigen (prior inf)
HBcAg- carrier state
Hep C- type, trans, longterm
RNA virus
Trans: blood
acute or chronic
Hep D: type, trans, serology, loc
RNA virus (need co-inf w b)
Acute/chronic
Trans: needles/sex
Serology: IgG/A/M, anti HDV
Italy
Hep E: type, trans, Dx
RNA virus
trans: fecal/oral
lab dx: antibodies to HEV anigens
Epstein barr virus: trans. Lab tests
Trans: oral
Lab: monospot, EBV titre
Cytomegalovirus dx
Rapid screen for IgM
Autoimmune hep: pop, tests (3)
F>M
- Seum anti smooth mm antibody
- serum anti mitochondrial antibody
- high serum pro
post hepatic jaundice (complete and partial blood markers)
complete- Serum bilirubin + serum ALP increased
Partial- Serum ALP increased (bilirubin can be normal)
liver failure mc cause, and lab resuts
mc- acitaminophen (med emergency)
- electrolyte imbalance (Serum NA, Ca, glu down)
- Blood ammonia increase
- serum albumin down
chronic hepatic damage causes(2) + symptoms
- alcoholic fatty liver (mc)
- chronic active hep following B/C virus inf
symptoms- poor appetite, fatigue, itching, fever, upper abdominal discomfort
Rarer causes of cirrhosis (3)
- willsons disease (measure copper/ caeruloplasmin)
- haemochromatosis
- alpha-1-antitrypsin deficiency
Primary liver cancers
hepatocellular carcinoma
cholargiosarcoma (bile ducts)
hepatic sarcoma (endothelial cells)
Secondary liver cancer and markers
spread from liver to other organs
-marker is AFP
