Liver 1 Flashcards
3 cholestatic dz indicators
ALP
5NT
GGTP
ALP is found in what 3 main tissues
Liver
Bone
Placenta
5NT is only elevated in what dz?
Hepatic dz
Which enzyme confirms origin of high ALP values
GGTP
What is the GGTP/ALP ratio to monitor compliance of alcoholics
> 2.5
Indicators of hepaticellular injury
AST or SGOT
ALT or SGPT
LDH
What additional tests needed to confirm source of ALP increase?
confirm source of ALP
increase: gamma-glutamyl transpeptidase, 5-
nucleosidase 12
- What conditions can cause an increase in ALP? - 2
• Indication of skeletal disease – Healing fractures – Osteomalacia – Values are elevated in teenagers/ children • Increased in the third trimester of pregnancy (placental ALP)
Alcoholic Liver Disease – 2 Biochemical
Markers
• AST:ALT ratio >2
• High concentra:ons of GGTP with
GGTP:ALP > 2.5
Where are the sources of5-Nucleotidase (5-NT) - 4
• Present in liver, heart, brain and blood vessels
What is the source of Gamma-Glutamyl Transpeptidase - 6
Liver kidney pancreas spleen heart, brain
Indicators of Hepatocellular Injury - 3
Ø Aspartate aminotransferase (AST or SGOT)
Ø Alanine aminotransferase (ALT or SGPT)
Ø Lactate dehydrogenase (LDH)
Aspartate Aminotransferase
(AST) - Very High
Very high (20 X ULN): acute viral hepatitis, drug induced hepatic injury
Aspartate Aminotransferase
(AST) - High
• High (10-20XULN): severe infectious
mononucleosis, alcoholic cirrhosis
Aspartate Aminotransferase
(AST) - Moderate
• Moderate (5-10xULN): chronic hepatitis
Aspartate Aminotransferase
(AST) - Low to Moderate
• Low to moderate (2-5xULN): hepatic tumors or unexplained (e.g. vigorous exercise)
Where can you find elevated AST Levels
Elevated levels found in any disease
with hepatocyte inflammation (hepatitis,
alcoholic cirrhosis)
What can elevated ALT levels distinguish?
Can be used to distinguish between myocardial and hepatic tissue damage - More specific to Liver
Alanine Aminotransferase (ALT) Levels - High
• Very high: viral or drug induced hepatitis
Alanine Aminotransferase (ALT) Levels - Moderate
• Moderate: infectious mononucleosis, chronic
hepatitis, intrahepatic cholestasis, early viral hepatitis, hepatic congestion due to heart failure
Alanine Aminotransferase (ALT) - Slight to moderate
• Slight to moderate: active cirrhosis, drug
induced or alcoholic hepatitis
- What are potential reasons for prolonged PT?
Malabsorption Malnutrition Warfarin Antibiotics Liver failure
Cause of Increased Bilirubin - Unconjugated 3 , conjugated 3, Both 1
Unconjugated (>70% indirect) Hemolytic anemia, Gilbert’s syndrome (UGT1A1), drugs (probenecid, rifampin) Conjugated (>50% direct) Bile duct obstruction, hepatitis, drugs Both Hepatitis
Liver Function Tests and Pregnancy - Increase - 3
conjugated bilirubin, ALP, and
α and β globulins
Liver Function Tests and Pregnancy - Decrease - 3
albumin, total serum protein, and γ globulin
Liver Function Tests and Pregnancy - Unchanged - 5
total bilirubin, AST, ALT,
GGT and prothrombin time
Drugs that Can Cause Cholestasis
• An:bio:cs – Erythromycin – Beta-‐lactams – Rifampin • Hormonal agents – Estrogens – Methyltestosterone – Anabolic steroids Not Exhausted
Drugs Causing Hepatocellular Injury - 2
APAP
Isoniazid
Not Exhausted
Hepa88s Biochemical Changes
- Increased bilirubin
- Decreased serum albumin
- Increase in gamma globulin
- ALP (moderate increase)
- ALT and AST increase up to 10 X
- Gamma-‐glutamyl transpep:dase (GGTP) increase
