Liver Flashcards
What does a rise in either the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) enzymes indicate when conducting a liver test?
That some kind of event happened to the liver and may be pathological. It does not indicate the degree of damage.
What does a rise in alkaline phosphatase (ALP) indicate.
Associated with biliary obstruction, however, it is also located in bones and can indicate growth in children.
What enzyme that rises along with ALP is liver specific for pathology?
Gamma glutamyl transpeptidase (GGTP)
What kind of pathology is associated with increased conjugated serum bilirubin?
Bile duct blockage or defective bile transporters
What kind of pathology is associated with increased unconjugated serum bilirubin?
bile overproduction, hemolysis
What is Gilbert syndrome?
Reduced glucuronyltransferase activity which conjugates bilirubin.
What is Dubin-Johnson syndrome?
Defective transporters on the apex of hepatocytes. Conjugated bile cannot be transported from hepatocytes to the biliary system.
(Rotor is very similar)
Congenital disease not specific to the liver that can lead to high conjugated bilirubin in the serum.
Sickle Cell disease
The liver synthesizes many globulin proteins which can be elevated with chronic liver disease. What diseases are associated with elevated:
- IgG
- IgM
- IgA
- autoimmune hepatitis
- primary biliary cirrhosis
- alcoholic liver disease
What test can be run to assess liver function when blood coagulation is a problem in a patient?
PT (pro-thrombin) time test. If it is increased it can mean liver disease or Vit. K deficiency. If PT time improves with administration of vit. K then the liver is fine, but if the time does not improve, liver disease is suspected.
Common chemical that inhibits the liver’s ability to detoxify the toxic metabolite of acetaminophen and often leads to ER visits.
Ethanol
-alcoholics that take Tylenol often end up in the ER due to liver toxicity
Describe the four stages of drug-induced liver disease or toxicity (DILT).
Stage I: occurs within several hours, anorexia, N/V
Stage II: cessation of stage I symptoms and feeling well, meanwhile aminotransferase, bilirubin and PT time rise.
Stage III: AST levels peak, vomiting, acidosis, encephalopathy, coma
Stage IV: recovery, no injury to liver in survivors
Name 4 treatments for drug overdose.
- Ipecac
- Activated charcoal
- Hemodialysis
- N-acetylcysteine
What can affect the liver’s ability to metabolize LOW clearance drugs?
Liver mass (tumors)
What can affect the liver’s ability to metabolize HIGH clearance drugs?
Reduced hepatic flow, shunting
What does the term UNITY mean in pharmacology?
A drug’s therapeutic effect is equal to its toxic effects. Usually this means it is not worth it to use this drug.
If a patient has abnormal liver tests and presents with this other symptom, it is considered DILT until ruled out. What is the other symptom?
Skin rash
Two major enzymes that convert ethanol to acetaldehyde.
- Alcohol dehydrogenase (ADH)
2. Microsomal ethanol oxidizing system (MEOS)
What is the most important risk factor in developing alcoholic liver disease.
Quantity of alcohol ingested
about 4-5 beers/day massively increases risk
What kind of aminotransferase test indicates alcoholic liver disease?
2:1 ratio of AST/ALT
Two main treatments for Alcoholic liver disease.
- Abstinence
2. Corticosteroids for DF>32 (discriminant function of liver)
Primary risk factor for Non-alcoholic fatty liver disease (NAFLD).
Insulin resistance
What characteristics indicate Metabolic syndrome or syndrome X?
-high abdominal fat
-high triglycerides
-low HDL
-high fasting sugar
-hypertension
(3 or more of these means you have syndrome X)
What is the two-hit hypothesis for the pathogenesis of NASH?
- Accumulation of liver fat
2. Lipid peroxidation creates free radicals with damage and inflame the liver
How is NAFLD and NASH diagnosed?
It is usually the diagnosis once all other liver pathology is ruled out.
- sometimes unexplained ALT rise or cryptogenic cirrhosis is considered non-alcoholic liver disesase
- both AST and ALT levels rise
- both ALP and GGTP levels rise
- no infection or autoimmune disease present
What is the only way to distinguish NAFLD from NASH?
Liver biopsy
Zone most affected in a hepatic lobule with NAFLD and NASH.
Zone 3
What’s the difference between Mallory bodies and Mallory hyaline?
Mallory bodies are seen on biopsy of alcoholic liver disease.
Mallory hyaline is seen on biopsy of non-alcoholic liver disease
What is now becoming a major association in patients with NASH?
Hepatocellular carcinoma, it is now becoming a regular practice to regularly screen patients that have or had NASH.
What is treatment for NASH?
Manage obesity, diabetes, hyperlipidemia, low alcohol intake.
