Liver

Question 1

What does a rise in either the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) enzymes indicate when conducting a liver test?

Answer 1

That some kind of event happened to the liver and may be pathological. It does not indicate the degree of damage.

Question 2

What does a rise in alkaline phosphatase (ALP) indicate.

Answer 2

Associated with biliary obstruction, however, it is also located in bones and can indicate growth in children.

Question 3

What enzyme that rises along with ALP is liver specific for pathology?

Answer 3

Gamma glutamyl transpeptidase (GGTP)

Question 4

What kind of pathology is associated with increased conjugated serum bilirubin?

Answer 4

Bile duct blockage or defective bile transporters

Question 5

What kind of pathology is associated with increased unconjugated serum bilirubin?

Answer 5

bile overproduction, hemolysis

Question 6

What is Gilbert syndrome?

Answer 6

Reduced glucuronyltransferase activity which conjugates bilirubin.

Question 7

What is Dubin-Johnson syndrome?

Answer 7

Defective transporters on the apex of hepatocytes. Conjugated bile cannot be transported from hepatocytes to the biliary system.
(Rotor is very similar)

Question 8

Congenital disease not specific to the liver that can lead to high conjugated bilirubin in the serum.

Answer 8

Sickle Cell disease

Question 9

The liver synthesizes many globulin proteins which can be elevated with chronic liver disease. What diseases are associated with elevated:

1. IgG
2. IgM
3. IgA

Answer 9

1. autoimmune hepatitis
2. primary biliary cirrhosis
3. alcoholic liver disease

Question 10

What test can be run to assess liver function when blood coagulation is a problem in a patient?

Answer 10

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.

Question 11

Common chemical that inhibits the liver’s ability to detoxify the toxic metabolite of acetaminophen and often leads to ER visits.

Answer 11

Ethanol

-alcoholics that take Tylenol often end up in the ER due to liver toxicity

Question 12

Describe the four stages of drug-induced liver disease or toxicity (DILT).

Answer 12

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

Question 13

Name 4 treatments for drug overdose.

Answer 13

1. Ipecac
2. Activated charcoal
3. Hemodialysis
4. N-acetylcysteine

Question 14

What can affect the liver’s ability to metabolize LOW clearance drugs?

Answer 14

Liver mass (tumors)

Question 15

What can affect the liver’s ability to metabolize HIGH clearance drugs?

Answer 15

Reduced hepatic flow, shunting

Question 16

What does the term UNITY mean in pharmacology?

Answer 16

A drug’s therapeutic effect is equal to its toxic effects. Usually this means it is not worth it to use this drug.

Question 17

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?

Answer 17

Skin rash

Question 18

Two major enzymes that convert ethanol to acetaldehyde.

Answer 18

1. Alcohol dehydrogenase (ADH)

2. Microsomal ethanol oxidizing system (MEOS)

Question 19

What is the most important risk factor in developing alcoholic liver disease.

Answer 19

Quantity of alcohol ingested

about 4-5 beers/day massively increases risk

Question 20

What kind of aminotransferase test indicates alcoholic liver disease?

Answer 20

2:1 ratio of AST/ALT

Question 21

Two main treatments for Alcoholic liver disease.

Answer 21

1. Abstinence

2. Corticosteroids for DF>32 (discriminant function of liver)

Question 22

Primary risk factor for Non-alcoholic fatty liver disease (NAFLD).

Answer 22

Insulin resistance

Question 23

What characteristics indicate Metabolic syndrome or syndrome X?

Answer 23

-high abdominal fat
-high triglycerides
-low HDL
-high fasting sugar
-hypertension
(3 or more of these means you have syndrome X)

Question 24

What is the two-hit hypothesis for the pathogenesis of NASH?

Answer 24

1. Accumulation of liver fat

2. Lipid peroxidation creates free radicals with damage and inflame the liver

Question 25

How is NAFLD and NASH diagnosed?

Answer 25

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

Question 26

What is the only way to distinguish NAFLD from NASH?

Answer 26

Liver biopsy

Question 27

Zone most affected in a hepatic lobule with NAFLD and NASH.

Answer 27

Zone 3

Question 28

What’s the difference between Mallory bodies and Mallory hyaline?

Answer 28

Mallory bodies are seen on biopsy of alcoholic liver disease.

Mallory hyaline is seen on biopsy of non-alcoholic liver disease

Question 29

What is now becoming a major association in patients with NASH?

Answer 29

Hepatocellular carcinoma, it is now becoming a regular practice to regularly screen patients that have or had NASH.

Question 30

What is treatment for NASH?

Answer 30

Manage obesity, diabetes, hyperlipidemia, low alcohol intake.