synthesized in liver, SENSITIVE for liver fxn - prealbumin sensitive for nutrition - bad cirrhosis --> NOT PROD albumin

Liver Flashcards by m b

LFT: Bilirubin gen

Breakdown of RBC destruction
Removed by liver, excreted by bile
2 form: direct/conj and indirect/unconj (NOT water soluble so carried by albumin)
CONJ in liver

How well did you know this?

Not at all

Perfectly

LFT: bilirubin INC

INC in conj BR: biliary obs
INC in unconj BR: hemolysis, hepatocellular dz, drugs
Gilbert’s: BR can’t get into liver to become water soluble so INC unconj, DEC conj
Dubin-Johnson: hyperbilirubinemia

How well did you know this?

Not at all

Perfectly

LFT: AST

found in liver, cardiac musc, sk musc, kidneys, brain, pancreas, lungs, leukocytes, and erythrocytes
AST:ALT ratio > 2:1 suggests alcoholic liver dz

How well did you know this?

Not at all

Perfectly

LFT: AST INC

elev. w/ tissue damage

elev. in hepatitis, cholestasis, OH, drug tox.

How well did you know this?

Not at all

Perfectly

LFT: ALT

More specific for liver damage than AST

INC in tissue damage, cholestasis, hepatitis, OH, drug tox

How well did you know this?

Not at all

Perfectly

LFT: AST and ALT

drug tox –> extreme elev. of both enz
mild elev: CMN in NML nonwhites
ELEV in DM, obese and hyperlipidemic – related to fatty liver

How well did you know this?

Not at all

Perfectly

LFT: elev AST and ALT in asx pt

Autoimmune hepatitis, hep b and c, drug/toxins, EtOH, Fatty liver, tumors, hemodynamic d/o (CHF), Fe (hemochromatosis), Cu (Wilson’s Dz), alpha1-antitrypsin deficiency, muscle injury

HIGHEST ELEV: toxic/ischemic inj, acute viral hep, chronic hep, cirrhosis

How well did you know this?

Not at all

Perfectly

LFT: alkaline phosphatase

In liver, bone, placenta, and less CMN: SI
Isoenz can tell you if it’s coming from bone/liver
If only AP is elev, and no other LFT, then probably coming from bone

How well did you know this?

Not at all

Perfectly

LFT: alk phos INC

INC in INC bone production
INC nml in kids, preg (d/t placental prod of AP)
Elev in biliary tract dz,
EXT elev in cmn bile duct obs, bone carcinoma, metastatic bone dz, 1’ hepatic dz

How well did you know this?

Not at all

Perfectly

LFT: lactic dehydrogenase

not cmnly for LFT, LDH also appears in lung tissue
total LDH and LDH05 elev in hepatic congestion/ inflamm or injury/ skel. musc inj
heart and lung dz elev different LDH isoenzymes

How well did you know this?

Not at all

Perfectly

LFT: Gamma Glutamyl Transpeptidase (GGT)

SPECIFIC FOR LIVER ONLY

used to differentiate source of INC AP
NOT found in bone
Very SENSITIVE to OH abuse, elev w/ 3+ drinks/d
elev in ALL forms of liver dz

How well did you know this?

Not at all

Perfectly

LFT: alpha-fetoprotein

screening for hepatocellular carcinoma
ELEV in chronic hepatitis
ELEV in testicular tumors

How well did you know this?

Not at all

Perfectly

LFT: Albumin

synthesized in liver, SENSITIVE for liver fxn

prealbumin sensitive for nutrition
bad cirrhosis –> NOT PROD albumin

How well did you know this?

Not at all

Perfectly

LFT: INC and DEC albumin

DEC – in malnutrition, protein loss from GI tract = malabsorption, protein loss from renal loss = nephrotic syndrome, LIVER CIRRHOSIS

How well did you know this?

Not at all

Perfectly

Child-Pugh score based on

serum BR, serum albumin, INR, ascites, encephalopathy

How well did you know this?

Not at all

Perfectly

Drugs/toxins/viruses that cause hepatitis

Carbon Cl4, acetaminophen, phenytoin, isoniazid, OH, amamita, EBV, CMV, autoimmune hep

How well did you know this?

Not at all

Perfectly

s/sx of hepatitis

fatigue, drowsiness, anorexia, nausea, fever, abd pain, myalgias, arthralgias
sx IMPROVE w/ onset of jaundice (and dark urine, 1-2wk after sx begin)
hepato and spleno-megaly

SEVERE: confusion, stupor, coma

hepatitis labs

mild anemia, lymphocytosis
ELEV bilirubin, AST/ALT, alk phos
abumin and PT affected in severe dz

fulminant hep more CMN in…

hep B, D, E

chronic hep more CMN in…

hep B and C

NOT in A or E

most CMN cause of chronic hep in US is…

hep C

Predisposes to hepatocellular CA

hep B and C

hep A virus gen

PICOMAVIRUS (rna)
humans only natural host
inactivated @ 185’+, formalin, Cl
fecal oral/food/daycare/SNF/shellfish

hep A patho

enters mouth
viral rep in liver
virus in blood/feces 10-12d post infxn
Can excrete 3+wks after sx onset (communicable 2 wks before to 1 wk post)

hep A Ab

IgM detectable at onset until 60-120d | IgG high during convalescence/recovery til indefinitely

hep A prevention

Ig | preexposure and postexposure w/in 14d

hep B virus gen

``` HEPADNAVIRIDAE family (dna) humans only known host Retains infectivity for 7+d at rm temp 350m chronically infected in world human carcinogen, causes up to 80% HC CA 600k deaths in 2002 5% risk of being chronic, higher risk w/ earlier infxn ```

hep B clinical

incubation: 60-150d (avg: 90d) Nonspecific prodrome: malaise, fever, HA, myalgia 50%+ infxn are asx

HBsAG (hep b surface Ag)

+ in acute phase | can signal chronic or carrier state

ANTI-HBs (Ab to HBsAG)

+ after clearance of HBsAG and post-immunization, implies immunity

ANT-HBc (Ab to Hep B core Ag)

IgM against HBc during ACUTE ifxn after HBsAG occurs during the window after clearance of HBsAG and before ANTI-HBsAG

HBeAG (secretory form of HBcAG)

ACTIVE viral replication and infectivity

factors promoting progression/severity of hep C

``` INC OH intake > 40y/o at time of infxn HIV co-infxn MALE Co-infxns (HBV) ```

transmission of hep C

percutaneous (IV drug, transfusion/transplant, dirty needles, contaminated equip-- hemodialysis, endoscopy, phlebotomy) permucosal (perinatal, sexual)

hep C gen

4x more CMN than HIV 1.8% transmission following needle stick from HCV+ source (w/ hollow bore needles) Rare reports of blood splash to eye, none from skin exposures to blood 1-2% among healthcare workers sexual transmission -- 15-20% of acute/chronic HCV in US

HCV screening ques

1. inected illegal drugs 2. clotting factors before 1987 3. blood/organs before july 1992 4. on chronic hemodialysis 5. evidence of liver dz 6. healthcare/ER/public safety worker after needle stick exposure 7. kids born to HCV mom

hep D epidemiology

ONLY in pts w/ hep B | transmitted via percutaneous

hep D patho

ss-RNA

hep E epidemiology

large epidemics of acute in developing countries | HIGH mortality in preg women

herpesvirus and hep

EBV = herpesvirus -- produces mild hep assoc w/ N/V 10-20% of pts CMV also herpesvirus, causing mild hep

HEP pre/post-exposure immuniz

Hep A, B, and D

hep estimates in US

acute infxn: HBV most then A then C fulminant deaths: HBV most then HAV chronic: HCV most then HBV then HDV chronic liver dz deaths: HCV then HBV then HDV