Liver Flashcards
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
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
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
LFT: AST INC
elev. w/ tissue damage
elev. in hepatitis, cholestasis, OH, drug tox.
LFT: ALT
More specific for liver damage than AST
INC in tissue damage, cholestasis, hepatitis, OH, drug tox
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
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
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
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
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
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
LFT: alpha-fetoprotein
screening for hepatocellular carcinoma
ELEV in chronic hepatitis
ELEV in testicular tumors
LFT: Albumin
synthesized in liver, SENSITIVE for liver fxn
- prealbumin sensitive for nutrition
- bad cirrhosis –> NOT PROD albumin
LFT: INC and DEC albumin
DEC – in malnutrition, protein loss from GI tract = malabsorption, protein loss from renal loss = nephrotic syndrome, LIVER CIRRHOSIS
Child-Pugh score based on
serum BR, serum albumin, INR, ascites, encephalopathy
Drugs/toxins/viruses that cause hepatitis
Carbon Cl4, acetaminophen, phenytoin, isoniazid, OH, amamita, EBV, CMV, autoimmune hep
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
- inected illegal drugs
- clotting factors before 1987
- blood/organs before july 1992
- on chronic hemodialysis
- evidence of liver dz
- healthcare/ER/public safety worker after needle stick exposure
- 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
