Liver

Question 1

How does liver disease effect PT/INR?

Answer 1

It prolongs it, causing inadequate production of certain clotting factors

Question 2

What does albumin do in the body?

Answer 2

It controls the osmotic pressure, which maintains fluid in the blood vessels

Question 3

What happens when albumin is decreased?

Answer 3

Leads to edema (in cirrhosis, liver failure, malnutrition, nonhepatic acute and chronic illness)

Question 4

What happens when albumin increases?

Answer 4

May indicate dehydration

Question 5

What are the hepatocellular enzymes and what do they do?

Answer 5

ALT and AST; they measure the severity of hepatocellular inflammation

Question 6

What is ALT specific too?

Answer 6

More specific to the liver and less to the heart, muscles and kidney

Question 7

What is AST specific too?

Answer 7

Presents in tissues with high metabolic activity and increased with liver disease, tumor, MI, and heat stroke

Question 8

What do you first consider with elevated AST and ALT?

Answer 8

Alcohol, Statins, and Tylenol

Question 9

What does it mean if the AST >1000 IU/L?

Answer 9

Often due to infection or toxins (meds, herbs, poisons); if it occurs within the first 24 hours of illness there is a high likelihood the patient will not survive

Question 10

If AST/ALT levels are elevated but <3x the normal what do you do?

Answer 10

Stop alcohol and all OTC meds and supplements; recheck in 2 weeks; if still elevated in 6 months refer to gastroenterologist

Question 11

What does it mean when ALT > AST?

Answer 11

Infectious hepatitis

Question 12

What does it mean when AST > ALT?

Answer 12

Alcohol related damage (usually a 3:1 to 8:1 ratio)

Question 13

What do you suspect if ratio is > 1 for ALT and AST?

Answer 13

Medications, viruses, autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha 1-antitrypsin deficiency, nonalcoholic fatty liver disease, a fast food heavy diet

Question 14

What are the biliary enzymes?

Answer 14

Alkaline phosphatase, bilirubin, and GGT

Question 15

What is suspected with an increase in biliary enzymes?

Answer 15

Cholestatic conditions (obstruction either within the liver itself or affecting the bile duct [gallstone, pancreatic mass])

Question 16

What is suspected if only the alkaline phosphatase is elevated?

Answer 16

Often indicates an infiltrative process (tumor mass); to confirm that it is from the liver a GGT should be drawn. GGT is usually elevated with liver disorders but not in bone disorders

Question 17

What if GGT is the only elevated liver test?

Answer 17

It may indicate excessive alcohol use

Question 18

What does the total bilirubin mean?

Answer 18

It is the function of Hgb breakdown; reflects the liver’s ability to dispose of Hgb; increases with obstructive jaundice, stones, or damaged liver cells

Question 19

What happens when the bilirubin is >3.5 mg/dL?

Answer 19

It results in jaundice, which indicates an obstruction in the bile duct area. Because no bilirubin should be excreted renally (normally goes out in the bowel), check urinalysis for bilirubinuria

Question 20

What medications cause liver damage?

Answer 20

Acetaminophen, anabolic steroids, NSAIDs, amiodarone, valproic acid, isoniazid, and azathioprine

Question 21

If bilirubin positive in urine, check for urobilinogen? What does it indicate if it is negative?

Answer 21

Complete obstruction (biliary cirrhosis, gallstone, pancreas tumor)

Question 22

If bilirubin is positive in urine, check for urobilinogen? What does it indicate if it is positive?

Answer 22

Partial obstruction or ‘hepatitis” (AST >2x normal with injury)