Liver Flashcards
How does liver disease effect PT/INR?
It prolongs it, causing inadequate production of certain clotting factors
What does albumin do in the body?
It controls the osmotic pressure, which maintains fluid in the blood vessels
What happens when albumin is decreased?
Leads to edema (in cirrhosis, liver failure, malnutrition, nonhepatic acute and chronic illness)
What happens when albumin increases?
May indicate dehydration
What are the hepatocellular enzymes and what do they do?
ALT and AST; they measure the severity of hepatocellular inflammation
What is ALT specific too?
More specific to the liver and less to the heart, muscles and kidney
What is AST specific too?
Presents in tissues with high metabolic activity and increased with liver disease, tumor, MI, and heat stroke
What do you first consider with elevated AST and ALT?
Alcohol, Statins, and Tylenol
What does it mean if the AST >1000 IU/L?
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
If AST/ALT levels are elevated but <3x the normal what do you do?
Stop alcohol and all OTC meds and supplements; recheck in 2 weeks; if still elevated in 6 months refer to gastroenterologist
What does it mean when ALT > AST?
Infectious hepatitis
What does it mean when AST > ALT?
Alcohol related damage (usually a 3:1 to 8:1 ratio)
What do you suspect if ratio is > 1 for ALT and AST?
Medications, viruses, autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha 1-antitrypsin deficiency, nonalcoholic fatty liver disease, a fast food heavy diet
What are the biliary enzymes?
Alkaline phosphatase, bilirubin, and GGT
What is suspected with an increase in biliary enzymes?
Cholestatic conditions (obstruction either within the liver itself or affecting the bile duct [gallstone, pancreatic mass])
What is suspected if only the alkaline phosphatase is elevated?
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
What if GGT is the only elevated liver test?
It may indicate excessive alcohol use
What does the total bilirubin mean?
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
What happens when the bilirubin is >3.5 mg/dL?
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
What medications cause liver damage?
Acetaminophen, anabolic steroids, NSAIDs, amiodarone, valproic acid, isoniazid, and azathioprine
If bilirubin positive in urine, check for urobilinogen? What does it indicate if it is negative?
Complete obstruction (biliary cirrhosis, gallstone, pancreas tumor)
If bilirubin is positive in urine, check for urobilinogen? What does it indicate if it is positive?
Partial obstruction or ‘hepatitis” (AST >2x normal with injury)
