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GI/Nutrition > Liver > Flashcards

Liver Flashcards

1
Q

The Liver plays a role in ______ and ______ metabolism

A

carbohydrate

lipid metabolism

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2
Q

The liver synthesizes over ______ different proteins

A

150

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3
Q

The liver stores vitamins and minerals ___, ____, _____, _____, and _____

A

Fe
Cu
Vitamin A
Vitamin D

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4
Q

The ______ makes bile which is required for absorption of dietary fat and fat soluble vitamins

A

liver

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5
Q

The liver produces and metabolizes _______..

A

hormones

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6
Q

The ______ is an immunologically active organ

A

liver

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7
Q

Approximately ____% asymptomatic patients have abnormal LFT value

A

9

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8
Q

Chronic liver disease or _______ was the 11th leading cause of death in the total US population in 2018.

A

cirrhosis

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9
Q

LFT tests describe _____ ______.

A

hepatic changes

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10
Q

Liver tests include:

A 
AST
ALT
ALP
GGT
LDH
Albumin
Total protein 
Bilirubin 
Pt/INR
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11
Q

The synthetic function test of the LFTs are

A

Albumin
PT/INR

Tests the synthetic function of the liver

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12
Q

Tests that detect hepatocellular injury

A

AST
ALT

hepatitis
liver cells die, blow up, and release enzymes into the blood stream

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13
Q

Test that detect cholestasis

A

ALP

Bilirubin

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14
Q

Tests for detoxification function of liver

A

Primary bilirubin

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15
Q

Acute liver injury is injury and death of liver cells which lead ____ enzymes to spill out of ______ into the blood stream.

A

liver

hepatocytes

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16
Q

Liver has an amazing ______ power. If insult ceases early then total resolution is possible

A

regeneration

17
Q

In chronic liver injury,, enzymes may be ______ elevated

A

chronically

18
Q

Metabolic, detoxification, and synthetic function of liver is ________ with time

A

compromised

19
Q 
To order LFT's, order a \_\_\_\_\_\_ with a \_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_. This will include:
Total Bilirubin
ALK Phos
ALT
AST
Albumin
Direct Bilirubin
A

CMP

Hepatic Function Panel

20
Q

_____ and ______ reflect direct liver cellular damage (hepatocellular damage).

A 
ALT
AST
(the transaminases)
Both enzymes are contained within the hepatocyte
Female enzyme levels are lower than men
LDF (sometimes)
21
Q 
Family hx
ETOH consumption 
Obesity 
Diabetes
Hyperlipidemia 
Meds/supplements
Autoimmune disease
A

Risks for liver disease

22
Q 
IVDU/cocaine use 
high risk sexual behavior 
Foreign travel 
Hx transfusions 
Tattoos
A

Hepatitis risk factors

23
Q

_____ liver enzymes do not mean the liver is normal

A

Normal

24
Q

Patients with normal _____ and ______ can have significant liver disease

A

AST
ALT

Occurs w/ chronic disease

25
Q

The first step in the evaluation of a patient w/ elevated transaminases but no symptoms is to ______ the test

A

repeat

26
Q

Common

Hepatitis 
(Autoimmune, HAV, HBV, HCV, others) 
Alcoholic liver disease 
Nonalcoholic steatohepatitis (NASH)
Medications
Rare
Hemochromatosis 
Gilbert's syndrome
Celiac sprue
Hyperthyroidism
Rare:
Alpha 1 antitrypsin deficiency
Wilson's Disease

Other

Muscle injury
Cholelithiasis
Masses (tumors)
Hemodynamic disorders (HF)

A

Ddx for elevated LFTs

gallstones
malignant or benign
marked hypovolemia

27
Q
  1. Abnormal levels of more than one enzyme
  2. Clinical signs and syx of liver disease
    (Does pt look sick)
  3. Greater than 3-5 fold elevation of an enzyme level
  4. Persistence of abnormal levels for more than 6 mos

Mild elevations up to 1.5-2x ULN may be normal and not indicate liver disease

A

When to worry about elevated aminotransferases (LFTs)

28
Q

Ephedra
Kava
Vitamin A

A

Herbs/Vitamins that can cause elevations in transaminases

29
Q 
Acetaminophen 
Statins
Antifungals/Azoles
ABX
Anti-TB drugs
NSAIDs
Tegretol 
Others
A

Meds that can cause elevations in transaminases

30
Q

_____ is more specific to the liver than AST.

A

ALT

Highest levels of ALT found in liver
AST found in liver, cardiac muscle, kidney.

31
Q

Normal AST/ALT ratio is ______.

A

<1

This ratio changes in a specific pattern in some conditions:
Alcoholic liver disease

Alcoholics are pyridoxine deficient and while both AST & ALT are pyridoxine dependent, ALT is more so this AST>ALT

32
Q

AST:ALT ratio of>2. This is suggestive of _______.

A

ETOH liver disease, especially if GGT >2x normal.

33
Q

AST:ALT ratio of<2. This is suggestive of _______.

ALT is higher

A

Acute or chronic viral hepatitis

NASH (ratio usually <1)

GI/Nutrition (5 decks)

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