Liver and Enzymes Flashcards
Conguated vs unconguigated bilirubin; which is water soluble?
What enzyme is deficience in Gilbert’s and Crigler-Najjar?
What is a sensitive test of liver metabolic function?
Conjugated
UDP-glucuronyl transferase
Congugated bilirubin because it needs energy to congugate
Total biliruben needs what to be measured, type of reaction?
Does direct need an accelerant?
How to calculate indirect?
Accelerant (caffeine/methanol); Diazo reaction
No; measures ~ 70-90% of conjugated bili
Indirect= Total- direct (conjugated)
Gilbert’s disease, enzyme, presentation, impairment in what metabolism?
Crigler-Najjar, severe type: presentation?
Dubin Johnson/Rotor?
Gilberts: UDP-GT (TA7 promoter), jundice with stress, irinotecan metabolism (chemo agent)
CJ: Type 1 severe UDP-GT deficiency, neonatal jaundice and kernicterus
DJ: Increased conjugated bili, liver with lipofuschin pigment
Rotor: No pigment
Which coag factor has shortest half life?
What liver protein reflect long term chance in protein synthesis?
FVII; PT good for monitoring acute liver disease
Albumin
Most specific test for liver?
Markers of cholestatic injury?
Most sensitive marker for liver damage?
GGT is most specific for liver; Alk Phos and ALT are decent
Alk phos and GGT because they are by canaliculus
ALT due to 48 hr 1/2 life vs AST 18 hr half life
% of babies get chronic Hep B if exposed?
What happens if “occult” Hep B reactivates?
What indicates active infection?
What antibody indicates recent exposure?
What Hep B antigen indicates high viral load?
95%, children/adults 5%
Death is pretty common
HbsAg
IgM Anti-HBc
HBeAg; can be positive after treatment
% of Hep C that becoames chronic?
Is there an Anti-HCV IgM test?
How to test for active infection?
50-70%
NO!; 40-50% negative fo Anti-HCV at time of presentation
HCV RNA quantitative
PBC antibody?
Autoimmune hepatitis antibodies for 3 types?
Sclerosing cholangitis antibodies?
PBC: Anti-mitochondrial M2
Autoimmune: ANA, anti-actin (Smooth muscle, type 1; most common USA), Liver kidney microsomal (type 2) or soluble liver antigen (SLA/ type 3)
SC: Atypical p-ANCA (anti-MPO), associated with UC
Acute hepatitis causes high level of what on labs?
AST to ALT in -OH vs toxic/ischemic?
Is PT increased in viral, -OH, toxic/ischemic liver disease?
Jaundice, or if not jaundiced ALT
>2 vs >1 (but transient)
No in PT, -OH: Normal to mild increase
Toxic/Ischemic great than 15 but returns quickly
Clues to autoimmune hepatitis?
Most common causes of drug-induced liver disease?
Some lab findings for Wilson’s?
What metal can be used to lower copper absorption?
High globulins BUT LOW ALBUMIN
Antibiotics and herbals
Low ceruloplasm, low copper but high free copper, low ALK, AST>ALT, high urine copper, high LDH, and high uncongugated bilirubin
Zn competes with copper
Complete obstruction of cholestatis causes what labs initally and what goes up over time?
Labs in chronic hepatitis?
AST and ALT but NOT ALK phos; it and GGT go up gradually as do conjugated bilirubin
Easy to miss; mild ALT and AST, Normal ALK and bili and PT; can cause patients to move onto cirrhosis
What labs scree for hemochromatosis and what is the gene/mutation?
What happens to polyclonal globulins in cirrhosis?
Other cirrhosis lab findings?
Fe/TIBC; if >50% (or 45% in women) then HFE gene (C282Y)
IgG, IgA (B-gamma bridging)
Low plts (low thrombopoeiten), AST, ALT mild increase, increased indirect bilirubin late in disease
What is troponin bound onto?
How long are TnT and TnI in blood?
Are troponins a marker of cardiac death?
Myoglobin is it cardiac specific, major risk?
Muscle fibers
7-14 days: TnT (7 more aminoacids on cardiac form) and TnI (has 21 more) so labs are more specific for cardiac forms
Not always; can be seen in ischemia and at risk patients
No; from muscle, short half life (4-6 hrs); KIDNEY DAMAGE
CK-MM vs MB?
How long to detect TnT and TnI?
Recurrent marker, at least hypothetically?
MM: Striated muscle and heart
MB: small part of skeletal muscle 0-5% skeletal and muscle
Hours; detects MI earliers; (20% increase in troponin is high MI)
CK-MB; cleared quickly and reappears quickly (many hospitals lack it)
Marker raised in congestive heart failure?
Acid phosphate from prostate inhibited by?
BNP increased in systolic function but not diastolic function; correlates individuals decompensation
Tartarate (osteoclasts/bone turnover is not); but we have tests for bone and prostate isoenzymes
