Liver Basics for Dietitians

Question 1

How to approach an abnormal liver test?

Answer 1

Is it spurious? Repeat the test!!!
Is it liver in origin?
Determine the following:
- sick or not sick
- acute or chronic hepatocellular or cholestatic
- H&P, ALT, and ALP will identify the etiology in cases

Question 2

AST (SGOT) can come from which tissues?

Answer 2

• Liver
• Skeletal muscle
• Cardiac muscle
• Kidney

Question 3

ALT (SGPT) can come from which tissues? (more than one may be correct):

Answer 3

only LIVER

Question 4

What can we determine form hepatocellular enzymes?

Answer 4

• Allow general assessment of liver injury
• Liver injury results in “leak” of enzymes from hepatocytes
• Elevations indicate parenchymal injury

Question 5

What are hepatocellular enzymes?

Answer 5

ALT

AST

Question 6

What are Cholestatic enzymes?

Answer 6

alkaline phosphatase and

gamma glutamyl transferase

Question 7

What do cholestatic enzymes indicate?

Answer 7

• Indicate disease to biliary system
• After injury, enzymes must be synthesized before they are released
• GGT more specific for liver but very (?too) sensitive

Question 8

What are clinical presentations of abnormal liver test?

Answer 8

• “First time” elevations
• Acute hepatitis
• Chronic hepatitis
• Cholestasis
• Cirrhosis
• Jaundice

Question 9

What is the normal level of ALT?

Answer 9

<35

Question 10

What is the normal level of ALP?

Answer 10

<147

Question 11

What is the normal level of Bilirubin?

Answer 11

<17.1

Question 12

What is the normal level of D-Bilirubin?

Answer 12

<5.1

Question 13

What is D-bilirubin?

Answer 13

Direct bilirubin correlates with conjugated bilirubin but tends to overestimate actual conjugated bilirubin, as it includes both the conjugated bilirubin and bilirubin covalently bound to albumin (delta-bilirubin).

Question 14

What is the normal ratio of ALT/AST?

Answer 14

<35

Question 15

What is the normal level of INR?

Answer 15

<1.3

Question 16

What are the clinical features of acute hepatitis?

Answer 16

• Fatigue, anorexia, nausea, jaundice
• ALT 10 fold
• usually self-limited

Question 17

What are the clinical features of chronic hepatitis?

Answer 17

• symptoms are variable

- 1.5-10-fold ALT

Question 18

What are some acute hepatitis?

Answer 18

Hepatitis A 
Hepatitis B
Drug-induced
Alcoholic hepatitis
Ischemic hepatitis

Question 19

What are some chronic hepatitis?

Answer 19

Hepatitis C 
Hepatitis B 
NASH or NAFL
Hemochromatosis 
Alcoholic liver dz
Autoimmune hepatitis

Question 20

What are some cholestasis?

Answer 20

PBC/ PSC NASH
Large duct obstruction
Drug-induced
Intrahepatic mass
Inflammation- associated

Question 21

What are the stages of progression of cirrhosis?

Answer 21

• chronic liver disease
• compensated cirrhosis
• decompensated cirrhosis
• death

Question 22

What is NAFLD?

Answer 22

Non Alcoholic Fatty Liver Disease

- steatosis by imaging or histology in the absence of secondary causes (alcohol, other drugs, etc.)

Question 23

What is the histologic spectrum of liver damage?

Answer 23

NAFL-steatosis –> NASH –> Cirrhosis –> Death

Question 24

What is the target of multitarget treatment

Answer 24

GLP-1