Liver Disease Flashcards
Hepatitis serology
Vaccination: antiHBs
Acute infection: antiHBs, antiHBc IgM
Chronic infection: antiHBc IgG, HBsAg
LFTs
ALT - hepatic
AST - hepatic - liver, skeletal, heart, kidneys, brain, RBCs
ALP - biliary - hepatobiliary, bone, placenta, kidney, GI
GGT - biliary
Amylase (more sensitive) - pancreas
Lipase (more specific) - pancreas
LFTs
ALT is more specific for liver dx than AST
In liver dx: ALT > AST
(Exception: alcoholic liver dx AST > ALT)
If AST high and ALT normal -> think extrahepatic ex. muscle (check CK)
If ALP high and GGT normal -> think extrahepatic ex. bone (inc. osteoblastic activity)
Sudden inc. in ALP & GGT -> hepatocellular carcinoma
Alcohol -> ++ inc. GGT
Jaundice, anemia, inc. unconjugated bilirubin. Everything else is okay.
Hemolytic jaundicce
Jaundice, inc. unconjugated and conjugated bilirubin. ++ inc. AST and ++ inc. ALT. ALP is inc./N
Hepatocellular jaundice
Jaundice, inc. unconjugated and ++ inc. conjugated bilirubin. Inc. AST & ALT. +++ inc. ALP & GGT.
Obstructive jaundice
Epigastric pain radiating to back, fever, inc. amylase and lipase.
Pancreatitis
Fever, RUQ pain, jaundice, dark urine, ++ inc. ALT and AST (400-4000 IU) (ALT>AST). Inc. ALP.
Hepatitis
Fever, RUQ pain, jaundice, dark urine, +++ inc. ALT and AST (> 10000 IU) (ALT>AST). Inc. ALP.
Acetaminophen toxicity
Fever, RUQ pain, jaundice, dark urine, inc. ALT and AST (< 400 IU) (AST>ALT). ALP inc./N, inc. GGT.
Alcoholic steatohepatitis
Fever, RUQ pain, leukocytosis, inc. bilirubin, inc. ALP, inc. amylase, inc. lipase.
Biliary pancreatitis
What is the tumour marker for hepatocellular carcinoma?
Alpha-fetoprotein
What is the frequency of endoscopy in compensated patients? In decompensated patients?
1-3 yrs
1 yr
