Liver Disease Flashcards
Tests of hepatocellular damage
AST 10-30
ALT 11-45
BR C<0.2, T<1.2
Tests of biliary tract disease
Alk Phos 30-130
GGT (F<24, M<38)
BR C<0.2, T<1.2
Tests of etiology
-Hepatitis virus antigens/antibodies
-Alpha fetoprotein
-Immunoglobulins
-Iron, trans, ferritin (hemochromatosis)
-Copper, Cerulo (Wilson’s)
Jaundice is usually detectable when the serum total bilirubin ___
exceeds 2 – 3 mg/dL
Bilirubin is ____
very light senstive
-stable for months when frozen and protected from light
____ increases bilirubin in blood slightly in the normal person and more markedly in Gilbert’s disease
Fasting
-decreases with sunbathing and is slightly lower in women than in men
Elevations of the unconjugated bilirubin without significant elevations of the conjugated are seen in:
-Hemolytic
-Gilbert’s
-Crigler-Najjar
-Liver immaturity
-Cirrhosis
G HICC
Elevations of the conjugated plus unconjugated bilirubin are seen in:
-Hepatitis
-Cirrhosis
-Posthepatic obs
-Dubin Johnson
-Rotor’s
-Cholestasis drug induced
CC HROD
Rotor’s vs DJS
DJS
-liver pigmentation, GB not visualized
Rotor’s
-no liver pigmentation, GB visualized
Bilirubinuria
Bilirubinuria is seen in: HROD
a. Biliary obstruction
b. Hepatocellular damage
c. Dubin-Johnson syndrome
d. Rotor’s syndrome
Plasma total protein concentrations in liver disease often are near ___ because a decrease of albumin is offset by an increase of globulins
normal
A ____ of the prothrombin time (PT) is an indicator of hepatic dysfunction as the synthesis of the coagulation factors is impaired in hepatocellular disease
Prolongation
-severe: PTT also prolonged
____ blood ammonia is seen in severe liver disease and in actual or impending hepatic coma
Elevated
due to:
-Reduced removal of ammonia and shunting
-Blood ammonia levels show some correlation with the deepness of coma
Most sensitive indicators of hepatic cell injury =
AST, ALT
-sensitive, not specific
ALT elevated, but not AST
-Mild hepatic disease
-Recovery hepatitis phase
(ALT elevations persist longer than AST)
ALT is more sensitive
The general rule applies that the ____ the alkaline phosphatase, the ____ the chances for post-hepatic obstruction
higher, greater
*If the elevation is less than three times normal, consider hepatocellular disease
*If greater than three times the upper reference limit, consider post-hepatic obstruction
The alkaline phosphatases show differential heat stability
bone < intestine < liver < placenta < Regan enzyme (most heat stable)
BILP
GGT
-differentiating bone and liver sources of alkaline phosphatase (no GGT in bone)
-sensitive indicator of alcohol-induced liver disease and of recent alcohol ingestion
Detection of HAV IgG without HAV IgM
implies resolved infection or past immunization
Detection of IgG against Hb surface antigen (HBsAb)
implies recovery (or successful immunization) and lifelong protection from infection
IgG antibodies against HB core antigen (HBcAb)
imply infection with HB at some point
