Liver Disease

Question 1

With regard to serology, LTFs, CBC what will you see with:

Acute Hep B?

Answer 1

Acute:

HBs-Ag (+), Anti-HBs (-), Anti-HBc/IgM (+), IgG (-)

• remember that IgM appears b/4 IgG

Elevated ALT and AST

Alk phospate (ALP) elevated, bilirubin elevated

WBCs low or normal

Question 2

With regards to serology, CBC, CMP, what would you expect with:

Chronic Hep B infection

Answer 2

Chronic:

HBs-Ag (+ >6 months), Anti-HBs (-), Anti-HBc/IgG (+)

AST and ALT elevated

Alk Phosphatase (ALP) and bilirubin elevated

Serum albumin decreased

PT prolonged

Question 3

Basic or Comprehensive metabolic panel needed for liver function?

And what does it include that is helpful for liver function?

Answer 3

Comprehensive metabolic panel:

The Basic MP is glucose, Ca++, Electrolytes [Na+, K+, CO2, Cl-], Kidney fnx [Bun, Creatinine]

The Comprehensive MP is BMP plus Proteins [albumin and total protein], LFTs [ALP, AFT, AST & bilirubin]

Question 4

What are the liver measures in the CMP and what does each tell you about the liver?

Answer 4

Proteins

• Albumin - synthesized in the liver and a true measure of hepatic function.
• Total protein

LFTs:

• Aspartate aminotransferase (AST)
• Alanine aminotranferase (ALT)
  
  • elevated levels suggest injury
  • AST/ALT > 2 suggests EtOH hep
  • AST/ALT < 1 often with viral hep
• Alkaline phosphatase (ALP/AP)
  
  • From cells lining the billiary tract
  • Elevated levels suggest obstruction
  • Slight elevation in hepatocellular disease
• Bilirubin - direct or indirect?
  
  • Conjugated usually with viral hep or obstruction
  • Unconjugated - something wrong with the enzymatic pathway of conjugation.
• Gamma glutamyl transpeptidase (GGT/GGTP)
  
  • Most sensitive for obstruction
  • Elevated GGT and AP? Biliary disease
  • Elevated AP and normal GGT? skeletal disease, childhood or PG.