Liver Disease Cases Flashcards
AST/ALT 500-3000 indicates
acute hepatitis
AST/ALT <500-3000 indicates
chronic hepatitis
AST/ALT >5-10000 indicates
acetominophen toxicity, shock liver
AST>ALT ratio of 2-3:1 or greater indicates
alcohol hepatitis
AST>ALT ratio 1-2:1 indicates
cirrhosis
ALT>AST indicates
fatty liver disease
AST and ALT elevation indicates
liver disease, celiac, hypothyroidism, muscle damage
Sources of Alk Phos
bone, placenta, liver, kidney
T/F biliary obstruction has higher elevation in alk phos than intrahepatic cholestasis
F
Examples of intrahepatic cholestasis
drug induced, pbc, hepatic granulomas/sarcoid
Examples of extrahepatic cholestasis
bile duct obstruction due to stones, cancer, psc
Sources of indirect bilirubin
hemolysis or resorption of hematomas
Are cholestasis and hyperbilirubinemia synonymous?
no –> cholestasis of pregnancy has no bilirubin elevation necessarily
Is there higher bilirubin in intrahepatic disease/hepatocellular disease or in extrahepatic cholestasis?
intrahepatic cholestasis or hepatocellular disease
Which hepatitis virus is dna?
hbv
Which hepatitis viruses are enterically transmitted?
HAV, HEV
Diagnostic marker for acute HepA
IgM
Immunity marker for HepA
total antibody + and IgM - (suggests it’s all IgG)
Prevention of HepA
Ig prophylaxis or vaccine
E protein
precore mutation in HBV that prevents secretion of E protein –> some people are e+/-
T/F The younger you are the more likely you have a subclinical HBV infection
T –> allows it to persist in the population
What is immune tolerance in HBV?
you have lots of viral particles but no impact on the liver –> normal histology, markers –> early transmission/perinatal (but Eantigen+)
Risk of cirrhosis in HepC
20% in 20 years
Leading risk factor for liver cancer in US
HepC cirrhosis
Difference between liver cancer in HepB and HepC
in HepC it is seen only with cirrhosis
Disadvantages to HepC ELISA
delay between infection and detection (window period), immunosuppressed patients may not make detectable response, false positive
Does a -HepC antibody test rule out infection?
No –> only viral RNA test is definitive
R > 5 and ALT >2x uln indicates
hepatocellular DILI (R = ALT/uln/ALKP/uln)
RULN indicates
cholestatic DILI
2<5 indicates
mixed cholestatic and hepatocellular DILI
Hys law
if ALT >3X and Tbili>2X, likelihood of death is about 10%
Xanthomas suggest hepatocellular/cholestatic disease
cholestatic
PSC vs PBC demographic
PSC = young men, PSC = older women
