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GIT > Liver enzymes > Flashcards

Liver enzymes Flashcards

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1
Q

How do we measure proteins?

A

Purification
Antibodies
Function

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2
Q

What are some enzymes found in the blood?

A

CAERULOPLASMIN - Ferroxidase

CLOTTING FACTORS - Proteases

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3
Q

Which enzymes are on the liver cell surface

A

ALP

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4
Q

Which enzymes are in the mitochondria?

A

Mitochondrial AST

Lysosomal SOD

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5
Q

What marks the destruction of the cell?

A

Degradation of the cytoskeleton
Swelling
Mallory hyaline

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6
Q

What usually happens in cell death?

A

It usually blisters in the skin - this then pops open and the bubles can be released into the blood as blebs.
They contain broken down mitochondria

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7
Q

Can the cell survive blebing/blistering?

A

Yes - it may just be a marker of cell damage

Can repair by removing toxin or restoring oxygen

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8
Q

Questions about enzymes which are detected

A

Where did they come from (cell)?
How did they get into the blood?
How quickly does the body remove them from the blood?

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9
Q

What are the enzymes in the cytoplasm of the liver cell?

A

ALT, AST, LD

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10
Q

What are the nucleus in the cytoplasm of the liver cell?

A

DNA synthase

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11
Q

WHat is seen in liver necrosis

A

Virus, Toxin, Anoxia
ALT, AST, LD
esp AST with toxins

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12
Q

What is seen in biliary disease

A

Gallstones, cancer

ALP, GGT

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13
Q

Inducing drugs and what they induce?

A

Alcohol and anticonvulsants

GGT ALT

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14
Q

ALT

A

Changes pyruvate to lactate
The anaerobic metabolism of glucose
This occurs in the liver and muscle (mainly in the liver)

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15
Q

AST

A

Malate shuffle

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16
Q

What happens in hepatitis?

A

ALT – Cytosol – Liver&raquo_space;> muscle , kidney

AST – Cytosol & Mitochondrial – Liver, Muscle, Blood cells

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17
Q

Source of ALT and AST?

A

ALT is in the liver

AST is in all mitochondria

18
Q

What happened if the AST>ALT?

A

Acute, affecting mitochondria

esp. Acute virus, EtOH

19
Q

What is going on if ALT>AST?

A

Chronic / resolving
esp. hepatitis
Drugs, Chronic virus, Metabolic

20
Q

Some other viral diseases causing hepaiitis?

A
  • EBV (60%)
  • CMV (55%)
  • Q FEVER (23%)
  • RUBELLA (40% (?))
21
Q

ALT markers?

A 
Normal ALT = 50
MILD  ALT=250
MODERATE ALT=1000
SEVERE  ALT=5000 (half the liver is dead)
ALT of 10000 = going to die
22
Q

What are acute Hep B ALT levels?

A

Can be very high even 2500 units

23
Q

What is a lethal dose of paracetamol?

A

15g

24
Q

why would ALT be elevated by AST be normal?

A

Such a chronic disease that there is not really any significant destruction

25
Q

What happens in the end stage of cirrhosis?

A

There is not enough liver to actually damage and release liver enzymes

26
Q

Where is ALP produced

A

Bone, Liver, Placenta

27
Q

Where is GGT produced

A

Liver, Biliary Epithelium, Renal

28
Q

What does GGT do?

A

Adds glutamyl groups to generate GLUTATHIONE

29
Q

Why is GGT induced by drugs and alcohol?

A

Tries to produce gluthatione to coutner the toxic effects of these drugs

30
Q

What does ALP do?

A

Assists in the transfer across the cell membrane

31
Q

What causes increased production of bilirubin?

A

Heamolysis

32
Q

What causes decreased excretion of bilirubin?

A

Gilberts, Dubin Johnson, Hepatitis

33
Q

What happens in extra hepatic cholestasis?

A

Elevated Conjugated Bilirubin

34
Q

What happens in intrahepatic cholestasis?

A

No Jaundice

No increase in Bilirubin

35
Q

What do high concentrations of bile do in the liver?

A

High concentrations will degrade the billary membrane

36
Q

How do GGT and ALP get into the blood stream?

A

Indirectly via the lymphatics

37
Q

What happens when NAD+ is depleted?

A

Glutathione is switched on in order to accommodate for the reduction in NAD+

38
Q

If GGT is very high what would you expect to see?

A

ALT would be up - destruction because the cells cannot keep pace with the high levels of toxins

39
Q

Relationship between liver obstruction and hepatocellular death?

A

HEPATOCELLULAR DEATH – Death of liver cells – Inflammation & swelling –Biliary Obstruction

BILIARY OBSTRUCTION – Inability to excrete toxins – Accumulation of toxins in hepatocyte –Hepatocellular death

40
Q

What happens to fructose?

A

The liver can convert it to glucose but instead it converts it to fat

41
Q

What is the cause of fatty liver?

A

Sugar consumption = high fructose levels = conversion to fat

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