Liver Enzymes Flashcards
What enzyme is specific to the liver?
Alk phosphatase
What enzyme is measured in LFTs, but can also come from muscles?
AST
What are the three AST-predominant elevation causes?
Alcoholic-related liver injury
Steatosis
Cirrhosis
What are examples of severe ALT and AST elevations? (5)
Acute viral hepatitis
Meds
Wilson’s disease
Acute Budd-Chiari syndrome
What are the sources of AST?
Liver and skeletal muscle
What are the sources of alk phos?
Liver, bone, placenta
What are the sources of ALT?
Liver kidneys (much more liver specific than AST)
What is the classic ratio of AST:ALT?
2:1
If there is an elevation in AST or ALT, you should consider what? How?
rhabdomyolysis
Check creatine kinase
Direct bilirubin is elevated in what?
blockage
Indirect bili is elevated in what?
Liver failure or hemolysis
What does total bili measure?
Breakdown of Hb
What is the equation to total bili?
D bili + I bili
What is Gilbert’s syndrome?
Defect in glucuronide transferase that only becomes apparent during times of stress
What is the cause of neonatal jaundice?
fetal Hb lyse and liver cannot keep up.
What is the test for hemolysis?
Coomb’s test
What are retics like in hemolysis?
Elevated
What is Crigler-Najjar syndrome? What is the major complication with this? How is it inherited?
Deficiency in UDP-glucuronosyltransferase. The disorder results in a form of nonhemolytic jaundice, which results in high levels of unconjugated bilirubin and often leads to brain damage in infants. The disorder is inherited in an autosomal recessive manner.
You see a pt with AST» ALT. What lab should you check next? What are you assessing for?
CK
Rhabdomyolysis
What is the enzyme that is lacking in Crigler-Najjar syndrome?
UDP-glucuronosyltransferase
What is Dubin-Johnson syndrome? SSx?
Inability to transport bilirubin out of the liver, but liver is otherwise fine. Results in elevated direct bilirubin, without any increase in AST or ALT
This is benign
When is alk phos elevated?
inflammation of the biliary tree
What are the two bone diseases that cause elevated alk phos?
Metastatic prostate CA
Paget’s disease
Back pain with elevated alk phos?
Prostate CA mets
If your alk phos is high, what is the next test to order to distinguish if it comes from bone or the liver? How can this be used to determine what the alk phos elevation is caused by?
Gamma glutamyl transferase
If high = liver damage
What are the three chemical for liver synthesizing functions (NOT the LFTs)?
Bili
Albumin
INR
What are the two serum protein tests?
Albumin
Total protein
Lytic bone lesions = ?
Multiple myeloma
Total protein - albumin should be what value? What does this indicate?
3.5 g. If higher, indicates CA of some sort
Rouleaux formation = ?
RBC stacking in multiple myeloma
Increased albumin can be increased in what?
Dehydration
What happens to the anion gap with lower albumin?
Lowers
What is the value of ammonia levels?
Assess for hepatic encephalopathy
What are the four antibodies that are specific to the liver?
Antinuclear ab (ANA)
Antimitochondrial ab (AMA)
Anti smooth muscle (ASMA)
Anti liver-kidney-microsomal (LKM)
What are the two lab signs of primary biliary cirrhosis?
Disproportionate increase in alk phos
Positive antimitochondrial ab
Who gets primary biliary cirrhosis
Middle aged females with sjogren’s or raynaud’s
What is primary sclerosing cholangitis?
Bile duct inflammation and obliterative fibrosis
What are the labs that indicate primary sclerosing cholangitis? Imaging findings?
Disproportionate increase in alk phos
Beads on a string bile ducts
What is the treatment for primary sclerosing cholangitis?
Liver transplant
Primary sclerosing cholangitis usually occurs with what disease?
Ulcerative colitis
What are the three antibodies that are elevated in autoimmune hepatitis?
ANA
Antismooth muscle antibody
Anti liver-kidney-muscles ab
Who usually gets autoimmune hepatitis? What does this cause?
Young females
Hepatocellular damage
What Ig is elevated in autoimmune hepatitis?
IgG
What are the labs that should be checked to assess for Fe overload?
Ferritin
What are the labs that should be checked for copper overload?
Ceruloplasmin
What are the labs that should be checked for alpha 1 antitrypsin deficiency?
Alpha 1 antitrypsin levels
What are the labs that should be checked with celiac disease?
Tissue transglutaminase
IgA levels
What are the labs that should be checked with hepatocellular cancer?
alpha fetoprotein
High ferritin can indicate what? Low?
High = can be infx Low = can be Fe deficiency
What is Rotor syndrome?
AR disease characterized by a benign increase in bilirubin and a non-itching jaundice.
