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Gastrointestinal > Liver Enzymes > Flashcards

Liver Enzymes Flashcards

1
Q

What enzyme is specific to the liver?

A

Alk phosphatase

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2
Q

What enzyme is measured in LFTs, but can also come from muscles?

A

AST

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3
Q

What are the three AST-predominant elevation causes?

A

Alcoholic-related liver injury

Steatosis
Cirrhosis

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4
Q

What are examples of severe ALT and AST elevations? (5)

A

Acute viral hepatitis
Meds
Wilson’s disease
Acute Budd-Chiari syndrome

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5
Q

What are the sources of AST?

A

Liver and skeletal muscle

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6
Q

What are the sources of alk phos?

A

Liver, bone, placenta

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7
Q

What are the sources of ALT?

A

Liver kidneys (much more liver specific than AST)

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8
Q

What is the classic ratio of AST:ALT?

A

2:1

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9
Q

If there is an elevation in AST or ALT, you should consider what? How?

A

rhabdomyolysis

Check creatine kinase

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10
Q

Direct bilirubin is elevated in what?

A

blockage

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11
Q

Indirect bili is elevated in what?

A

Liver failure or hemolysis

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12
Q

What does total bili measure?

A

Breakdown of Hb

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13
Q

What is the equation to total bili?

A

D bili + I bili

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14
Q

What is Gilbert’s syndrome?

A

Defect in glucuronide transferase that only becomes apparent during times of stress

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15
Q

What is the cause of neonatal jaundice?

A

fetal Hb lyse and liver cannot keep up.

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16
Q

What is the test for hemolysis?

A

Coomb’s test

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17
Q

What are retics like in hemolysis?

A

Elevated

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18
Q

What is Crigler-Najjar syndrome? What is the major complication with this? How is it inherited?

A

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.

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19
Q

You see a pt with AST» ALT. What lab should you check next? What are you assessing for?

A

CK

Rhabdomyolysis

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20
Q

What is the enzyme that is lacking in Crigler-Najjar syndrome?

A

UDP-glucuronosyltransferase

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21
Q

What is Dubin-Johnson syndrome? SSx?

A

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

22
Q

When is alk phos elevated?

A

inflammation of the biliary tree

23
Q

What are the two bone diseases that cause elevated alk phos?

A

Metastatic prostate CA

Paget’s disease

24
Q

Back pain with elevated alk phos?

A

Prostate CA mets

25
Q

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?

A

Gamma glutamyl transferase

If high = liver damage

26
Q

What are the three chemical for liver synthesizing functions (NOT the LFTs)?

A

Bili
Albumin
INR

27
Q

What are the two serum protein tests?

A

Albumin

Total protein

28
Q

Lytic bone lesions = ?

A

Multiple myeloma

29
Q

Total protein - albumin should be what value? What does this indicate?

A

3.5 g. If higher, indicates CA of some sort

30
Q

Rouleaux formation = ?

A

RBC stacking in multiple myeloma

31
Q

Increased albumin can be increased in what?

A

Dehydration

32
Q

What happens to the anion gap with lower albumin?

A

Lowers

33
Q

What is the value of ammonia levels?

A

Assess for hepatic encephalopathy

34
Q

What are the four antibodies that are specific to the liver?

A

Antinuclear ab (ANA)
Antimitochondrial ab (AMA)
Anti smooth muscle (ASMA)
Anti liver-kidney-microsomal (LKM)

35
Q

What are the two lab signs of primary biliary cirrhosis?

A

Disproportionate increase in alk phos

Positive antimitochondrial ab

36
Q

Who gets primary biliary cirrhosis

A

Middle aged females with sjogren’s or raynaud’s

37
Q

What is primary sclerosing cholangitis?

A

Bile duct inflammation and obliterative fibrosis

38
Q

What are the labs that indicate primary sclerosing cholangitis? Imaging findings?

A

Disproportionate increase in alk phos

Beads on a string bile ducts

39
Q

What is the treatment for primary sclerosing cholangitis?

A

Liver transplant

40
Q

Primary sclerosing cholangitis usually occurs with what disease?

A

Ulcerative colitis

41
Q

What are the three antibodies that are elevated in autoimmune hepatitis?

A

ANA
Antismooth muscle antibody
Anti liver-kidney-muscles ab

42
Q

Who usually gets autoimmune hepatitis? What does this cause?

A

Young females

Hepatocellular damage

43
Q

What Ig is elevated in autoimmune hepatitis?

A

IgG

44
Q

What are the labs that should be checked to assess for Fe overload?

A

Ferritin

45
Q

What are the labs that should be checked for copper overload?

A

Ceruloplasmin

46
Q

What are the labs that should be checked for alpha 1 antitrypsin deficiency?

A

Alpha 1 antitrypsin levels

47
Q

What are the labs that should be checked with celiac disease?

A

Tissue transglutaminase

IgA levels

48
Q

What are the labs that should be checked with hepatocellular cancer?

A

alpha fetoprotein

49
Q

High ferritin can indicate what? Low?

A 
High = can be infx
Low = can be Fe deficiency
50
Q

What is Rotor syndrome?

A

AR disease characterized by a benign increase in bilirubin and a non-itching jaundice.

Gastrointestinal (42 decks)

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