Liver Enzymes

Question 1

1. Raised transaminases suggest
2. AST and ALT increases over 10 times upper limit suggests:
3. AST and ALT increases unto 5 times suggests

Answer 1

1. hepatocellular injury
2. srugs, viral hepatitis, hypoxia
3. infection, alcohol, fatty liver or medication

Question 2

TRUE OR FALSE
1/ AST is released into serum in proportion to cellular damage
2/ ALT is released into serum in proportion to cellular damage

Answer 2

1/ TRUE
AST is released in proportion to cellular damage
ALT does not indicate degree of liver damage

(Ref: LITFL)

Question 3

ALP is produced in the

Answer 3

Liver
Intestine
bone
placenta

Question 4

ALP and concurrent elevation of GGT indicates

Answer 4

likely liver origin

Question 5

Causes of isolated ALP?

Answer 5

Bone disease e.g. Paget’s in over 50 year olds, vitamin D deficiency, metastasis

Question 6

How long does GGT take to decrease after cessation of alcohol?

Answer 6

2-3 weeks

Question 7

What is unconjugated hyperbilirubenimia in adults due to?

Answer 7

gilbert’s syndrome or haemolysis

Question 8

ALP more than 3 times of ALT suggests

ALT more than 3 times of ALP suggests

Answer 8

cholestasis

Hepatocellular damage

Question 9

What are the causes of cholestasis?

Answer 9

Biliary obstruction
Pregnancy
Drugs
Infiltration (e.g. malignancy)

Question 10

What are the causes of hepatocellular damage?

Answer 10

Infection 
Alcohol AST often >2 times of ALT
Fatty Liver
Drugs e.g. panadol 
Metal overload (e.g. haemochromatosis, copper overlod) 
Autoimmune

Question 11

Where is ALT and AST found?

Answer 11

1/ AST Found in decreasing levels in: (Relatively low organ specificity)
Liver, cardiac, skeletal muscle, kidney, brain, pancreas, red blood cells

2/ ALT - liver

Question 12

Causes of the following ratios:
1/ AST: ALT = 1
2/ AST: ALT >2.5
3/AST:ALT<1

Answer 12

1/ ischemia (CCF, necrosis) 
2/ alcoholic hepatitis 
3/ Hepatitis 
- toxic 
- viral

Question 13

Causes of an increased ALP

Answer 13

Liver: hepatic tumour, viral hepatitis, infectious mononucleosis
Pregnancy - from placenta to serum late pregnancy
Bone
-Osteomalacia
-Bone metastasis
-Pagets disease
-Deficiency induced Ricket’s
-Adolescents and children with rapid bone growth
-Osteoporisis
- hyperparathyroid

Causes of isolated rise in ALP
CCF (Often associated with AST and ALT rise)
Hodgkin’s
IBD
Diabetes