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Diagnostics (Final Exam) > Liver Function > Flashcards

Liver Function Flashcards

1
Q

What does a high ALT and AST reflect?

A
  • inflammation

- hepatocellular damage

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2
Q

Does bilirubin rise with inflammation?

A

Bilirubin, Direct bilirubin and indirect bilirubin only rise if inflammation is severe

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3
Q

Which labs will be elevated with cholestasis (obstruction of bile)?

A
  • Bilirubin
  • Bilirubin direct (conjugated)
  • Alkaline Phosphatase

May see:
-GGT

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4
Q

Which labs are typically on a liver function panel?

A
  1. albumin
  2. Bilirubin
  3. Bilirubin direct (conjugated)
  4. Bilirubinn indirect (unconjugated)
  5. Alk phosphatase
  6. Total Protein
  7. ALT (alanin aminotransferase)
  8. AST (aspartate transaminase)
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5
Q

What is Gamma-Glutamul Transpeptidase (GGT) useful for?

A

GGT helps determine source of Alkaline phosphatase elevation

If GGT and Alk phos elevated = liver

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6
Q

What are these labs suggestive of?

Low albumin
Low total protein
Prolonged PT

A

Reduced liver function

  • low albumin
  • low total protein
  • prolonged PT
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7
Q

Is there a direct relationship between severity of liver disease and transaminase levels?

A

NO

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8
Q

Which is worse:

  1. Very high ALT and AST, normal albumin and PT
  2. Normal ALT and AST with low albumin and high PT/INR
A

2

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9
Q

What is the name for a gallstone getting stuck in the common bile duct?

A

choledocholithiasis

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10
Q

What symptoms would someone with choledocholithiasis present with?

A
  1. Pain - biliary colic
  2. Jaundice
  3. Clay-colored stools
  4. Cola colored urine
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11
Q

Which form of bilirubin is excreted from the liver in bile?

A

conjugated bilirubin

conjugated bilirubin is then converted to urobilinogen by bacteria and 90% is excreted in feces - 10% in urine

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12
Q

What is the name for dark urine?

A

bilirubinuria

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13
Q

What is the name for clay colored stools?

A

acholic

Conjugated bilirubin > urobilinogen > stercobilin (brown)

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14
Q

Which form of bilirubin is water soluble: unconjugated or conjugated?

A

conjugated bilirubin is water soluble, so when it can’t reach the duodenum it passes to the bloodstream and excreted by the kidneys

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15
Q

Isolated elevation in Indirect (unconjugated bilirubin is often due to what?

A

Gilbert Syndrome

  • benign
  • diagnosis made by ruling out other causes of elevated indirect bilirubin
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16
Q

Where alk phosphatase derived from?

A
  • Liver
  • Bone

(very small amount from intestines)

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17
Q

What are the common causes of reduced liver function?

A
  1. cirrhosis
  2. Severe hepatitis
  3. Toxic insult (eg. acetominophen overdose)
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18
Q

Name 5 signs of reduces liver function

A
  1. Fatigue
  2. Portal Hypertension
  3. Ascites
  4. Jaundice (increased bilirubin due to failure of hepatocyte to conjugate and failure to excrete bile = unconjugated bilirubin accumulates in fatty tissues, most noteably the skin)
  5. Easy bruising/bleeding
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19
Q

Is ALT or AST more specific to the liver?

A

ALT

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20
Q

Name 3 common herbs/vitamins that can cause elevations in ALT and AST

A
  1. Ephedra
  2. Kava
  3. Vitamin A
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21
Q

Name 7 medications that can often cause elevation in transaminases

A
  1. Acetaminophen (because it is often combined with opiates)
  2. Statins
  3. Antifungals
  4. Antibiotics
  5. Anti-TB drugs
  6. NSAIDS
  7. Tegretol
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22
Q

When should you be worried about elevated AST and ALT?

A
  • If other liver tests are abnormal
  • > 3-5 fold elevation of enzyme level
  • Persistently abnormal for > 6 months
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23
Q

If ALT and AST are mildly elevated (<3 times normal) what may be the concern?

A
  1. Fatty liver (Non-alcoholic Fatty Liver Disease)

2. EtOH related

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24
Q

What might elevated AST signify?

A
  1. Alcoholic hepatitis
  2. Common bile duct obstruction (choledocholithiasis)
  3. Cholangitis (infection that can result from choledocholithiasis)
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25
Q

If AST is higher than ALT what does that suggest?

A

ETOH liver disease (especially if GGT >2x normal)

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26
Q

If ALT is higher than AST what does that suggest?

A
  • Acute or chronic viral hepatitis

- NASH (Non-alcoholic steatohepatitis)

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27
Q

Having cirrhosis places patient at risk for what?

A
  • liver failure

- liver cancer

28
Q

What are the 4 risk factors for NAFLD and NASH

A
  1. Obesity
  2. Hypertriglyceridemia/Dyslipidmia
  3. Insulin resistance and DM
  4. Medications (corticsteroids, estrogen, tamoxifen, amiodarone, anti HIV medications)
29
Q

What would be found on an ultrasound of a patient with NAFLD?

A

increased echogenicity

*ultrasound is initial test

30
Q

What would be found on a CT of NAFLD?

A

decreased attenuation

31
Q

What is the general approach to treating NAFLD?

A
  • Weight loss for patients who are obese
  • Hep A & B vaccinations
  • Avoid alcohol consumption
  • Treatment of risk factors for cardiovascular disease
32
Q

What disease is caused by mutation of HFE gene which regulates the uptake of iron?

A

Hereditary hemochromatosis

-autosomal recessive

33
Q

What is the classic triad of hereditary hemochromatosis?

A
  1. Cirrhosis
  2. Diabetes mellitus
  3. Bronze skin pigmentation
34
Q

What is transferrin?

A

transferrin is the main iron-binding protein

35
Q

What is ferritin?

A

marker of iron storage

36
Q

transferrin and ferritin may be elevated in what disease?

A

hereditary hemochromatosis

37
Q

How is hereditary hemochromatosis managed?

A
  • therapeutic phlebotomy (~1-2 weeks)
  • avoid iron rich foods
  • avoid insults to the liver (eg. alcohol)
38
Q

If untreated, what can hereditary hemochromatosis lead to?

A 
DM
Cardiomyopathy
hypopituitarism
hypogonadism
hypothyroidism
extra-hepatic cancer
39
Q

What is the prevalence of autoimmune hepatitis?

A

11-25 per 100,000 people

-about 3 times more common in females

40
Q

What other labs tests may be done in addition to elevated ALT and AST in autoimmune hepatitis?

A
  1. Increased total IgG
  2. (+) ANA (antinuclear antibodies)
  3. (+) ASMA (anti- smooth muscle antibodies)
41
Q

What is the name of the autosomal recessive disease that leads to impaired biliary copper excretion causing accumulation of copper in the liver, brain and cornea?

A

Wilson disease

42
Q

Will ceruloplasmin be high or low in Wilson’s disease?

A

LOW

ceruloplasmin is the major copper-carrying protein

43
Q

Hepatitis A: transmission

A

fecal oral

44
Q

Hepatitis A: incubation period

A

10-50 days

45
Q

Does hepatitis A lead to chronic disease, cirrhosis or hepatocellular cancer?

A

No

46
Q

Hepatitis A transmission

A
  • Household
  • Daycare
  • Sexual contact
  • injection and non-injection drug users
47
Q

Heptatitis A prognosis children versus adult

A

Children: >90% asymptomatic

Adults: 25-50% asymptomatic

48
Q

What percent of Hep A infections recover completely?

A

99%

49
Q

When do you vaccinate for Hep A?

A

Vaccinate within 2 weeks of exposure

if contraindication to vaccine, give immunoglobulin

50
Q

When do you vaccinate children against Hep A?

A

between 12-23 months of age

51
Q

Explain why patients wil become jaundice with hepatitis

A

When ALT and AST become very elevated (inflammation in the liver) you will also see a high bilirubin

52
Q

If a patient has IgM anti-HAV negative and IgG anti-HAV positive what does this indicate?

A

Past infection and/or immunity

53
Q

How is Hepatitis B transmitted?

A

Blood, sexual contact, parenteral contact (injection)

54
Q

What are common symptoms related to hepatitis infection?

A
  • fever
  • jaundice
  • nausea and vomiting
  • dark urine
55
Q

Contrast Acute HBV and Chronic HBV

A

Acute HBV:

  • young children and immunosuppressed= asymptomatic
  • 30-50% of those older than 5 have typical hepatitis symptoms

Chronic HBV:

  • asymptomatic until late disease
  • premature death due to cirrhosis
56
Q

How is chronic Hep B infection managed?

A

antiviral medications

57
Q

How will labs look for Hep B infection?

A

Acute infection: VERY HIGH ALT and AST

Chronic infection: mildly elevated ALT and AST

58
Q

When is the surface antigen for Hep B present in the blood?

A

Incubation and Acute phase

59
Q

What does Hep B e antigen (HBeAg) presence indicate?

A

HBeAg indicates high levels of HBV (virus is replicating)

-not a primary care concern

60
Q

Total Hep B core antibody

A

appears at onset and persists for life

61
Q

IF anti-HBc is present, the person has what?

A

natural immunity

62
Q

If someone has anti-HBs were they vaccinated?

A

yes.

Vaccine gives a person anti-HBs but doesn’t give anti-HBc so “c” is natural

63
Q

What is the leading cause of liver transplants in the US?

A

Chronic HCV (hepatitis C)

64
Q

What is the most common tranmission means of Hep C?

A

injection drug use

Also common:

  • needlestick in health care
  • Mom to baby in birth
65
Q

Who needs to be screened for Hepatitis C?

A
  1. Everyone born between 1945-1965
  2. Injection drug users
  3. Blood product recipients before 1992
  4. HIV
  5. Known exposure
66
Q

How do you screen for Hepatits C?

A
  1. Look for HCV antibody
  2. Look for HCV RNA

If both positive: patient has Hep C

Diagnostics (Final Exam) (2 decks)

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