Liver Function Flashcards
what is the other name for AST
serum glutamic oxalocetic transamniase
SGOT
what is the other name for ALT
serum glutamic pyruvic transamniase
SGPT
AST is found primarily where
liver heart kidney pancreas muscle
AST is elevated when
significant tissue damage
what is the normal value for AST
7-40
which enzyme is found in liver, heart, kidney, pancreas, and muscle
AST
ALT is elevated when
hepatocellular necrosis*
alcohol liver damage
kidney infection
myocardial infarction
what enzyme is primarily elevated during hepatocellular necrosis
ALT
what is the normal value for ALT
5-36
LDH stands for what
lactic acid dehydrogenase
LDH is elevated when
cellular death or leakage from the cell
hemolysis –> prehepatic
if other tests are elevated it may indicate –>
myocardial infarction
pulmonary infarction
what is the normal values for LDH
50-150
ALP is elevated when
biliary obstruction*
blastic bone disease
pregnancy
skeletal growth
what is the normal values for ALP
30-120
what does GGT stand for
gama glutamyl transpeptidase
GGT is elevated when
cholangitis liver disease occult bile duct obstruction alcohol abuse drug abuse
total bilirubin is elevated when
liver disease
hemolytic anemia
drugs
what are the lab results seen in prehepatic jaundice
BLOOD
increase unconjugated bilirubin
increase albumin
URINE and POOP
increase or normal urobilinogen - yellow urine
normal steracobilinogen
what are the lab results seen in intrahepatic jaundice
BLOOD
increase unconjugated and conjugated bilirubin - BOTH
big increase AST and ALT
slight increase ALP
URINE
increase bilirubin - dark urine
what are the lab results seen in posthepatic jaundice
BLOOD
increase conjugated bilirubin
big increase in ALP
slight increase in AST and ALT
URINE and POOP
increase bilirubin in urine - dark urine
urobilinogen and steracobilinogen –>
incomplete obstruction = decrease
complete obstruction = absent
what causes prehepatic, intrahepatic, and post hepatic jaundice
prehepatic - hemolysis
intrahepatic - impaired conjugation, viral hepatitis, drugs, cirrhosis, tumors of liver
post hepatic - obstruction of bile ducts, gallstones, and tumors of bile ducts or pancreas
what are the symptoms of hemolytic jaundice
weakness, dark urine, anemia, leterus, splenomegaly
what gives feces its color
stercobilinogen
what are the different types of obstructive jaundice
intrahepatic obstruction - hepatitis, PBC (primary biliary cirrhosis), drugs
extrahepatic obstruction - stones, stricture/stenosis, compression, inflammation, tumors of ampulla of vater, choledochal cyst, biliary atresia
what are the causes of intrahepatic jaundice
gilberts syndrome - decreased GT activity - unable to conjugate bilirubin
grigler najjar syndrome - absence of UDPGT activity - unable to conjugate bilirubin
familial disorders - dubin johnson syndrome and rotor syndrome
hepatitis, cirrhosis, drugs
intrahepatic jaundice symptoms
weakness, loss of appetite, hepatomegaly, palmar erythema, spider angiolectasis
what are the clinical features of cholestasis
pain due to malignancy, disease, or stretching of liver capsule
fever due to ascending cholangitis
palpable or tender gall bladder
enlarged smooth liver
what does the proportion of conjugated bilirubin to total bilirubin indicate
<20% - prehepatic, gilberts, crigler najjar
20-40% of total - hepatic
40-60% of total - hepatic or post hepatic
> 50% of total - post hepatic
prehepatic is mostly unconjugated so low % and post hepatic is conjugated so high % of conjugated/total bilirubin
unconjugated bilirubin is transported with what in the liver
ligandin or Z protein
unconjugated bilirubin is conjugated with what to form conjugated bilirubin
glucouronic acid
conjugated bilirubin is converted to what in the GI small intestine
how
where doe it go next
urobilinogen
bacterial proteases
urobilinogen will be excreted via feces, enter enterohepatic circulation and go back to liver, or go to kidney to be excreted in the urine
__% of urobilinogen reabsorbed from the intestines into the portal vein
__% of urobilinogen excreted in the feces
10% rebasorbed and back to the liver
90% excreted in the feces
secreted bile salts from the gall bladder are __% new bile salts
and __% old recycled bile salts
5% new synthesized bile salts
95% old recycled bile salts
what % of bile salts are reabsorbed by the small intestine
what % of bile salts are excreted in the feces
95% reabsorbed
5% excreted in feces
what is normal GGT value
0-30
what is normal total bilirubin value
0.2 - 1.5
