Liver function Flashcards
Hepatic Function Panel is also called
Liver function test
Not reported with Comprehensive Metabolic Panel (CMP) but on LFT
Bilirubin Direct (conjugated)* Bilirubin Indirect unconjugated
BUN gives you an idea of what
Hydration levels
Elevations typical of inflammation
ALT (sensitive)
AST (shots)
Elevations typical of cholestasis (usu. due to obstruction)
Bilirubin
Bilirubin Direct (conjugated)
Alkaline Phosphatase
Then you to GGT
Sometimes used as a marker of alcohol consumption
GGT
Tests that indicate reduced liver function
- Albumin LOW
2. PT (usu. ordered with INR) prolonged/HIGH
Is normally caused by what
obstruction
Is Direct BR water soluble
yes
what poop dark urine what you thinking
Cholestasis pattern
Cholestasis pattern urobilinogen pattern
decreased
Isolated elevation in Indirect (Unconjugated) Bilirubin often due to
Gilbert Syndrome
aka familial non-hemolytic jaundice
Gilbert Syndrome
IF GGT is elevated where is the alk phose from
Liver
Cirrhosis results from
chronic liver disease
scarring cannot be repaired
Cirrhosis
Portal hypertension, Jaundice can be signs of what
Cirrhosis
Low platelets due to issues with the spleen because of the portal HTN
Cirrhosis
Definitive diagnosis & staging of liver failure
requires liver biopsy
can someone have normal ALT, AST and a bad liver
yes
What is more sensitive ALT, AST
ALT
Acetaminophen can often effect what LFT
AST
The easiest way to determine if a medication is responsible is to
stop it and see if the lab value returns to normal.
when do you want to worry about alt, ast
- 3-5 X normal
2. It’s been elevated for 6 months
three conditions you will see elevated ALT, AST
Obesity
Type 2 DM
Hyperlipidemia
“painless jaundice” what are you thinking
cancer
Hepatic steatosis =
fatty liver
fatty liver can progress to
NASH
NASH can progress to
cirrhosis
do you have to be fat to have a patty liver
no
As of 2008, prevalence of NAFLD was
11%
Is NAFLD common
yes
↑ALT & AST
what condition
NAFLD
what the first test after LFT for NASH
ultrasound
what is more specific for nash test
CT
Weight loss for patients who are obese
Hep A & B vaccinations
Avoid alcohol consumption
Treatment of risk factors for cardiovascular disease
treatments for NASH
Hereditary disorder of iron metabolism
Hereditary Hemochromatosis
Hereditary Hemochromatosis what type of disease (doinate, resessive)
Autosomal recessive
Clinical symptoms generally absent until the 5th decade
Symptoms appear earlier in men – why?
Hereditary Hemochromatosis
Hereditary Hemochromatosis Triad
cirrhosis, DM, bronze skin pigmentation
is the main iron-binding protein
transferrin
marker of iron storage
ferritin
transferrin & ferritin would be what is Hereditary Hemochromatosis
(high)
Management
Therapeutic phlebotomy
No optimal regimen – usually removal of 1 unit of blood every 1-2 weeks
Avoid iron rich foods (e.g. red meat, vit. C)
Avoid insult to liver (no alcohol)
Hereditary Hemochromatosis
most common liver related lab finding
High ALT, AST
what medications can damage the liver
any
transaminases means what
ALT
AST
AST:ALT ratio of < 1 (ALT higher)
what going on (2)
Acute or chronic viral hepatitis
NASH (Nonalcoholic steatohepatitis)
AST:ALT ratio of > 1
Suggestive of ETOH liver disease, esp if GGT > 2X normal
Fatty infiltration + associated inflammation = (?)
NASH
Obesity
Hypertriglyceridemia / Dyslipidemia
Insulin resistance & DM
risk factors for NASH
disease that has an elevated ALT>AST
NAFLD, NASH
Cirrhosis Cardiac enlargement / cardiomyopathy DM Skin hyperpigmentation (can be signs of)
Hereditary Hemochromatosis
If transferrin saturation (TS) < 45 (normal) & ferritin normal
no further testing needed
transferrin is what
iron binding protein
ferritin is what
Iron storage protein
A serum test is a
blood test
Major cause of death is decompensated (severe) cirrhosis, HCC, DM, & cardiomyopathy
Hereditary Hemochromatosis
Therapeutic phlebotomy primary treatment for what condition
Hereditary Hemochromatosis
Fatty liver Disease Hemochromatosis Autoimmune hepatitis Wilson disease (are all associated with an elevation in what finding)
elevated ALT, AST
what disease effects women for in there 40-50
Autoimmune hepatitis (3.6-1)
3 additional labs that are elevated with Autoimmune hepatitis
Increased total IgG (gamma-globulin)
+ ANA (antinuclear antibodies)
+ ASMA (anti-smooth muscle antibodies
Management
Refer to hepatologist
Corticosteroid (prednisone) often prescribed
Autoimmune hepatitis
Very rare hereditary disorder of cellular copper transport
Wilson disease
Kayser-Fleischer rings in about ½ of pts with liver disease
Wilson disease
ceruloplasmin with Wilsons
Low
Untreated Wilson disease
Fatal
Copper what disease
Wilson
Iron what disease
Hereditary Hemochromatosis
effects for women what disease
Autoimmune hepatitis
wilsons Prognosis for those who receive treatment is
excellent
Put the 4 conditions with elevated alt, ast in order from common to rare
- Fatty liver
- HH
- autoimmune
- Wilson
3 other less common cause for elevated AST, ALT
Celiac disease
Hypothyroidism
Adrenal insufficiency
hepatitis is (?) of the liver
inflammation
when they say check for hepatitis what are they looking for
A, B,C
infectious / endemic hepatitis
HEP A
Hep A incubation period
Incubation period 10-50 days
Hep A transmittion
fecal oral
what dramatically reduced HEP- A transmission
vaccination of daycare kids
Fever, jaundice are main symptoms of what
Hep A
> 90% childhood infections asymptomatic (what condition)
HEP- A
prognosis for Hepatitis A
99% of cases recover completely
When do you vaccinate kids for Hep- A
12-23 months
why do people get jaundice
increased Bilirubin
what indicates recent Hep A infection
IG-M
How is Hep- B transmitted
Blood
Is Hepatitis a virus or bacteria
Virus
is a leading cause of cirrhosis & hepatocellular carcinoma worldwide
Hep- B
why would immunosuppressed adults are asymptomatic
because their immune system is not stong enough to mount a response
Fever and jundice (think what)
hepatitis
if you are infected as an infant what are the changes you will get chronic Hep B
> 90%
if you are infected 1-5 what are the changes you will get chronic Hep B
25-50%
if you are infected adult what are the changes you will get chronic Hep B
5%
acute hepatitis has what labs elevated
Elevated ALT, ST (very high)
ALT, AST with chronic Hep B
may not be elevated
If you have the surface antigen what does that mean
you have HEPITITIS (today)
Hep B surface antibody (anti-HBs) means what
Immunized or cleaed it
Hep B surface antigen (HBsAg):
protein on surface of the virus (part of the virus).
They have hepatitis today
Total Hep B core antibody (anti-HBc):
They used to have the infection but have cleared it (core)
Surface antibody:
immunized
Vaccine does not result in anti-HBc, so if someone has anti-HBs + but does not have anti-HBc, immunity is from vaccination
remember
Transmitted primarily through large or repeated percutaneous exposures to infectious blood
Hep- C
the leading cause for liver transplants in the U.S.
Hep- C
currently the most common means of HCV transmission in U.S.
Injection use
If you mother has what type of Hep you are likely to get it
Hep- C
Incubation period for Hep- C
4-12 weeks
what percentage of people infected with Hep C develop a chronic infection
75%
do people with chronic Hep- C have symptoms
usually asymptomatic until late disease
what ages would you not give hep a vaccine post expose
12 months - 40 years
when did they not test blood banks for Hep
1945-1965
(not in handout) – unlike other infections, having had (?) does not provide immunity to re-infection
Hep C
