Liver function Flashcards
1
Q
Hepatic Function Panel is also called
A
Liver function test
2
Q
Not reported with Comprehensive Metabolic Panel (CMP) but on LFT
A
Bilirubin Direct (conjugated)* Bilirubin Indirect unconjugated
3
Q
BUN gives you an idea of what
A
Hydration levels
4
Q
Elevations typical of inflammation
A
ALT (sensitive)
AST (shots)
5
Q
Elevations typical of cholestasis (usu. due to obstruction)
A
Bilirubin
Bilirubin Direct (conjugated)
Alkaline Phosphatase
Then you to GGT
6
Q
Sometimes used as a marker of alcohol consumption
A
GGT
7
Q
Tests that indicate reduced liver function
A
- Albumin LOW
2. PT (usu. ordered with INR) prolonged/HIGH
8
Q
Is normally caused by what
A
obstruction
9
Q
Is Direct BR water soluble
A
yes
10
Q
what poop dark urine what you thinking
A
Cholestasis pattern
11
Q
Cholestasis pattern urobilinogen pattern
A
decreased
12
Q
Isolated elevation in Indirect (Unconjugated) Bilirubin often due to
A
Gilbert Syndrome
13
Q
aka familial non-hemolytic jaundice
A
Gilbert Syndrome
14
Q
IF GGT is elevated where is the alk phose from
A
Liver
15
Q
Cirrhosis results from
A
chronic liver disease
16
Q
scarring cannot be repaired
A
Cirrhosis
17
Q
Portal hypertension, Jaundice can be signs of what
A
Cirrhosis
18
Q
Low platelets due to issues with the spleen because of the portal HTN
A
Cirrhosis
19
Q
Definitive diagnosis & staging of liver failure
A
requires liver biopsy
20
Q
can someone have normal ALT, AST and a bad liver
A
yes
21
Q
What is more sensitive ALT, AST
A
ALT
22
Q
Acetaminophen can often effect what LFT
A
AST
23
Q
The easiest way to determine if a medication is responsible is to
A
stop it and see if the lab value returns to normal.
24
Q
when do you want to worry about alt, ast
A
- 3-5 X normal
2. It’s been elevated for 6 months
25
three conditions you will see elevated ALT, AST
Obesity
Type 2 DM
Hyperlipidemia
26
"painless jaundice" what are you thinking
cancer
27
Hepatic steatosis =
fatty liver
28
fatty liver can progress to
NASH
29
NASH can progress to
cirrhosis
30
do you have to be fat to have a patty liver
no
31
As of 2008, prevalence of NAFLD was
11%
32
Is NAFLD common
yes
33
↑ALT & AST
| what condition
NAFLD
34
what the first test after LFT for NASH
ultrasound
35
what is more specific for nash test
CT
36
Weight loss for patients who are obese
Hep A & B vaccinations
Avoid alcohol consumption
Treatment of risk factors for cardiovascular disease
treatments for NASH
37
Hereditary disorder of iron metabolism
Hereditary Hemochromatosis
38
Hereditary Hemochromatosis what type of disease (doinate, resessive)
Autosomal recessive
39
Clinical symptoms generally absent until the 5th decade
| Symptoms appear earlier in men – why?
Hereditary Hemochromatosis
40
Hereditary Hemochromatosis Triad
cirrhosis, DM, bronze skin pigmentation
41
is the main iron-binding protein
transferrin
42
marker of iron storage
ferritin
43
transferrin & ferritin would be what is Hereditary Hemochromatosis
(high)
44
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
45
most common liver related lab finding
High ALT, AST
46
what medications can damage the liver
any
47
transaminases means what
ALT
| AST
48
AST:ALT ratio of < 1 (ALT higher)
| what going on (2)
Acute or chronic viral hepatitis
| NASH (Nonalcoholic steatohepatitis)
49
AST:ALT ratio of > 1
Suggestive of ETOH liver disease, esp if GGT > 2X normal
50
Fatty infiltration + associated inflammation = (?)
NASH
51
Obesity
Hypertriglyceridemia / Dyslipidemia
Insulin resistance & DM
risk factors for NASH
52
disease that has an elevated ALT>AST
NAFLD, NASH
53
```
Cirrhosis
Cardiac enlargement / cardiomyopathy
DM
Skin hyperpigmentation
(can be signs of)
```
Hereditary Hemochromatosis
54
If transferrin saturation (TS) < 45 (normal) & ferritin normal
no further testing needed
55
transferrin is what
iron binding protein
56
ferritin is what
Iron storage protein
57
A serum test is a
blood test
58
Major cause of death is decompensated (severe) cirrhosis, HCC, DM, & cardiomyopathy
Hereditary Hemochromatosis
59
Therapeutic phlebotomy primary treatment for what condition
Hereditary Hemochromatosis
60
```
Fatty liver Disease
Hemochromatosis
Autoimmune hepatitis
Wilson disease
(are all associated with an elevation in what finding)
```
elevated ALT, AST
61
what disease effects women for in there 40-50
Autoimmune hepatitis (3.6-1)
62
3 additional labs that are elevated with Autoimmune hepatitis
Increased total IgG (gamma-globulin)
+ ANA (antinuclear antibodies)
+ ASMA (anti-smooth muscle antibodies
63
Management
Refer to hepatologist
Corticosteroid (prednisone) often prescribed
Autoimmune hepatitis
64
Very rare hereditary disorder of cellular copper transport
Wilson disease
65
Kayser-Fleischer rings in about ½ of pts with liver disease
Wilson disease
66
ceruloplasmin with Wilsons
Low
67
Untreated Wilson disease
Fatal
68
Copper what disease
Wilson
69
Iron what disease
Hereditary Hemochromatosis
70
effects for women what disease
Autoimmune hepatitis
71
wilsons Prognosis for those who receive treatment is
excellent
72
Put the 4 conditions with elevated alt, ast in order from common to rare
1. Fatty liver
2. HH
3. autoimmune
4. Wilson
73
3 other less common cause for elevated AST, ALT
Celiac disease
Hypothyroidism
Adrenal insufficiency
74
hepatitis is (?) of the liver
inflammation
75
when they say check for hepatitis what are they looking for
A, B,C
76
infectious / endemic hepatitis
HEP A
77
Hep A incubation period
Incubation period 10-50 days
78
Hep A transmittion
fecal oral
79
what dramatically reduced HEP- A transmission
vaccination of daycare kids
80
Fever, jaundice are main symptoms of what
Hep A
81
>90% childhood infections asymptomatic (what condition)
HEP- A
82
prognosis for Hepatitis A
99% of cases recover completely
83
When do you vaccinate kids for Hep- A
12-23 months
84
why do people get jaundice
increased Bilirubin
85
what indicates recent Hep A infection
IG-M
86
How is Hep- B transmitted
Blood
87
Is Hepatitis a virus or bacteria
Virus
88
is a leading cause of cirrhosis & hepatocellular carcinoma worldwide
Hep- B
89
why would immunosuppressed adults are asymptomatic
because their immune system is not stong enough to mount a response
90
Fever and jundice (think what)
hepatitis
91
if you are infected as an infant what are the changes you will get chronic Hep B
> 90%
92
if you are infected 1-5 what are the changes you will get chronic Hep B
25-50%
93
if you are infected adult what are the changes you will get chronic Hep B
5%
94
acute hepatitis has what labs elevated
Elevated ALT, ST (very high)
95
ALT, AST with chronic Hep B
may not be elevated
96
If you have the surface antigen what does that mean
you have HEPITITIS (today)
97
Hep B surface antibody (anti-HBs) means what
Immunized or cleaed it
98
Hep B surface antigen (HBsAg):
protein on surface of the virus (part of the virus).
| They have hepatitis today
99
Total Hep B core antibody (anti-HBc):
They used to have the infection but have cleared it (core)
100
Surface antibody:
immunized
101
Vaccine does not result in anti-HBc, so if someone has anti-HBs + but does not have anti-HBc, immunity is from vaccination
remember
102
Transmitted primarily through large or repeated percutaneous exposures to infectious blood
Hep- C
103
the leading cause for liver transplants in the U.S.
Hep- C
104
currently the most common means of HCV transmission in U.S.
Injection use
105
If you mother has what type of Hep you are likely to get it
Hep- C
106
Incubation period for Hep- C
4-12 weeks
107
what percentage of people infected with Hep C develop a chronic infection
75%
108
do people with chronic Hep- C have symptoms
usually asymptomatic until late disease
109
what ages would you not give hep a vaccine post expose
12 months - 40 years
110
when did they not test blood banks for Hep
1945-1965
111
(not in handout) – unlike other infections, having had (?) does not provide immunity to re-infection
Hep C
