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Diagnostic Imaging #3 > Liver function > Flashcards

Liver function Flashcards

1
Q

Hepatic Function Panel is also called

A

Liver function test

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2
Q

Not reported with Comprehensive Metabolic Panel (CMP) but on LFT

A 
Bilirubin Direct (conjugated)*
Bilirubin Indirect unconjugated
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3
Q

BUN gives you an idea of what

A

Hydration levels

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4
Q

Elevations typical of inflammation

A

ALT (sensitive)

AST (shots)

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5
Q

Elevations typical of cholestasis (usu. due to obstruction)

A

Bilirubin
Bilirubin Direct (conjugated)
Alkaline Phosphatase
Then you to GGT

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6
Q

Sometimes used as a marker of alcohol consumption

A

GGT

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7
Q

Tests that indicate reduced liver function

A
  1. Albumin LOW

2. PT (usu. ordered with INR) prolonged/HIGH

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8
Q

Is normally caused by what

A

obstruction

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9
Q

Is Direct BR water soluble

A

yes

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10
Q

what poop dark urine what you thinking

A

Cholestasis pattern

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11
Q

Cholestasis pattern urobilinogen pattern

A

decreased

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12
Q

Isolated elevation in Indirect (Unconjugated) Bilirubin often due to

A

Gilbert Syndrome

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13
Q

aka familial non-hemolytic jaundice

A

Gilbert Syndrome

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14
Q

IF GGT is elevated where is the alk phose from

A

Liver

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15
Q

Cirrhosis results from

A

chronic liver disease

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16
Q

scarring cannot be repaired

A

Cirrhosis

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17
Q

Portal hypertension, Jaundice can be signs of what

A

Cirrhosis

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18
Q

Low platelets due to issues with the spleen because of the portal HTN

A

Cirrhosis

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19
Q

Definitive diagnosis & staging of liver failure

A

requires liver biopsy

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20
Q

can someone have normal ALT, AST and a bad liver

A

yes

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21
Q

What is more sensitive ALT, AST

A

ALT

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22
Q

Acetaminophen can often effect what LFT

A

AST

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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.

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24
Q

when do you want to worry about alt, ast

A
  1. 3-5 X normal

2. It’s been elevated for 6 months

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25
Q

three conditions you will see elevated ALT, AST

A

Obesity
Type 2 DM
Hyperlipidemia

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26
Q

“painless jaundice” what are you thinking

A

cancer

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27
Q

Hepatic steatosis =

A

fatty liver

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28
Q

fatty liver can progress to

A

NASH

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29
Q

NASH can progress to

A

cirrhosis

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30
Q

do you have to be fat to have a patty liver

A

no

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31
Q

As of 2008, prevalence of NAFLD was

A

11%

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32
Q

Is NAFLD common

A

yes

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33
Q

↑ALT & AST

what condition

A

NAFLD

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34
Q

what the first test after LFT for NASH

A

ultrasound

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35
Q

what is more specific for nash test

A

CT

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36
Q

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

A

treatments for NASH

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37
Q

Hereditary disorder of iron metabolism

A

Hereditary Hemochromatosis

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38
Q

Hereditary Hemochromatosis what type of disease (doinate, resessive)

A

Autosomal recessive

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39
Q

Clinical symptoms generally absent until the 5th decade

Symptoms appear earlier in men – why?

A

Hereditary Hemochromatosis

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40
Q

Hereditary Hemochromatosis Triad

A

cirrhosis, DM, bronze skin pigmentation

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41
Q

is the main iron-binding protein

A

transferrin

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42
Q

marker of iron storage

A

ferritin

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43
Q

transferrin & ferritin would be what is Hereditary Hemochromatosis

A

(high)

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44
Q

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)

A

Hereditary Hemochromatosis

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45
Q

most common liver related lab finding

A

High ALT, AST

46
Q

what medications can damage the liver

A

any

47
Q

transaminases means what

A

ALT

AST

48
Q

AST:ALT ratio of < 1 (ALT higher)

what going on (2)

A

Acute or chronic viral hepatitis

NASH (Nonalcoholic steatohepatitis)

49
Q

AST:ALT ratio of > 1

A

Suggestive of ETOH liver disease, esp if GGT > 2X normal

50
Q

Fatty infiltration + associated inflammation = (?)

A

NASH

51
Q

Obesity
Hypertriglyceridemia / Dyslipidemia
Insulin resistance & DM

A

risk factors for NASH

52
Q

disease that has an elevated ALT>AST

A

NAFLD, NASH

53
Q 
Cirrhosis
Cardiac enlargement / cardiomyopathy
DM
Skin hyperpigmentation
(can be signs of)
A

Hereditary Hemochromatosis

54
Q

If transferrin saturation (TS) < 45 (normal) & ferritin normal

A

no further testing needed

55
Q

transferrin is what

A

iron binding protein

56
Q

ferritin is what

A

Iron storage protein

57
Q

A serum test is a

A

blood test

58
Q

Major cause of death is decompensated (severe) cirrhosis, HCC, DM, & cardiomyopathy

A

Hereditary Hemochromatosis

59
Q

Therapeutic phlebotomy primary treatment for what condition

A

Hereditary Hemochromatosis

60
Q 
Fatty liver Disease 
Hemochromatosis 
Autoimmune hepatitis
Wilson disease
(are all associated with an elevation in what finding)
A

elevated ALT, AST

61
Q

what disease effects women for in there 40-50

A

Autoimmune hepatitis (3.6-1)

62
Q

3 additional labs that are elevated with Autoimmune hepatitis

A

Increased total IgG (gamma-globulin)
+ ANA (antinuclear antibodies)
+ ASMA (anti-smooth muscle antibodies

63
Q

Management
Refer to hepatologist
Corticosteroid (prednisone) often prescribed

A

Autoimmune hepatitis

64
Q

Very rare hereditary disorder of cellular copper transport

A

Wilson disease

65
Q

Kayser-Fleischer rings in about ½ of pts with liver disease

A

Wilson disease

66
Q

ceruloplasmin with Wilsons

A

Low

67
Q

Untreated Wilson disease

A

Fatal

68
Q

Copper what disease

A

Wilson

69
Q

Iron what disease

A

Hereditary Hemochromatosis

70
Q

effects for women what disease

A

Autoimmune hepatitis

71
Q

wilsons Prognosis for those who receive treatment is

A

excellent

72
Q

Put the 4 conditions with elevated alt, ast in order from common to rare

A
  1. Fatty liver
  2. HH
  3. autoimmune
  4. Wilson
73
Q

3 other less common cause for elevated AST, ALT

A

Celiac disease
Hypothyroidism
Adrenal insufficiency

74
Q

hepatitis is (?) of the liver

A

inflammation

75
Q

when they say check for hepatitis what are they looking for

A

A, B,C

76
Q

infectious / endemic hepatitis

A

HEP A

77
Q

Hep A incubation period

A

Incubation period 10-50 days

78
Q

Hep A transmittion

A

fecal oral

79
Q

what dramatically reduced HEP- A transmission

A

vaccination of daycare kids

80
Q

Fever, jaundice are main symptoms of what

A

Hep A

81
Q

> 90% childhood infections asymptomatic (what condition)

A

HEP- A

82
Q

prognosis for Hepatitis A

A

99% of cases recover completely

83
Q

When do you vaccinate kids for Hep- A

A

12-23 months

84
Q

why do people get jaundice

A

increased Bilirubin

85
Q

what indicates recent Hep A infection

A

IG-M

86
Q

How is Hep- B transmitted

A

Blood

87
Q

Is Hepatitis a virus or bacteria

A

Virus

88
Q

is a leading cause of cirrhosis & hepatocellular carcinoma worldwide

A

Hep- B

89
Q

why would immunosuppressed adults are asymptomatic

A

because their immune system is not stong enough to mount a response

90
Q

Fever and jundice (think what)

A

hepatitis

91
Q

if you are infected as an infant what are the changes you will get chronic Hep B

A

> 90%

92
Q

if you are infected 1-5 what are the changes you will get chronic Hep B

A

25-50%

93
Q

if you are infected adult what are the changes you will get chronic Hep B

A

5%

94
Q

acute hepatitis has what labs elevated

A

Elevated ALT, ST (very high)

95
Q

ALT, AST with chronic Hep B

A

may not be elevated

96
Q

If you have the surface antigen what does that mean

A

you have HEPITITIS (today)

97
Q

Hep B surface antibody (anti-HBs) means what

A

Immunized or cleaed it

98
Q

Hep B surface antigen (HBsAg):

A

protein on surface of the virus (part of the virus).

They have hepatitis today

99
Q

Total Hep B core antibody (anti-HBc):

A

They used to have the infection but have cleared it (core)

100
Q

Surface antibody:

A

immunized

101
Q

Vaccine does not result in anti-HBc, so if someone has anti-HBs + but does not have anti-HBc, immunity is from vaccination

A

remember

102
Q

Transmitted primarily through large or repeated percutaneous exposures to infectious blood

A

Hep- C

103
Q

the leading cause for liver transplants in the U.S.

A

Hep- C

104
Q

currently the most common means of HCV transmission in U.S.

A

Injection use

105
Q

If you mother has what type of Hep you are likely to get it

A

Hep- C

106
Q

Incubation period for Hep- C

A

4-12 weeks

107
Q

what percentage of people infected with Hep C develop a chronic infection

A

75%

108
Q

do people with chronic Hep- C have symptoms

A

usually asymptomatic until late disease

109
Q

what ages would you not give hep a vaccine post expose

A

12 months - 40 years

110
Q

when did they not test blood banks for Hep

A

1945-1965

111
Q

(not in handout) – unlike other infections, having had (?) does not provide immunity to re-infection

A

Hep C

Diagnostic Imaging #3 (3 decks)

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