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DS Unit 4 > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

What are the LFT’s?

A 
Total Protein
Albumin
Alkaline Phosphatase
AST (SGOT)
ALT (SGPT)
LDH
Bilirubin 
Total
Direct 
Indirect
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2
Q

What is the total protein adult ri?

A

6.4 – 8.3 g/dl

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3
Q

What is the total protein children ri?

A

Newborn: 4.6 – 7.4 g/dl
Infant: 6 – 6.7 g/dl
Child: 6.2 – 8 g/dl

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4
Q

What are the indications for a total protein test?

A

Used to diagnose, evaluate and monitor following diseases:

Liver disease

Intestinal/renal protein wasting states

Immune disorders

Impaired nutrition

Chronic edematous states

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5
Q

What are the functions of protein?

A 
Muscles
Enzymes
Hormones
Transport substances
Structural components of cell membrane
Channels
Osmotic pressure
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6
Q

What is the function of prealbumin?

A

Transports thyroxine

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7
Q

Where is albumin formed?

A

Liver

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8
Q

how much of the total protein is albumin?

A

60% of serum protein

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9
Q

What is the function of albumin?

A

Transports drugs, hormones & enzymes

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10
Q

What happens to protein levels in liver cell disease?

A

When liver cells diseased, they are unable to synthesize albumin and albumin level decreases. Because half life of albumin is 12-18 days, severe impairment of albumin synthesis may not be recognized for months.

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11
Q

What key proteins do globulins make up?

A

Antibodies, glycoproteins, lipid proteins, clotting factors and complement

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12
Q

What are the three types of globulins?

A

Alpha
Beta
Gamma

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13
Q

What molecules are alpha globulins present in?

A

Alpha1 antitrypsin, haptoglobin, prothrombin, cholinesterase

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14
Q

What molecules are beta globulins present in?

A

Lipoproteins, plasminogen, fibrinogen

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15
Q

What molecules are gamma globulins present in?

A

Immune globulins

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16
Q

What conditions exhibit increased gamma globulin levels?

A
  1. MM: gamma glob from neoplastic plasma cells.
  2. Chronic Inflamm Dis: RA, SLE; have asst autoantibodies.
  3. Malignancy: Hodgkins, lymphoma, leukemia
  4. Cirrhosis: pathophys not known.
  5. Acute or chronic Infection results in ab response
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17
Q

What conditions exhibit decreased gamma globulin levels?

A
  1. Genetic immune disorders
  2. Secondary immune deficiency
    Steroid use
    Nephrotic Syndrome
    Leukemia
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18
Q

What are the adult ri for albumin?

A

3.5-5.0 g/dl

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19
Q

What are the childhood ri for albumin?

A

Newborn: 3.5-5.4 g/dl
Infant: 4.4-5.4 g/dl
Children: 4-5.9 g/dl

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20
Q

What are the indications for albumin testing?

A

Measure of nutritional status
Measure of hepatic function
Measure of renal function

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21
Q

Where is albumin synthesized?

A

Liver

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22
Q

Albumin is a major contributor of what kind of pressure?

A

Osmotic pressure

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23
Q

Albumin is important in the transport of what?

A

Fatty acids
Thyroid hormones
Steroid hormones

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24
Q

What happens to the albumin concentration in dehydration?

A

Increased albumin levels

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25
Q

What conditions are asst with decreased albumin levels?

A
  1. Malnutrition: lack of aa for building proteins; also liver dysfunction asst with malnutrition also contributes to low albumin levels.
  2. Pregnancy: increased demands on the body
  3. Hepatic disease: Hepatitis, cirrhosis, metastatic liver tumor
    Liver: site of albumin synthesis.
  4. Malabsorption: Crohns Disease
  5. Third space losses: ascitis, third degree burns
  6. Overhydration
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26
Q

What are the normal adult ri for alkaline phosphatase?

A

30-120 units/L

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27
Q

What are the normal elderly ri for alkaline phosphatase?

A

Slightly higher than adults

Adults 30-120units/L

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28
Q

What are the normal elderly ri for alkaline phosphatase?

A 
Children (units/l)
<2 yrs      85-235 
2-8 yrs      65-210
9-15 yrs    60-300
16-21 yrs  30-200
29
Q

What are the indications for alkaline phosphatase?

A

Detect and monitor diseases of Liver and Bone

30
Q

Where are the highest concentrations of ALP?

A
  1. Liver and biliary tract epithelium: Kupffer cells
  2. Bone
    A. Most frequent extrahepatic source of ALP
    B. New bone growth = increased ALP levels
31
Q

How do you distinguish between ALP from the bone and the liver?

A

ALP1 – Liver

ALP2 - Bone

32
Q

What conditions are associated with increased ALP

A
  1. Primary cirrhosis
  2. Biliary obstruction
    A. Intrahepatic
    B. Extrahepatic
  3. Liver tumor
    A. Primary
    B. Metatstatic
  4. Normal bones of growing children
  5. Healing fracture
  6. Paget’s Disease
33
Q

Aspartate Aminotransferase (AST) normal adult and elderly ri?

A

0–35 units/l

34
Q

Aspartate Aminotransferase (AST) normal Childhood ri?

A

10-140 units/l
Highest in newborns
Lowest in adolescents (10-40 units/l)

35
Q

What are the indications for AST testing?

A

Suspected occlusive coronary artery disease

Suspected hepatocellular disease

36
Q

Where is AST found?

A 
Found in metabolically active tissues
Heart
Liver
Skeletal muscle
Pancreas
RBC’s
Kidneys

If disease or injury in any of these cells
Cells lyse and release AST

37
Q

What is AST level directly related to?

A

Number of cells injured

38
Q

When is AST increased post injury?

A

Elevated 8 hours post injury
Peaks 24-36 hours post injury
Returns to normal in 3-6 days

39
Q

Increased AST are asst with what cardiac conditions?

A

MI
Cardiac surgery
Cardiac catheterization
Angioplasty

40
Q

Increased AST are asst with what hepatic conditions?

A
  1. Hepatitis
    AST rises up to 20x normal (700 units/L)
  2. Cirrhosis
    Level depends on amount inflammation
  3. Hepatic mets
  4. Infectious mono with hepatitis
41
Q

Increased AST are asst with what skeletal muscle conditions?

A

Muscle trauma
Recent noncardiac surgery
Severe deep burns
Recent seizures

42
Q

Increased AST are asst with what other conditions?

A
  1. Acute pancreatitis
  2. Acute extrahepatic obstruction
    - Gallstone
    - Level rises 10x normal
43
Q

Decreased ASt levels are asst. with what conditions?

A

Acute renal disease

Chronic renal dialysis

44
Q

What are Alanine Aminotransferase (ALT) ri for children, adults, and elderly?

A

4-36 units/l

45
Q

What are the indications for ALT testing?

A

Hepatocellular disease

Identification

Monitoring treatment

46
Q

Where is ALT normally found?

A

Found primarily in liver

Injury or disease affecting liver will cause
release of this enzyme

47
Q

What test is ALT usually ordered with?

48
Q

What conditions are asst. with increased ALT?

A 
Hepatitis
Hepatic necrosis
Cirrhosis
Cholestasis
Hepatotoxic drugs
Obstructive jaundice
49
Q

What are the adult/elderly ri for LDH?

A

100-190 units/l

50
Q

What are the indications for LDH testing?

A 
Heart
Liver
RBCs
Kidneys
Skeletal muscle
Brain 
Lungs
51
Q

What is the clinical significance of LDH?

A

Diseased or injured cells lyse  release LDH into bloodstream
5 isoenzymes make up total LDH

52
Q

Where are the 5 LDH enzymes produced?

A

LDH1 – heart

LDH2 – reticuloendothelial system (makes up the greatest part of LDH)

LDH3 – lungs

LDH4 – kidney, placenta,pancreas

LDH5 – liver, striated muscle

53
Q

What happens to the LDH levels after an MI?

A

Rises within 24-48 hours post MI
Peaks in 2-3 days post MI
Returns to normal in 5-10 days

54
Q

What conditions are asst with increased LDH

A

MI
Pulmonary disease: embolism, infarction, pneumonia, CHF
Hepatic disease
RBC disease: hemolytic or megaloblastic anemia
Muscular dystrophy
Renal parenchymal disease
Neoplastic states

55
Q

What are the normal adult, elderly, and children ri for bilirubin?

A

Total: 0.3 – 1.0 mg/dl
Indirect: 0.2 - 0.8 mg/dl
Direct: 0.1 – 0.3 mg/dl

56
Q

What are the newborn normal ri for bilirubin?

A

1.0 – 12.0 mg/dl

57
Q

What are the critical values for bilirubin?

A

Adult
>12 mg/dl
Newborn
>15 mg/dl

58
Q

What are the indications for bilirubin testing?

A

Evaluate liver function
Hemolytic anemias
Newborn jaundice

59
Q

What is the clinical significance of bilirubin?

A
  1. As RBC’s are broken down in spleen, hemoglobin is released
    Hgb  heme & globin
  2. Heme broken down to form biliverdin
  3. Biliverdin is transformed into indirect bilirubin
  4. Indirect bili is conjugated with glucuronide, Results in conjugated (direct) bili.
  5. Direct bili is then excreted from liver cells into intrahepatic canaliculi, then hepatic ducts, then CBD, then bowel
60
Q

What % of total bili is indirect/unconjugated bili?

61
Q

What % of total bili is direct/conjugated bili?

62
Q

At what Tbili level does jaundice occur?

A

TBili > 2.5 mg/dl

63
Q

What does jaundice result from?

A

Normal metabolism of bilirubin

Excretion of bilirubin

64
Q

Define physiologic jaundice of newborn

A

Occurs when infant’s liver does not have sufficient conjugating enzymes
Results in high levels unconj (indirect) bili

65
Q

What complications can occur from jaundice of newborn?

A

Can pass through blood-brain barrier and cause encephalopathy (kernicterus)

66
Q

What newborn bili levels indicate treatment?

A

Bili > 15 in newborns requires immediate treatment – exchange transfusions, light therapy

67
Q

Increased direct bilirubin implies what type of defect?

A
  1. If defect occurs after conjugation bili, direct bili is increased:
    A. Consider extrahepatic dysfunction
    -Obstruction of CBD by gallstone
    -Tumor blocking CBD
68
Q

Increased indirect bilirubin implies what type of defect?

A
  1. If defect occurs before conjugation bil, increased indirect bili:

A. Hepatocellular dysfunction

  • Hepatitis
  • Cirrhosis

B. Hemolysis

C. Drugs

D. Gilbert Syndrome

69
Q

What is Gilbert syndrome?

A

congenital enzyme defect interrupts conjugation of bili; indirect bili rises

DS Unit 4 (9 decks)

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