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MD2 Pathology > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

List the 4 main functions of the liver

A

Protein metabolism
CHO metabolism
Lipid metabolism
Detoxification and excretion

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2
Q

What are the 8 LFTs commonly provided by labs in Aus?

A 
Protein
Albumin
Bilirubin
ALT
AST
GGT
ALP
LD
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3
Q

What are the 6 main liver proteins?

A 
Albumin
a1-antitrypsin
a2-macroglobulin
Haptoglobin
B-lipoprotein
Transferrin
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4
Q

Which liver enzymes are predominantly cytoplasmic?

A

ALT
AST
LD

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5
Q

Which liver enzymes are nuclear?

A

DNA synthase

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6
Q

Which liver enzymes are located on the membrane?

A

ALP

GGT

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7
Q

Which liver enzymes are associated with organelles?

A

Mitochondrial AST

Lysosomal SOD

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8
Q

What liver enzymes rise in liver necrosis?

A

ALT
AST
LD

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9
Q

Which liver enzyme is particularly elevated in toxin-mediated liver necrosis? Why?

A

AST

Also damages organelles causing further release of AST

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10
Q

Which liver enzymes rise in biliary disease?

A

ALP

GGT

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11
Q

Give 2 examples of drugs which induce certain liver enzymes

A

Alcohol

Anticonvulsants

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12
Q

Which liver enzymes are typically elevated with inducing drugs?

A

ALP

GGT

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13
Q

What is the role of ALT?

A

Converts alanine to pyruvate which can then be converted to glucose (part of gluconeogenesis)

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14
Q

What is the role of AST?

A

Important in Krebs cycle (involved in transporting oxaloacetate from the cytoplasm into the mitochondria)

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15
Q

Is ALT or AST liver-specific?

A

ALT (L for liver-specific)

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16
Q

Which has a longer half-life: AST or ALT? What are the clinical implications?

A

ALT (L for longer, S for shorter)
AST > ALT suggests acute process affecting mitochondria (e.g. toxins)
ALT > AST suggests chronic/resolving process (e.g. hepatitis)

17
Q

Which has the longest half-life: ALT, AST or GGT?

A

GGT (5-7 days)

18
Q

List 4 viruses (other than viral hepatitis) that can cause hepatitis

A

EBV
CMV
Q fever
Rubella

19
Q

Define a mild, moderate and severe ALT level

A

Mild: 250
Moderate: 1000
Severe: 5000

20
Q

What pattern of ALT is seen in chronic viral hepatitis?

A

Intermittent rises as virus tries to “break out” of liver to infect further

21
Q

What levels are generally seen in acute vs chronic hepatitis B/C?

A

Acute: can be around 5000
Chronic: 50-250

22
Q

List 6 medications/herbs that can cause liver damage

A 
Flucloxacillin
Amoxicillin
Statins (atorva, simvi, prava, fluva)
Ethanol
Paracetamol
Herbal tea (kombucha)
23
Q

Where is ALP found?

A

Liver
Bone
Placenta

24
Q

Where is GGT found?

A

Liver
Biliary epithelium
Some renal

25
Q

What is GGT involved in?

A

Glutathione metabolic pathway (antioxidant pathway)

26
Q

What are the clinical features of extra- vs intra-hepatic cholestasis?

A

Extra: elevated conjugated bilirubin, markedly elevated GGT and ALP
Intra: no jaundice, normal bilirubin, mildly elevated GGT and ALP

27
Q

What is a very poor sign in a pt with suspected cancer?

A

Very low albumin

28
Q

What is Gilbert’s syndrome?

A

Mutation in promoter region of UDP glucuronosyltransferase (7 vs 6 normal repeats)

29
Q

What is bilirubin a predictor of? Describe the relationship. What is hypothesised to be the underlying reason for this relationship?

A

Cardiac disease
The higher the bilirubin, the lower the risk of cardiac events
Bilirubin is a physiological antioxidant which protects the myocardium and prevents LDL being oxidated

30
Q

What is the effect of fasting in a pt with Gilbert’s disease?

A

Bilirubin rises as body is metabolically stressed

31
Q

What is the effect of weight on liver enzymes?

A

Increased ALT

32
Q

List 8 determinants of raised ALT

A 
Younger men
Ethnicity
BMI
WHR
Serum leptin
Serum triglycerides
Serum insulin
Plasma glucose
33
Q

What initial tests are recommended in suspected liver disease?

A

Serology
Iron studies
Glucose and lipids

34
Q

List 4 second line liver tests

A

HFE gene
AutoAbs
a1-antitrypsin assay
Urine copper

35
Q

What are some of the drawbacks of LFTs?

A

Little prognostic value
Little value for monitoring effect of therapy
Do not assess liver “function” quantitatively or dynamically (more accurately liver damage tests)

MD2 Pathology (28 decks)

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