Liver Function Tests Flashcards
1
Q
Percentage of abnormal LFTs:
A
10%
2
Q
Two tests for serum aminotransferases:
A
ALT and AST
3
Q
Two synthetic function tests:
A
PT/INR and albumin
4
Q
Biliary testing (3):
A
- Alkaline phosphatase
- GGTP/5 nucleotide
- Bilirubin
5
Q
Normal ALT reference range:
A
7-56
6
Q
Transaminases are present in what 4 organs:
A
- Kidney
- Liver
- Muscle
- Heart
7
Q
ALT is only in:
A
The liver
8
Q
Normal AST reference range:
A
5-40
9
Q
Four causes of elevated transaminases:
A
- Fatty
- Alcohol
- Medications
- Viral hepatitis
10
Q
In an asymptomatic patient if the transaminases are __ pursue testing
A
more than 2x upper limit of normal
11
Q
AST and ALT ratio in alcohol
A
2: 1 - Likely
3: 1 - Definite
12
Q
In non-alcoholic fatty liver disease, what transaminase is higher?
A
ALT
13
Q
Four reasons that AST and ALT are over 500
A
- Viral hepatitis
- Medication induced
- Shock liver (hypotensive)
- Autoimmune
14
Q
Alkaline phosphatase (biliary testing) is found in what 4 tissues?
A
- Bile ducts
- Bones
- Placenta
- Intestines
15
Q
Normal alk - phosphatase range:
A
44-147
16
Q
What four reasons would cause for the alkaline phosphatase to be high?
A
- Biliary obstruction
- Med-induced cholestasis
- Cirrhosis
- Bone disorders
17
Q
To confirm the high Alkaline phosphate, what three tests can you run?
A
- Fractionated alkaline phosphatase
- GGTP
- 5-nucotidase
18
Q
Direct bilirubin is:
A
Conjugated
19
Q
Formula for indirect bilirubin
A
Total - direct
20
Q
Where is bilirubin conjugated?
A
In the liver - made water soluble
21
Q
Colonic bacteria deconjugate the bilirubin and metabolize it to form urobilinogen which is oxidized to form:
A
urobilin (urine) and stercobilin (stool)
22
Q
What type of bilirubin is not water soluble (not present in urine):
A
Unconjugated (indirect)
23
Q
With chronic biliary obstruction or hepatitis why is the urine dark and stool clay colored?
A
Conjugated (direct - water soluble) bilirubin cannot be excreted into the bile - spills over into urine and none in stools.
24
Q
Two causes of isolated indirect bilirubin elevation:
A
- Hemolysis
- Gilbert’s disease
25
What concentration can you detect jaundice in sclera/soft palate?
3-4 mg/dL in good light
26
As PT goes up, your chance of dying:
Also goes up
27
Albumin is a:
Negative phase reactant - declines in systemic disease
28
Albumin levels:
3.5 - 5
29
Quantitative Serum Globulin findings (3):
- Autoimmune hepatitis: Eleavted IgG + IgM
- Primary biliary cirrhosis: Elevated IgM
- Alcoholism: Elevated IgA
30
You can have bodily pruritus with (2):
Liver and kidney disease
31
PE findings of chronic liver disease (7):
- Muscle wasting
- Spider angiomas
- Palmar erythema
- Lymphadenopathy
- Testicular atrophy
- Organomegaly
- Ascites - edema - caput medusa
32
If AST is high, check AST. If more than 2x normal...
Recheck the ALT
33
If alkaline phosphatase is high what should you check next?
GGT or Alk phosphatase fractionated
34
If albumin and INR is abnormal, check:
AGAIN
35
When do you do a liver biopsy?
ALT more than 3X ULN for more than 6 months
36
Liver biopsy if you suspect what disease?
NASH
37
Three reasons for conjugated hyperbilirubinemia:
- Hereditary cholestatic syndromes
- Hepatocellular dysfunction
- Biliar obstruction
38
Two reasons for unconjugated hyperbilirubinemia:
- Increased production (hemolysis)
| - Impaired uptake - Gilbert's, drug reaction, post hepatitis
39
What percent of people drink alcohol
73%
40
Alcohol use disorder is mot prevalent in what four populations?
- Men
- Whites
- Native Americans
- Unmarried
41
You can still have fatty liver disease even if:
You are lean
42
The fatty deposits in the liver can resolve with:
abstinence
43
You are at the highest risk for death from alcohol if you drink:
More than 120 Gms/day (12 drinks/day)
44
What two characteristics are at risk for alcoholic hepatitis?
Men, middle-aged (40 - 60)
45
How many peopler are cirrhotic and will die within 6 months with alcoholic hepatitis?
1/2 are cirrhotic and 40% die in 6 months
46
Do you typically need a liver biopsy for alcoholic hepatitis?
Generally, no
47
Tx for general alcoholic hepatitis:
Supportive: Nutrition, abstinence and prevention
48
Tx for severe alcoholic hepatitis: (Maddrey over 32)
Prenisolone and Pentoxifylline
49
Definition of Non-Alcoholic Fatty liver disease:
Fatty infiltration affecting >5% hepatocytes in the absence of alcohol consumption.
50
What is the most common form of liver disease in the US?
NAFLD
51
Definition of Non-alcoholic steatohepatits (NASH)
Presence of more than 5% hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis
52
Percentage of hepatomegaly in NAFLD:
75%
53
Who is at the highest risk for NASH and cirrhosis?
Older adults with DM and high transaminases
54
Gold standard for NAFLD
Liver biopsy - but is not mandatory
55
NAFLD liver enzyme findings:
```
ALT > AST (minimal)
Alk phosphate (normal or minimally elevated)
```
56
INR and albumin will be normal in a patient with NAFDL unless the liver:
Is cirrhotic
57
Most common cause of death for NAFLD:
CV is the most common cause of death
58
If you have NASH and cirrhosis, what is risk of liver related mortality?
3%
59
NASH risk of cirrhosis:
10 - 20%
60
___ is the third leading indication for liver transplant
NASH
61
Treating NAFLD/NASH:
- Weight loss
- No alcohol
- Pioglitazone (NASH)
- Vitamin E
62
What is the most toxic to the liver?
Acetaminophen 7.5/8 grams can be a lethal dose
63
Who is at highest risk for acetaminophen abuse?
- Alcohol users
| - Glutathione deficient - without this, go to the toxic pathway
64
If you have cirrhosis, what is the dose for Acetaminophen a day?
2 g/day
65
Recommended dose for a normal adult without liver disease:
3 g/day
66
Herbals associated with acute toxicity (5):
- Comfrey
- Germander
- Mistetoe
- Hydroxycut
- Chaparral
67
What is fulminant liver failure?
Onset of hepatic encephalopathy within 8 weeks after onset of liver disease - Confusion and jaundice
68
What is the #1 cause of fulminant liver failure in the US?
Tylenol
69
Antidote for tylenol
N-acetylcysteine
70
If in acute liver failure you should be:
In the ICU/hospital transplant center
71
Wilson disease genetics:
autosomal recessive - copper metabolism
72
Presence of what indicates Wilson's disease:
Kayser-Fleischer rings in the iris
73
Treatment for Wilson disease:
Copper chelators or liver transplant
74
Other systems affected by too much copper with Wilson's disease:
- Hepatits
- Neuropsychiatric (tremor, depression)
- Hemolytic anemia
- Portal HTN
75
Three tests for diagnosis of Wilson's disease:
- Low serum ceruloplasmin
- High urine and serum copper levels
- Liver biopsy or eye exam
76
Definition of hemochromatosis:
Autosomal recessive disorder of altered iron metabolism - humans cannot remove excess iron
77
Who is most at risk for hemochromatosis?
Middle aged men is most common - elderly presentation for women
78
What do you screen for with hemochromatosis?
Transferrin saturation, if over 45%, a full work up is needed
79
Genetic test for hemochromatosis:
HFE
80
Treatment for Hemochromatosis:
Phlebotomy - first line
81
Autoimmune hepatitis usually affects:
Young women (x10 more common than men)
82
Medication that commonly induces autoimmune hepatitis:
Tetracyclines
83
Two characteristics of presentation for autoimmune hepatitis:
Fatigue and jaundice
| **Young women
84
Diagnostic test for Autoimmune hepatitis:
Liver biopsy
85
What labs are high for autoimmune hepatitis?
- ALT and AST
- Bilirubin
- Quantitative immunoglobulins
86
Thee treatments for autoimmune hepatitis:
- High dose oral prednisone
- Azathioprine (maintenance)
- Life long immunosuppression
87
Genetics Alpha 1 Anti-trypsin Deficiency:
Autosomal heritable of A1AT (protease inhibitor)
88
Targets of A1AT (2):
- Lungs - COPD
| - Liver - Accumulation of A1At = Toxic
89
Gene associated with most aggressive disease:
Pizz
90
Gilbert's syndrome definition:
Heritable deficiency in essential enzyme that conjugates bilirubin
91
What is high in Gilbert's syndrome?
Unconjugated bilirubinemia
92
Labs in Gilbert's syndrome:
High unconjugated bilibrubin
| *Normal LFTs
93
Treatment for Gilbert's syndrome
Reassurance
94
Are statins safe in liver disease?
Are safe in the setting of transaminase elevations
