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GI > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

Percentage of abnormal LFTs:

A

10%

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2
Q

Two tests for serum aminotransferases:

A

ALT and AST

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3
Q

Two synthetic function tests:

A

PT/INR and albumin

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4
Q

Biliary testing (3):

A
  • Alkaline phosphatase
  • GGTP/5 nucleotide
  • Bilirubin
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5
Q

Normal ALT reference range:

A

7-56

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6
Q

Transaminases are present in what 4 organs:

A
  • Kidney
  • Liver
  • Muscle
  • Heart
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7
Q

ALT is only in:

A

The liver

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8
Q

Normal AST reference range:

A

5-40

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9
Q

Four causes of elevated transaminases:

A
  • Fatty
  • Alcohol
  • Medications
  • Viral hepatitis
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10
Q

In an asymptomatic patient if the transaminases are __ pursue testing

A

more than 2x upper limit of normal

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11
Q

AST and ALT ratio in alcohol

A

2: 1 - Likely
3: 1 - Definite

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12
Q

In non-alcoholic fatty liver disease, what transaminase is higher?

A

ALT

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13
Q

Four reasons that AST and ALT are over 500

A
  • Viral hepatitis
  • Medication induced
  • Shock liver (hypotensive)
  • Autoimmune
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14
Q

Alkaline phosphatase (biliary testing) is found in what 4 tissues?

A
  • Bile ducts
  • Bones
  • Placenta
  • Intestines
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15
Q

Normal alk - phosphatase range:

A

44-147

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16
Q

What four reasons would cause for the alkaline phosphatase to be high?

A
  • Biliary obstruction
  • Med-induced cholestasis
  • Cirrhosis
  • Bone disorders
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17
Q

To confirm the high Alkaline phosphate, what three tests can you run?

A
  • Fractionated alkaline phosphatase
  • GGTP
  • 5-nucotidase
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18
Q

Direct bilirubin is:

A

Conjugated

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19
Q

Formula for indirect bilirubin

A

Total - direct

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20
Q

Where is bilirubin conjugated?

A

In the liver - made water soluble

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21
Q

Colonic bacteria deconjugate the bilirubin and metabolize it to form urobilinogen which is oxidized to form:

A

urobilin (urine) and stercobilin (stool)

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22
Q

What type of bilirubin is not water soluble (not present in urine):

A

Unconjugated (indirect)

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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.

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24
Q

Two causes of isolated indirect bilirubin elevation:

A
  • Hemolysis

- Gilbert’s disease

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25
Q

What concentration can you detect jaundice in sclera/soft palate?

A

3-4 mg/dL in good light

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26
Q

As PT goes up, your chance of dying:

A

Also goes up

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27
Q

Albumin is a:

A

Negative phase reactant - declines in systemic disease

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28
Q

Albumin levels:

A

3.5 - 5

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29
Q

Quantitative Serum Globulin findings (3):

A
  • Autoimmune hepatitis: Eleavted IgG + IgM
  • Primary biliary cirrhosis: Elevated IgM
  • Alcoholism: Elevated IgA
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30
Q

You can have bodily pruritus with (2):

A

Liver and kidney disease

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31
Q

PE findings of chronic liver disease (7):

A
  • Muscle wasting
  • Spider angiomas
  • Palmar erythema
  • Lymphadenopathy
  • Testicular atrophy
  • Organomegaly
  • Ascites - edema - caput medusa
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32
Q

If AST is high, check AST. If more than 2x normal…

A

Recheck the ALT

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33
Q

If alkaline phosphatase is high what should you check next?

A

GGT or Alk phosphatase fractionated

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34
Q

If albumin and INR is abnormal, check:

A

AGAIN

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35
Q

When do you do a liver biopsy?

A

ALT more than 3X ULN for more than 6 months

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36
Q

Liver biopsy if you suspect what disease?

A

NASH

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37
Q

Three reasons for conjugated hyperbilirubinemia:

A
  • Hereditary cholestatic syndromes
  • Hepatocellular dysfunction
  • Biliar obstruction
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38
Q

Two reasons for unconjugated hyperbilirubinemia:

A
  • Increased production (hemolysis)

- Impaired uptake - Gilbert’s, drug reaction, post hepatitis

39
Q

What percent of people drink alcohol

A

73%

40
Q

Alcohol use disorder is mot prevalent in what four populations?

A
  • Men
  • Whites
  • Native Americans
  • Unmarried
41
Q

You can still have fatty liver disease even if:

A

You are lean

42
Q

The fatty deposits in the liver can resolve with:

A

abstinence

43
Q

You are at the highest risk for death from alcohol if you drink:

A

More than 120 Gms/day (12 drinks/day)

44
Q

What two characteristics are at risk for alcoholic hepatitis?

A

Men, middle-aged (40 - 60)

45
Q

How many peopler are cirrhotic and will die within 6 months with alcoholic hepatitis?

A

1/2 are cirrhotic and 40% die in 6 months

46
Q

Do you typically need a liver biopsy for alcoholic hepatitis?

A

Generally, no

47
Q

Tx for general alcoholic hepatitis:

A

Supportive: Nutrition, abstinence and prevention

48
Q

Tx for severe alcoholic hepatitis: (Maddrey over 32)

A

Prenisolone and Pentoxifylline

49
Q

Definition of Non-Alcoholic Fatty liver disease:

A

Fatty infiltration affecting >5% hepatocytes in the absence of alcohol consumption.

50
Q

What is the most common form of liver disease in the US?

A

NAFLD

51
Q

Definition of Non-alcoholic steatohepatits (NASH)

A

Presence of more than 5% hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis

52
Q

Percentage of hepatomegaly in NAFLD:

A

75%

53
Q

Who is at the highest risk for NASH and cirrhosis?

A

Older adults with DM and high transaminases

54
Q

Gold standard for NAFLD

A

Liver biopsy - but is not mandatory

55
Q

NAFLD liver enzyme findings:

A 
ALT > AST (minimal)
Alk phosphate (normal or minimally elevated)
56
Q

INR and albumin will be normal in a patient with NAFDL unless the liver:

A

Is cirrhotic

57
Q

Most common cause of death for NAFLD:

A

CV is the most common cause of death

58
Q

If you have NASH and cirrhosis, what is risk of liver related mortality?

A

3%

59
Q

NASH risk of cirrhosis:

A

10 - 20%

60
Q

___ is the third leading indication for liver transplant

A

NASH

61
Q

Treating NAFLD/NASH:

A
  • Weight loss
  • No alcohol
  • Pioglitazone (NASH)
  • Vitamin E
62
Q

What is the most toxic to the liver?

A

Acetaminophen 7.5/8 grams can be a lethal dose

63
Q

Who is at highest risk for acetaminophen abuse?

A
  • Alcohol users

- Glutathione deficient - without this, go to the toxic pathway

64
Q

If you have cirrhosis, what is the dose for Acetaminophen a day?

A

2 g/day

65
Q

Recommended dose for a normal adult without liver disease:

A

3 g/day

66
Q

Herbals associated with acute toxicity (5):

A
  • Comfrey
  • Germander
  • Mistetoe
  • Hydroxycut
  • Chaparral
67
Q

What is fulminant liver failure?

A

Onset of hepatic encephalopathy within 8 weeks after onset of liver disease - Confusion and jaundice

68
Q

What is the #1 cause of fulminant liver failure in the US?

A

Tylenol

69
Q

Antidote for tylenol

A

N-acetylcysteine

70
Q

If in acute liver failure you should be:

A

In the ICU/hospital transplant center

71
Q

Wilson disease genetics:

A

autosomal recessive - copper metabolism

72
Q

Presence of what indicates Wilson’s disease:

A

Kayser-Fleischer rings in the iris

73
Q

Treatment for Wilson disease:

A

Copper chelators or liver transplant

74
Q

Other systems affected by too much copper with Wilson’s disease:

A
  • Hepatits
  • Neuropsychiatric (tremor, depression)
  • Hemolytic anemia
  • Portal HTN
75
Q

Three tests for diagnosis of Wilson’s disease:

A
  • Low serum ceruloplasmin
  • High urine and serum copper levels
  • Liver biopsy or eye exam
76
Q

Definition of hemochromatosis:

A

Autosomal recessive disorder of altered iron metabolism - humans cannot remove excess iron

77
Q

Who is most at risk for hemochromatosis?

A

Middle aged men is most common - elderly presentation for women

78
Q

What do you screen for with hemochromatosis?

A

Transferrin saturation, if over 45%, a full work up is needed

79
Q

Genetic test for hemochromatosis:

A

HFE

80
Q

Treatment for Hemochromatosis:

A

Phlebotomy - first line

81
Q

Autoimmune hepatitis usually affects:

A

Young women (x10 more common than men)

82
Q

Medication that commonly induces autoimmune hepatitis:

A

Tetracyclines

83
Q

Two characteristics of presentation for autoimmune hepatitis:

A

Fatigue and jaundice

**Young women

84
Q

Diagnostic test for Autoimmune hepatitis:

A

Liver biopsy

85
Q

What labs are high for autoimmune hepatitis?

A
  • ALT and AST
  • Bilirubin
  • Quantitative immunoglobulins
86
Q

Thee treatments for autoimmune hepatitis:

A
  • High dose oral prednisone
  • Azathioprine (maintenance)
  • Life long immunosuppression
87
Q

Genetics Alpha 1 Anti-trypsin Deficiency:

A

Autosomal heritable of A1AT (protease inhibitor)

88
Q

Targets of A1AT (2):

A
  • Lungs - COPD

- Liver - Accumulation of A1At = Toxic

89
Q

Gene associated with most aggressive disease:

A

Pizz

90
Q

Gilbert’s syndrome definition:

A

Heritable deficiency in essential enzyme that conjugates bilirubin

91
Q

What is high in Gilbert’s syndrome?

A

Unconjugated bilirubinemia

92
Q

Labs in Gilbert’s syndrome:

A

High unconjugated bilibrubin

*Normal LFTs

93
Q

Treatment for Gilbert’s syndrome

A

Reassurance

94
Q

Are statins safe in liver disease?

A

Are safe in the setting of transaminase elevations

GI (2 decks)

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