Liver Lab Questions Flashcards

1
Q

A 61 year-old man lost 8 kg during the last 4 months. He complains of pruritus and frequently occurring dull epigastric pain. He has noted dark-colored urine, but lightcolored stools lately. He has jaundice. The gall bladder is palpable, but non-tender.

Laboratory results: serum bilirubin: 310 µmol/l, mostly direct urine Ubg: negative ASAT: 82 U/l ALAT: 91 U/l alkaline phosphatase: 540 U/l prothrombin time: INR = 2.6 What is the cause of his jaundice? What further tests do you consider?

A

Sudden Weight Loss → Tumor?

INR↑ (Check Vit K input)+UBG(-) → Obstructive Jaundice

Pruritus → LPX↑→ Bile Acid Irritating Nerve on skin

non-tender GB → Courvosoivier Sign

Pancreatic Carcinoma + US and ERCB

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2
Q

An icteric woman has the following laboratory parameters:

serum indirect bilirubin: 54 µmol/l, serum direct bilirubin: 5,1 µmol/l, urine bilirubin: negative, ASAT: 19 U/l, ALAT: 22 U/l, LDH: 720 U/l, Ht: 0.33 l/l

plasma Haptoglobin and Hemopexin concentrations are significantly decreased What is the cause of her jaundice?

A

Indirect bilirubin → Pre-Hepatic

LDH↑ and Ht↓→ Hemolytic Anemia

Haptoglobin and Hemopexin↓ → Intravascular Anemia

Acute/Chronic → Reticulocyte Lever Measurment

(EPO Takes time to effect)

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3
Q

A 38 year-old man, who regularly drinks alcohol. He has never been ill before, but he has grown icteric in the last couple of days. He has a temperature, and is a little anemic. His liver is palpable an inch below the ribs, it is slightly tender.

Laboratory results: urine color: dark brown, serum total bilirubin: 150 µmol/l, ASAT: 160 U/l, ALAT: 60 U/l ,GGT: 490 U/l ,MCV: 103 fl

What is the cause of his jaundice?

A

GGT: 490 U/l + Alcohol (CYP450 Function↑) with

Slightly Tender Liver + ASAT↑ and ALAT↑ → Alcoholic Hepatitis

MCV ↑ → Macrocytic Anemia from Vit-B12 deficiency in alcholism

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4
Q

A 47 year-old man, who has been on hemodialysis for 5 years before he got his kidney transplantation. He has little body hair, a large, protruding belly, slim extremities and gynecomastia.

Laboratory results: ASAT: 85 U/l ALAT: 76 U/l prothrombin time: INR = 2.7; it does not change after vitamin K administration, albumin: 28 g/l, K + : 3.3 mmol/l, Ht: 0.36 What is the most likely diagnosis?

A

Slim Extremities + Gynecomastia → Steroids not Eliminated

INR↑(even with with VitK) and Albumin↓ → Cirrhosis

Ht↓ → Regular Liver Diseases Finding

Ascites Belly→Fluid loss→RAAS↑ →K+↓

hemodialysis and transplantation with Liver Enzymes In blood → HCV Infection

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5
Q

A 38 year-old woman complains of recurrent, sharp pain in the right upper quadrant of her abdomen. She has been vomiting, has fever and jaundice.

Laboratory results: serum bilirubin: 50 µmol/l, mostly direct, Ubg: negative, ASAT: 180 U/l, alkaline phosphatase: 640 U/l

What is the cause of her symptoms, and how can you prove the diagnosis?

A

UBG(-) and ALP↑ →Obstructive Jaudice

5 Fs + Right uper quadrant→ Gallstone

(here female and Fertile)

US+ ERCB + Laproscopy

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6
Q

A 25 year-old man has been icteric for a few days.

His laboratory values: serum indirect bilirubin: 47 µmol/l ,serum direct bilirubin: 4 µmol/l, ASAT: 18 U/l, ALAT: 23 U/l, alkaline phosphatase: 66 U/l, Ht: 0.48, Hb: 162 g/l

What is the cause of his jaundice? What further tests are necessary?

A

Indirect Billirubin↑ and ALT+AST OK

also Paitent is Young and all other parameters are normal

Gillbert Syndrome

No Further Tests Needed

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7
Q

A 32 year-old man has been complaining of fatigue, malaise and a temperature for a week. His liver is palpable ¾ of an inch below the ribs, it is a bit tender.

His laboratory results: serum indirect bilirubin: 28 µmol/l, serum direct bilirubin: 24 µmol/l, Ubg: increased, ASAT: 870 U/l, ALAT: 1180 U/l, alkaline phosphatase: 310 U/l

What is the most likely diagnosis, and how can you prove it? What further tests are necessary

A

Equal Bilirubin types↑ → Hepatocellular Jaundice

UBG ↑ → No Obstruction

ALAT:ASAT Ratio ↑ + Fever → Viral Hepatitis

Check Familly → HepA

Check Sexuall Partners→ HepB

If presists after 6 months → HepC, antiviral therapy

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8
Q

A 28 year-old woman. She is complaining of fatigue, malaise and nausia.

Her laboratory results: serum total bilirubin: 45 µmol/l, ALAT: 220 U/l, alkaline phosphatase: 200 U/l, γ-globulins: 33 g/l (↑), RF and ANA: positive

What is the most likely diagnosis, and what tests should be done?

A

RF and ANA → SLE most likely

ALAT and ASAT↑ → Liver Damage

most Probably Autoimmune Hepitits

Antibodies screeening, GGT, Pregnancy

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9
Q

A 30 year-old woman, who is 164 cm tall, her body weight is 81 kg. She saw her doctor, because she had noted a yellow discoloration of her skin accompanied by itching. She mentions she has had unpleasant gastrointestinal symptoms after meals for a long time: feeling full, having nausea. Physical examination reveals: yellow skin and sclera, spleen is not palpable, liver enlarged by an inch. The right upper quadrant of her abdomen is clearly sensitive on palpation.

Laboratory findings: serum bilirubin: 150 µmol/l urine bilirubin: positive Ubg: decreased ASAT: 53 U/ alkaline phosphatase: 710 U/l GGT: 390 U/l

What is the most likely diagnosis?

A

UBG↓,GGT+ALP↑→ Obstructive Jaundice

sensitive on palpation + Female+”Fat” (5Fs) → Gallstone

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10
Q

A newborn baby is admitted to the hospital with a complaint of increasing jaundice.

The serum bilirubin is 160 µmol/l.

What can be the cause of the jaundice if this bilirubin is mainly:

Direct

(4)

A

Infection

Biliary Atresia

Dubin Jonson Syndrome

Rotor Syndrome

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11
Q

A newborn baby is admitted to the hospital with a complaint of increasing jaundice.

The serum bilirubin is 160 µmol/l.

What can be the cause of the jaundice if this bilirubin is mainly:

Indirect

(4)

A

Physiological Jaundice after Birth

Erythroblastosis Fetalis

Gillbert Syndrome

Crigler Najjar Syndrome

Photothearpy is used to solubilize the execes dermal Bilirubin

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