Liver Lab Questions Flashcards
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?
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
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?
Indirect bilirubin → Pre-Hepatic
LDH↑ and Ht↓→ Hemolytic Anemia
Haptoglobin and Hemopexin↓ → Intravascular Anemia
Acute/Chronic → Reticulocyte Lever Measurment
(EPO Takes time to effect)
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?
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
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?
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
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?
UBG(-) and ALP↑ →Obstructive Jaudice
5 Fs + Right uper quadrant→ Gallstone
(here female and Fertile)
US+ ERCB + Laproscopy
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?
Indirect Billirubin↑ and ALT+AST OK
also Paitent is Young and all other parameters are normal
Gillbert Syndrome
No Further Tests Needed
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
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
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?
RF and ANA → SLE most likely
ALAT and ASAT↑ → Liver Damage
most Probably Autoimmune Hepitits
Antibodies screeening, GGT, Pregnancy
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?
UBG↓,GGT+ALP↑→ Obstructive Jaundice
sensitive on palpation + Female+”Fat” (5Fs) → Gallstone
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)
Infection
Biliary Atresia
Dubin Jonson Syndrome
Rotor Syndrome
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)
Physiological Jaundice after Birth
Erythroblastosis Fetalis
Gillbert Syndrome
Crigler Najjar Syndrome
Photothearpy is used to solubilize the execes dermal Bilirubin
