liver labs Flashcards
Describe the lab test patterns which may indicate poor hepatocyte synthesis Describe the lab test patterns which may indicate direct hepatocyte injury Describe the lab test patterns which may indicate obstructive biliary injury Describe the lab test patterns which may indicate improper bilirubin clearance Describe the lab test patterns which may indicate pancreatitis
test for intact liver synthesis
albumin
PT
INR
why is albumin not a good indicator for acute liver disease
albumin has a long half life
protein and albumin in liver disease will be:
low
non-hepatic causes of hypoalbuminia
protein malnutrition
nephrotic syndrome
severe burns
PT test result in liver damage
prolonged
why is PT test good for acutre liver damage
PT will respond within 24 hours of insult
PT used for
reye’s, acetominaphen OD, acute EtOH hepatitis
can also prolong PT
vitamin K deficincy
if hepatocytes are not synthesising properly then:
albumin will be low, PT and INR will be long
albumin 1.5 indicates
severe, end stage liver disease
lest for hepatocyte injury
AST, ALT, LD, GGT
test for liver metabolic function
ammonia
elevation of AST withOUT ALT indicates
cardiac or muscle disease
most specific liver enzyme test
ALT
500-1000 ALT indicates
acute viral hep
ischemic hep
acute toxic liver injury
autoimmune hepatitis
ALT and AST 10x the normal range ALMOST ALWAYS indicate
severe direct hepatocyte damage
highly suggestive of alchoholic hepatitus
AST:ALT greater than 2
tests of biliary excretory function and obstruction of bile flow
elevated ALP, GGT, and bilirubin
elevated alkaline phosphatase is elevated in thee non-sick people
pregnant women
alkaline phoshatase 10x normal level can mean
extra-hepatobiliary obstruction
extra-hepatobiliary obstruction can be caused by
common bile duct obstruction or pancreatic cancer
Their major use is to determine if an elevated ALP is of hepatic etiology
GGT
in normal people, almost all bilirubin is
unconjugated
jaundice indicates elevated
bilirubin
hereditary unconjugated bilirubin
crigler-najjar sydrome
worst kind of crigler-najjar sydrome
type 1
mild jaundice with stress and illness
gilbert syndrome
conjugated bilirubin with all other normal liver functions intact
dubin-Johnson syndrome
possible causes of NEWBORN jaundice
ABO or RH immune mediated hemolysis
moderate/severe Rh hemolysis can cause
hydrops fetalis
deposition of unconjugated bilirubin in fetal brain
kernicturus
Markedly elevated unconjugated bilirubin?
Think
hemolysis
Markedly elevated conjugated bilirubin?
Think
hepatic injury or obstruction
primary test of pancreatic insuffeciency
fecal fat test
most common cause of acute pancreatitis
gallstones
more specific test for pancretitis
lipase
most common cause of chronic pancreatitis
EtOH
most COMMON test for pancreatitis
amylase
amalyse peaks at
12-72 hour
non pancreatitis cause of high amylase
IgG-Amylase Complexes
lipase peaks at
24 hours
can lead to increased lipase (non-pancreatitits)
pancreatic duct obstruction or renal impairment
non enzyme tests associated with acute pancreatitis
hyperTG, high hemocrit,
