Liver Labs - Schoenwald Flashcards by Alice Richards

CMP example

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what are the fxns of the liver

produces bilirubin

aa and cho metabolism

produces coag factors

produces albumin

lipid metabolism

cholesterol production

metabolizes most drugs and hormones

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what coagulation factors does the liver produce

vitamin K dependent

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what are the vitamin K dependent clotting factors

VII

proteins c, s

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what are liver fxn tests (3)

albumin

prealbumin

prothrombin

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fxns of albumin (2)

maintains plasma oncotic pressure

main carrier of hormones, drugs, anions, fatty aids

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what is the “carrier” protein

albumin

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albumin decreases with

severe liver damage → ex cirrhosis

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how is albumin prognostic of liver dz outcomes

low = poor prognosis

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8 nonhepatic causes of hypoalbuminemia

malnutrition

malabsorption

protein loss from kidney/gut

increased volume of distribution → ascites/overhydration

pregnancy

burns

trauma

etoh

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hypoalbumin is not associated w. symptoms until

extremely low

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what are some symptoms of extremely low albumin (3)

peripheral edema

ascites

pulmonary edema

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how does low albumin lead to edema

albumin maintains oncotic pressure → if low → fluid leaks from intravascular space to interstitial spaces of tissue or into body cavities

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low albumin levels affect interpretation of what other lab

calcium levels

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where is prealbumin synthesized

liver

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T/F prealbumin has a smaller body pool than albumin

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is prealbumin affected by hydration status

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total protein =

albumin + globulin

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globulin =

total immunoglobulins in serum

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is globulin synthesized by the liver

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is globulin measured or calculated

calculated

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is total protein helpful in assessing liver dz

not if albumin is known

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what is total protein useful for assessing

immune or hematologic dysfxn

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where is PT produced

liver

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what does PT measure

extrinsic coagulation pathway

what factors are involved in the extrinsic clotting pathway

II V VII X

what drug pathway does PT evaluate

coumadin

PT is prolonged when liver dz is \>

80% loss of fxn

is PT specific for liver dz

nonhepatic causes of elevated PT (3)

vit K deficiency clotting factor deficiency AI dz → lupus

what does aPTT measure

intrinsic clotting pathway

what clotting factors are involved in the intrinsic clotting pathway

II V VIII IX X XI

aPTT is used to monitor what drug pathway

heparin

is aPTT dependent on liver fxn

no! → ***not produced in the liver***

what are the 5 liver enzymes

**ALP →** alkaline phosphatase **GGT →** gamma glutamyl transpeptidase **AST →** aspartate aminotransferase **ALT →** alanine aminotrasferase **LDH →** lactate dehydrogenase

where is ALP found (6)

liver bone placenta small intestine kidneys leukocytes

ALP is mc found in (2)

liver bone

ALP elevations \> __ x normal are suggestive of cholestasis

increased __ with normal __ are suggestive of non hepatic source of liver enzyme abnormalities

increased ALP w. normal GGT

etoh abstinence decreases what liver enzyme by 50%

GGT

AST/ALT assess \_\_, and are released into serum dt \_\_

cellular damage leaky cell/necrosis of cell

do higher concentrations of ALT/AST correlate w. poor prognosis in liver dz

\_\_ elevations without \_\_ elevations suggest non cardiac source of liver enzyme abnormalities

AST elevations w.o ALT elevations

\_\_ is generally higher than \_\_ in etoh abuse

AST higher than ALT

AST/ALT ratio \>1 suggests

etoh liver dz

AST/ALT ratio \< 1 suggests

hepatitis

where is LDH found (6)

heart liver blood brain skeletal m lung

is LDH elevated in liver dz

yes

serum bilirubin =

sum of conjugated and unconjugated bilirubin

2 causes of increased bilirubin (2)

obstruction liver damage

what is the hallmark sign of elevated bilirubin

jaundice

what is Gilbert's syndrome

benign trait w. intermittent elevations in unconjugated bilirubin

the majority of ammonia originates from

intestinal bacterial catabolism

elevations of __ result in hepatic encephalopathy

ammonia

there are serologies for which strands of hepatitis

A B C D E

which hepatitis strands have fecal to oral spread

A E

which hepatitis strands are blood borne

B C D

what lab value is a tumor marker for hcc

alpha fetoprotein

\_\_ is elevated in 70-80% of hcc cases

alpha fetoprotein

exocrine fxn of the pancreas

secretion into ducts

endocrine fxn of pancreas

secretion into circulation

enzymes associated w. exocrine fxn of the pancreas

**digestive enzymes:** trypsin chymotrypsin amylase lipase

hormones associated w. endocrine fxn of pancreas

insulin glucagon

pancreatitis is assessed using what 2 lab values

amylase lipase

sx of pancreatitis (2)

n/v severe abd pain w. radiation to the back

2 main causes of pancreatitis

etoh abuse gallstones

amylase is secreted by (2)

pancreas salivary glands

amylase rises w.in __ hours of onset of acute pancreatitis, and peak at __ hours

**rise:** 2-6 **peak:** 20-30

t/f lipase is more sensitive than amylase in pancreatitis screening

T! lipase is more sensitive than amylase

t/f: lipase declines slower than amylase

which lab value is a tumor marker for colorectal carcinomas

carcinoembryonic antigen (CEA)

CEA is not used for __ of colorectal cancer, but is used to \_\_

diagnosis monitor progress of tx