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Clin Med II - Exam 3 > Liver Labs - Schoenwald > Flashcards

Liver Labs - Schoenwald Flashcards

1
Q

CMP example

A
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2
Q

what are the fxns of the liver

A

produces bilirubin

aa and cho metabolism

produces coag factors

produces albumin

lipid metabolism

cholesterol production

metabolizes most drugs and hormones

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3
Q

what coagulation factors does the liver produce

A

vitamin K dependent

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4
Q

what are the vitamin K dependent clotting factors

A

II

VII

IX

X

proteins c, s

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5
Q

what are liver fxn tests (3)

A

albumin

prealbumin

prothrombin

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6
Q

fxns of albumin (2)

A

maintains plasma oncotic pressure

main carrier of hormones, drugs, anions, fatty aids

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7
Q

what is the “carrier” protein

A

albumin

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8
Q

albumin decreases with

A

severe liver damage → ex cirrhosis

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9
Q

how is albumin prognostic of liver dz outcomes

A

low = poor prognosis

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10
Q

8 nonhepatic causes of hypoalbuminemia

A

malnutrition

malabsorption

protein loss from kidney/gut

increased volume of distribution → ascites/overhydration

pregnancy

burns

trauma

etoh

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11
Q

hypoalbumin is not associated w. symptoms until

A

extremely low

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12
Q

what are some symptoms of extremely low albumin (3)

A

peripheral edema

ascites

pulmonary edema

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13
Q

how does low albumin lead to edema

A

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

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14
Q

low albumin levels affect interpretation of what other lab

A

calcium levels

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15
Q

where is prealbumin synthesized

A

liver

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16
Q

T/F prealbumin has a smaller body pool than albumin

A

T

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17
Q

is prealbumin affected by hydration status

A

no

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18
Q

total protein =

A

albumin + globulin

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19
Q

globulin =

A

total immunoglobulins in serum

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20
Q

is globulin synthesized by the liver

A

no

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21
Q

is globulin measured or calculated

A

calculated

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22
Q

is total protein helpful in assessing liver dz

A

not if albumin is known

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23
Q

what is total protein useful for assessing

A

immune or hematologic dysfxn

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24
Q

where is PT produced

A

liver

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25
Q

what does PT measure

A

extrinsic coagulation pathway

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26
Q

what factors are involved in the extrinsic clotting pathway

A

II

V

VII

X

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27
Q

what drug pathway does PT evaluate

A

coumadin

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28
Q

PT is prolonged when liver dz is >

A

80% loss of fxn

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29
Q

is PT specific for liver dz

A

no

30
Q

nonhepatic causes of elevated PT (3)

A

vit K deficiency

clotting factor deficiency

AI dz → lupus

31
Q

what does aPTT measure

A

intrinsic clotting pathway

32
Q

what clotting factors are involved in the intrinsic clotting pathway

A

II

V

VIII

IX

X

XI

33
Q

aPTT is used to monitor what drug pathway

A

heparin

34
Q

is aPTT dependent on liver fxn

A

no! → not produced in the liver

35
Q

what are the 5 liver enzymes

A

ALP → alkaline phosphatase

GGT → gamma glutamyl transpeptidase

AST → aspartate aminotransferase

ALT → alanine aminotrasferase

LDH → lactate dehydrogenase

36
Q

where is ALP found (6)

A

liver

bone

placenta

small intestine

kidneys

leukocytes

37
Q

ALP is mc found in (2)

A

liver

bone

38
Q

ALP elevations > __ x normal are suggestive of cholestasis

A

4

39
Q

increased __ with

normal __ are suggestive of

non hepatic source of liver enzyme abnormalities

A

increased ALP

w. normal GGT

40
Q

etoh abstinence decreases what liver enzyme by 50%

A

GGT

41
Q

AST/ALT assess __,

and are released into serum dt __

A

cellular damage

leaky cell/necrosis of cell

42
Q

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

A

no

43
Q

__ elevations without

__ elevations suggest non cardiac source of liver enzyme abnormalities

A

AST elevations w.o ALT elevations

44
Q

__ is generally higher than

__ in etoh abuse

A

AST higher than ALT

45
Q

AST/ALT ratio >1 suggests

A

etoh liver dz

46
Q

AST/ALT ratio < 1 suggests

A

hepatitis

47
Q

where is LDH found (6)

A

heart

liver

blood

brain

skeletal m

lung

48
Q

is LDH elevated in liver dz

A

yes

49
Q

serum bilirubin =

A

sum of conjugated and unconjugated bilirubin

50
Q

2 causes of increased bilirubin (2)

A

obstruction

liver damage

51
Q

what is the hallmark sign of elevated bilirubin

A

jaundice

52
Q

what is Gilbert’s syndrome

A

benign trait w. intermittent elevations in unconjugated bilirubin

53
Q

the majority of ammonia originates from

A

intestinal bacterial catabolism

54
Q

elevations of __ result in hepatic encephalopathy

A

ammonia

55
Q

there are serologies for which strands of hepatitis

A

A

B

C

D

E

56
Q

which hepatitis strands have fecal to oral spread

A

A

E

57
Q

which hepatitis strands are blood borne

A

B

C

D

58
Q

what lab value is a tumor marker for hcc

A

alpha fetoprotein

59
Q

__ is elevated in 70-80% of hcc cases

A

alpha fetoprotein

60
Q

exocrine fxn of the pancreas

A

secretion into ducts

61
Q

endocrine fxn of pancreas

A

secretion into circulation

62
Q

enzymes associated w. exocrine fxn of the pancreas

A

digestive enzymes:

trypsin

chymotrypsin

amylase

lipase

63
Q

hormones associated w. endocrine fxn of pancreas

A

insulin

glucagon

64
Q

pancreatitis is assessed using what 2 lab values

A

amylase

lipase

65
Q

sx of pancreatitis (2)

A

n/v

severe abd pain w. radiation to the back

66
Q

2 main causes of pancreatitis

A

etoh abuse

gallstones

67
Q

amylase is secreted by (2)

A

pancreas

salivary glands

68
Q

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

and peak at __ hours

A

rise: 2-6

peak: 20-30

69
Q

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

A

T! lipase is more sensitive than amylase

70
Q

t/f: lipase declines slower than amylase

A

T!

71
Q

which lab value is a tumor marker for colorectal carcinomas

A

carcinoembryonic antigen (CEA)

72
Q

CEA is not used for __ of colorectal cancer,

but is used to __

A

diagnosis

monitor progress of tx

Clin Med II - Exam 3 (14 decks)

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