Liver Tests Flashcards
Describe protein degradation in the liver
- Transamination: Transfer of amino groups to form new amino acids. Alanine transaminase (ALT) or aspartate transaminase (AST)
- Deamination: AA’s converted to carbohydrate by removal of ammonia which is converted to urea and excreted by the kidneys.
Describe protein synthesis in the liver
- Synthesizes 90% of plasma proteins and 15% of total proteins
- albumin, immune function, c-reactive protein, ceruplasm, alpha 1 antitriypsin, ferritin, transferrin, prothrombin, lipoproteins (LDL, HDL, VLDL)
Describe carb/glucose control in the liver
glucose stored as glycogen in the liver
Describe lipid metabolism in the liver
liver produces lipoproteins and synthesizes cholesterol & phospholipids
Describe bile production in the liver
Produced and secreted by hepatocytes into biliary tree, drains into the gallbladder, secreted into small intestine to digest fats.
Describe the function of the liver as it relates to clotting
List 4 routine liver tests
What are the 4 main patterns of liver injury and how are they measured
Describe the markers of liver injury (AST and ALT)
What are the 3 liver test markers for cholestasis
- alk phos
- GGT
- bilirubin
Describe the alk phos test (marker for cholestasis)
can be elevated in bone growth
Describe GGT tests (marker for cholestasis)
Describe bilirubin tests (marker for cholestasis)
What two tests measure synthetic function (your actual liver function)
Describe the presentation and liver test findings for chronic liver disease
Describe the presentation & liver test findings for acute hepatitis
Describe the presentation and liver test findings for fulminant hepatitis
List some common causes of elevated liver tests
- Viral (Hep A-E, EBV, CMV, HSV)
- Metabolic (NAFLD, alc)
- Drugs (meds/supplements)
- Autoimmune
- Genetic (Wilson’s, hemochromatosis, A1A trypsin deficiency)
- Ischemic injury/shock
- Gallstone/Liver/Biliary lesion
List some hepatocellular injuries
List some cholestatic patterns of injury
List some cases in which AST would be greater than ALT
List some cases in which ALT will be greater than AST
What are some non-hepatic causes of ALT/AST elevations
What are some common causes of acute hepatocellular injury
- viral (Hep A-C, CMV, mono, HSV)
- alc overuse
- meds/supplements
- toxins
- autoimmune hepatitis
- wilson’s disease
What are some chronic causes of hepatocellular injury
- NAFLD
- hemochromatosis
- alpha-1-anti-trypsin deficiency
- Hep B & C
- autoimmune hepatitis
- Wilson’s disease
What is acute on chronic liver disease
looks like acute hepatitis but there is underlying chronic disease (alcohol, HBV/HCV, wilson’s, drugs)
List some cholestatic patterns of injury
- primary biliary cholangitis
- primary sclerosing cholangitis
- bile duct obstruction & strictures
- meds/supplements
- infiltrative diseases (sarcoidosis, TB)
- alcohol
- viral hepatitis
- cirrhosis
What are some non-hepatic causes of elevated alk phos
- bone disease
- hyperthyroidism
- pregnancy
- growth
- ESRD
- CHF
- blood types O & B
- DM
- gastric/intestinal ulcer
Describe conjugated vs unconjugated bilirubin
Conjugated = direct, from the liver
Unconjugated = bound to albumin, not directly from the liver
List a few causes of unconjugated and conjucated bilirubin elevation
Unconjugated: hemolysis, reduced uptake from meds, hyperthyroidism, cirrhosis, inherited disorders
Conjugated: inherited disorders, choledocholithiasis, intrinsic/extrinsic tumors, structures, chronic hepatitis, drugs
List some PE/ROS findings in liver disease
How to treat borderline ALT/AST elevations (<2x normal) to mild elevations (2-5x normal)
- d/c any hepatotoxic meds
- d/c alcohol
- assess risk for NAFLD and viral hepatitis
- labs (CBC, liver panel, BMP, PT/INR, Hep Ab testing) & ultrasound
- eval for autoimmune or refer to liver clinic for biopsy
- for mild elevations do not wait longer than 3 mos
How to treat moderate ALT/AST elevations (5-15x normal) to severe elevations (>15x normal)
- d/c alc and hepatotoxic meds
- eval for acute causes of liver failure: CBC, BMP, liver panel, PT/INR, Hep Abs
- ultrasound
- rever to ED or consult to admit (consider biopsy)
- severe: add on US with doppler, treat urgently
How to treat massive elevation of ALT/AST (ALT > 10,000)
- d/c alc and hepatotoxic meds
- assess for toxic ingestions, ischemia, rhabdomyolysis
- eval for acute liver failure
- US with doppler
- treat emergently or with urgent consult (biopsy)
What should be done if there is an elevated alk phos and transaminases +/- bilirubin
US abdomen to check for ductal abnormalities or blockages (can do MRCP or EUS/ERCP)
Describe the etiology of drug induced liver injury
Describe the presentation & diagnosis of drug induced liver injury
Describe the treatment for drug induced liver injury
Describe the etiology and presentation of alcohol associated liver disease
Describe the diagnosis and treatment of alcohol associated liver disease
Describe the etiology & presentation of metabolic-dysfunction associated steatotic liver disease
Describe the diagnosis & treatment of MASLD
Describe the etiology & presentation of autoimmune hepatitis
Describe the diagnosis & treatment of autoimmune hepatitis
Describe the etiology & presentation of hereditary hemochromatosis
Describe the diagnosis & treatment of hereditary hemochromatosis
Describe the etiology & presentation of Wilson’s disease
Describe the diagnosis & treatment of Wilson’s disease
