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Cumulative > Liver Tests > Flashcards

Liver Tests Flashcards

1
Q

Describe protein degradation in the liver

A
  • 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.
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2
Q

Describe protein synthesis in the liver

A
  • 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)
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3
Q

Describe carb/glucose control in the liver

A

glucose stored as glycogen in the liver

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4
Q

Describe lipid metabolism in the liver

A

liver produces lipoproteins and synthesizes cholesterol & phospholipids

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5
Q

Describe bile production in the liver

A

Produced and secreted by hepatocytes into biliary tree, drains into the gallbladder, secreted into small intestine to digest fats.

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6
Q

Describe the function of the liver as it relates to clotting

A
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7
Q

List 4 routine liver tests

A
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8
Q

What are the 4 main patterns of liver injury and how are they measured

A
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9
Q

Describe the markers of liver injury (AST and ALT)

A
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10
Q

What are the 3 liver test markers for cholestasis

A
  • alk phos
  • GGT
  • bilirubin
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11
Q

Describe the alk phos test (marker for cholestasis)

A

can be elevated in bone growth

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12
Q

Describe GGT tests (marker for cholestasis)

A
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13
Q

Describe bilirubin tests (marker for cholestasis)

A
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14
Q

What two tests measure synthetic function (your actual liver function)

A
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15
Q

Describe the presentation and liver test findings for chronic liver disease

A
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16
Q

Describe the presentation & liver test findings for acute hepatitis

A
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17
Q

Describe the presentation and liver test findings for fulminant hepatitis

A
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18
Q

List some common causes of elevated liver tests

A
  • 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
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19
Q

List some hepatocellular injuries

A
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20
Q

List some cholestatic patterns of injury

A
21
Q

List some cases in which AST would be greater than ALT

A
22
Q

List some cases in which ALT will be greater than AST

A
23
Q

What are some non-hepatic causes of ALT/AST elevations

A
24
Q

What are some common causes of acute hepatocellular injury

A
  • viral (Hep A-C, CMV, mono, HSV)
  • alc overuse
  • meds/supplements
  • toxins
  • autoimmune hepatitis
  • wilson’s disease
25
Q

What are some chronic causes of hepatocellular injury

A
  • NAFLD
  • hemochromatosis
  • alpha-1-anti-trypsin deficiency
  • Hep B & C
  • autoimmune hepatitis
  • Wilson’s disease
26
Q

What is acute on chronic liver disease

A

looks like acute hepatitis but there is underlying chronic disease (alcohol, HBV/HCV, wilson’s, drugs)

27
Q

List some cholestatic patterns of injury

A
  • primary biliary cholangitis
  • primary sclerosing cholangitis
  • bile duct obstruction & strictures
  • meds/supplements
  • infiltrative diseases (sarcoidosis, TB)
  • alcohol
  • viral hepatitis
  • cirrhosis
28
Q

What are some non-hepatic causes of elevated alk phos

A
  • bone disease
  • hyperthyroidism
  • pregnancy
  • growth
  • ESRD
  • CHF
  • blood types O & B
  • DM
  • gastric/intestinal ulcer
29
Q

Describe conjugated vs unconjugated bilirubin

A

Conjugated = direct, from the liver

Unconjugated = bound to albumin, not directly from the liver

30
Q

List a few causes of unconjugated and conjucated bilirubin elevation

A

Unconjugated: hemolysis, reduced uptake from meds, hyperthyroidism, cirrhosis, inherited disorders

Conjugated: inherited disorders, choledocholithiasis, intrinsic/extrinsic tumors, structures, chronic hepatitis, drugs

31
Q

List some PE/ROS findings in liver disease

A
32
Q

How to treat borderline ALT/AST elevations (<2x normal) to mild elevations (2-5x normal)

A
  • 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
33
Q

How to treat moderate ALT/AST elevations (5-15x normal) to severe elevations (>15x normal)

A
  • 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
34
Q

How to treat massive elevation of ALT/AST (ALT > 10,000)

A
  • 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)
35
Q

What should be done if there is an elevated alk phos and transaminases +/- bilirubin

A

US abdomen to check for ductal abnormalities or blockages (can do MRCP or EUS/ERCP)

36
Q

Describe the etiology of drug induced liver injury

A
37
Q

Describe the presentation & diagnosis of drug induced liver injury

A
38
Q

Describe the treatment for drug induced liver injury

A
39
Q

Describe the etiology and presentation of alcohol associated liver disease

A
40
Q

Describe the diagnosis and treatment of alcohol associated liver disease

A
41
Q

Describe the etiology & presentation of metabolic-dysfunction associated steatotic liver disease

A
42
Q

Describe the diagnosis & treatment of MASLD

A
43
Q

Describe the etiology & presentation of autoimmune hepatitis

A
44
Q

Describe the diagnosis & treatment of autoimmune hepatitis

A
45
Q

Describe the etiology & presentation of hereditary hemochromatosis

A
46
Q

Describe the diagnosis & treatment of hereditary hemochromatosis

A
47
Q

Describe the etiology & presentation of Wilson’s disease

A
48
Q

Describe the diagnosis & treatment of Wilson’s disease

A

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