Liver tests Flashcards
what are the sources of AST?
LIVER, SKELETAL MUSCLE, brain, RBCs, heart
what are the sources of ALT?
LIVER, kidney
which transaminase is less specific?
AST
when is AST released?
damaged hepatocytes
what is the classic ratio of AST to ALT?
2-to-1
what should always be considered for elevated AST : ALT ratios? what enzyme do you check for this?
rhabdomyolysis
creatine kinase
when does direct bilirubin build up?
biliary drainage is inadequate
what is the equation for indirect bilirubin?
total bili - direct bili
what are the sources of alkaline phosphatase?
liver, bone, placenta
when is alkaline phosphatase elevated?
stretch or inflammation of biliary tree
metastatic prostate cancer
paget disease
what test is used to determine alkaline phosphatase?
gamma glutamyl transferase (GGT)
if GGT is elevated what does that indicate? if it is not elevated?
alkaline phosphatase is from the liver
from the bone
alcoholic hepatitis is associated with a phenomenally high level of what compound?
bilirubin
what is the source of ammonia?
bacteria in large intestine
protein metabolism
high ammonia levels can result in what condition?
hepatic encephalopathy
what are the important antibodies for liver tests?
antinuclear antibody (ANA)
antimitochondrial antibody (AMA)
antismooth muscle antibody (ASMA)
anti liver-kidney-microsomal antibody (LKM)
ammonia is usually converted to what compound in the liver?
urea
total protein-albumin should be below what level? if higher, what conditions should be considered?
3.5
protein gap
autoimmune disease
cancer
what are the clinical features of primary biliary cirrhosis? what is the treatment?
disproportionate increase in alkaline phosphatase
positive antimitochondrial antibody
ursdiol
what is the result of primary biliary cirrhosis?
destruction of INTRA hepatic bile ducts
typically middle aged females
associated with Sjogren, Reynaud
what are the clinical features of primary sclerosing cholangitis? what is the treatment?
disproportionate increase in alkaline phosphatase
“beads on a string” bile ducts
onion skinning of bile ducts
liver transplant
what is the result of primary sclerosing cholangitis?
destruction of INTRA and EXTRA hepatic bile ducts
more common in males
associated with ulcerative colitis
which antibodies are seen in autoimmune hepatitis?
antinuclear antibody
antismooth muscle antibody
what is the most sensitive test for iron levels?
serum ferritin
