Metabolic and Autoimmune Liver Disease Flashcards
4 liver enzymes to test
ALT
AST
ALP (alkaline phosphatase)
Gamma GT
4 liver function tests
Albumin
INR
Bilirubin
Glucose
Lab clues for cirrhosis
AST > ALT 1.5-2 because AST is found in many more extrahepatic tissues than ALT
Elevated Igs (decreased kupffer cell mass, increased liver vascular shunting)
Leukopenia and thrombocytopenia (from splenomegaly)
Will ALP and GGT be up or down in cholestasis
Both up
Lab findings in alcoholic liver disease
AST > ALT (alcohol suppresses ALT) GGT markedly raised (induced by alcohol) IgA increased (induced by fat in liver) Ferritin increased (induced by steatosis, alcohol, and inflammation)
Non alcoholic fatty liver disease
DM, high TG and obesity are main risk factors
Visceral fat is the problem
Can also be genetic predispositions
Tx with weight reduction
Primary biliary cholangitis
Chronic progressive cholestatic liver disease
More in females
Destruction of the small-to-medium sized intrahepatic bile ducts
Treatment slows disease and may prevent/delay need for transplant
Treatment for PBC
1st line: ursodeoxycholic acid
2nd line: Obeticholic acid and/or fibrates
Autoimmune hepatitis
Unresolving inflammatory disease of the liver
Unknown cause
Can present as fulminant, acute or chronic
Mainly women
IgG, ANA, and ASMA most common
Treat with immunosuppression
Primary sclerosing cholangitis
Chronic, cholestatic liver disease
Characterized by inflammation and fibrosis of intra and extrahepatic bile ducts leading to the formation of bile duct strictures
Eventually develops into cirrhosis, portal hypertension and hepatic decompensation
Needs regular screening for malignancies
Main lab tests to look at for hemochromotosis
Raised ferritin (in the thousands) Transferrin saturation of > 45% in females and > 50% in males
Wilson’s disease
Uncommon autosomal recessive disease
Excessive Cu deposition in organs
Acute or chronic disease
Frequently associated with neuropsychiatric syndromes
Chelation therapy and maintainence with Zn