Path 8 Enzyme & Hepatitis Flashcards
3 lab tests for hepatocyte function
- Serum albumin
- PT time
- Serum ammonia
3 lab tests for hepatocyte injury
- AST
- ALT
- LDH
Test for biliary excretory function
- Serum bilirubin
- Alkaline phosphatase -> GGT
Specific for liver damage
ALT
Elevated AST with normal ALT
-MI, pericarditis, muscle disease
Alcoholic hepatitis lab
AST:ALT > 2
Viral hepatitis lab
AST:ALT < 1
Toxin lab
Extremely high AST
Alkaline phosphatase - other diseases
- Bone disease
- Hyperthyroidism
- CHF
GGT
Gamma-glutamyl transferase
-follow AlkPhosph
Unconjugated hyperbilirubinemia (4 causes)
- Hemolysis
- Cirrhosis (blood shunting)
- Gilbert’s syndrome
- Crigler-Najjar syndrome
Conjugated hyperbilirubinemia (3 causes)
- Dubin-Johnson syndrome
- Hepatitis
- Mechanical obstruction
Decreased albumin causes
- End-stage liver disease
- Edema and ascites
Prothrombin Time
- Increased in cirrhosis
- Doesn’t correct with vit. K
Hepatorenal syndrome
-Severe chronic liver disease -> decreased blood flow to kidney
Hepatic encephalopathy
- Asterixis
- Hyperactive reflexes
Nutmeg liver
Chronic passive congestion (R heart failure)
Budd-Chiari syndrome
- Hepatic vein thrombosis -> fatal
- Tx with portosystemic venous shunt
Budd-Chiari syndrome causes (5)
- Polycythemia vera
- Hepatocellularcarcinoma
- Pregnancy
- Oral contraceptives
- Paroxysmal nocturnal hemoglobinuria
Sinusoidal Obstruction Syndrome
- 20 to 30 days after bone marrow transplantation
- Toxic injury to sinusoidal endothelium -> thrombi -> hepatic vein fibrosis
Hepatitis A
- RNA
- fecal-oral
- Acute only
- No cancer risk
Hepatitis B
- dsDNA
- parenteral
- Acute (portal, lobar inflammation)
- 10% chronic (ground glass hepatocytes)
Hepatitis C
- ssRNA
- parenteral, vertical
- Chronic -> cirrhosis -> liver transplantation
- Mild steatosis, scattered dead hepatocytes
Hepatitis D
- RNA, needs Hep B
- parenteral
- Coinfection mild (5% chronic)
- Superinfection severe (80% chronic)
Hepatitis E
- ssRNA
- waterborne
- Self limited unless Pregnant Female
Oral-fecal hepatitis
HAV, HEV
Most common Fulminant hepatitis
HBV
Hepatitis that doesn’t cause carcinoma
HAV
Hepatitis immunization
HAV, HBV, HDV
Autoimmune hepatitis
- T cell mediated
- Hypergammaglobulinemia (elevated IgG)
- High autoantibody titers
Autoimmune hepatitis histo
-Plasma cells (more cytoplasm than lymphocytes)
Autoimmune hepatits prognosis
- Fatal w/o Tx
- Normal w/prednisone Tx
