Wk 8: Liver tests highlights

Question 1

Give examples of other liver-related tests (not all on CMP)

Answer 1

GGT, LDH, PT, AFP, Urea/Ammonia

Question 2

List the main liver tests (i.e. the ones on the CMP)

Answer 2

Liver enzymes: ALT, AST, ALP
Protein: Total, Albumin, Globulin, ratio
Bilirubin (total and direct)

Question 3

What makes up CMP?

Answer 3

BMP + most common LFTs = CMP

Question 4

List the categories of liver biochemical tests

Answer 4

1) Tests that detect injury to hepatocytes
2) Tests of the liver’s capacity to clear endogenous and exogenous substances from circulation (bilirubin)
3) Tests of the liver’s biosynthetic capacity (albumin, PT)
4) Tests that detect chronic inflammation in the liver, altered immunoregulation, or viral hepatitis
-Hepatitis serologies, immunoglobulins, specific autoantibodies

Question 5

What are aminotransferases (AST, ALT), LDH signs of?

Answer 5

Aminotransferases (AST, ALT), LDH
(Normally intracellular and are released when liver cells are injured)

Question 6

The 2 most sensitive indicators of acute hepatocellular injury (increase ~1 week before serum bilirubin) are what?

Answer 6

ALT and AST

Question 7

When are ALT and AST elevated?

Answer 7

In most liver diseases and in disorders that involve the liver

Question 8

What test is very sensitive and specific for liver disease?

Answer 8

ALT

Question 9

AST is less specific for liver disease than ALT, and is usually more elevated in _____________ and ______________

Answer 9

liver cirrhosis; alcoholic hepatitis

Question 10

Which is less specific for liver disease, ALT or AST?

Answer 10

AST

Question 11

What is used to diagnose liver and bone disorders?

Answer 11

Alkaline phosphatase (ALP)

Question 12

ALP:
1) When is it greatly increase?
2) When is it also increase?

Answer 12

1) Obstructive biliary disease (extrahepatic and intrahepatic) and cirrhosis
3) During new bone growth

Question 13

Most sensitive test for cancer metastasis to the liver is what?

Answer 13

ALP

Question 14

Albumin is a ___________ acute phase reactant

Answer 14

Negative

Question 15

What are the 2 main parts of total protein?

Answer 15

Albumin and globulins

Question 16

Different diseases have different combinations of increased/decreased proteins; give an example

Answer 16

chronic liver disease

Question 17

Albumin/globulin ratio should be what?

Answer 17

> 1.0 (e.g., more albumin than globulins)

Question 18

True or false: protein electrophoresis can be done on both serum and urine

Answer 18

True; called SPEP when serum

Question 19

Abnormal protein electrophoresis values can be further tested with what?

Answer 19

Immunofixation electrophoresis (IFE)

Question 20

SPEP & IFE: Polyclonal vs. Monoclonal Gammopathy:
1) What is polyclonal associated with?
2) What about monoclonal?

Answer 20

1) Infections/ inflammatory process
2) Usually neoplastic (e.g., multiple myeloma)

Question 21

Bilirubin is a product of what?

Answer 21

Heme breakdown

Question 22

Bilirubin Metabolism: #1: Spleen
1) What type of bilirubin does heme get metabolized to in the spleen?
2) What does it do?

Answer 22

1) unconjugated (indirect) bilirubin (lipid soluble)
2) Binds to albumin

Question 23

Bilirubin Metabolism: #2: Liver
The pt went into such shocking no jarring/ suffering from that

Answer 23

conjugated (direct) bilirubin (water soluble)

Question 24

Bilirubin Metabolism: #2: Liver
1) When had a (conjugated hyperbilirubinemia) happened in a very, very, very long accord, helped. Every body, every vessel, is transcendent of its bones, as it appears the police seems to have hear any “Justice owners”.
2) Pls lmk how I can best leverage my Nashville actions and far-left away of the people.

Answer 24

(conjugated hyperbilirubinemia)

Question 25

Bilirubin Metabolism: #3: Bowel & Kidney 1) What does conjugated bilirubin in bile travel through? 2) What are the 2 potential fates of conjugated bilirubin?

Answer 25

1) Biliary ducts to duodenum: 2) Unchanged in stool or converted to urobilinogen by bacteria in colon

Question 26

Bilirubin metabolism: 1) What can be reabsorbed in intestine (enters portal circulation)? 2) What happens to it?

Answer 26

1) Urobilinogen 2) some is excreted by kidney (small amounts in urine); some is converted to stercobilin in bowel (turns stool brown

Question 27

slide 20

Question 28

Bilirubin Metabolism: #3: Bowel & Kidney (con.)

Answer 28

> obstruction \>, have light not move much Light stools (“clay colored”) [lack of stercobilin] and conjugated hyperbilirubinemia

Question 29

Bilirubin Metabolism: #3: Bowel & Kidney (con.) 1) If conjugated bilirubin cannot be excreted into the intestine due to extrahepatic _______________ , this leads to ___________ stools (“clay colored”) [lack of stercobilin] and ___________ hyperbilirubinemia

Answer 29

obstruction; light; conjugated

Question 30

What makes up total bilirubin?

Answer 30

Direct + indirect

Question 31

Unconjugated (Indirect) Hyperbilirubinemia is usually due to what 3 things? Give an example of each

Answer 31

1) Bilirubin overproduction (hemolysis/hemolytic anemia) 2) Impaired hepatic uptake (drugs, etc) 3) Impaired hepatic conjugation (Gilbert disease)

Question 32

Give an example of backward leakage of bilirubin

Answer 32

Biliary tract obstruction

Question 33

________________ of abnormalities in liver biochemical tests is more accurate than any individual test

Answer 33

Pattern

Question 34

Patterns of liver tests: Aminotransferases (AST, ALT) are disproportionately elevated compared to ALP under what condition?

Answer 34

Hepatocellular damage (“hepatocellular pattern”)

Question 35

Give an example of when serum bilirubin may be elevated (conjugated hyperbilirubinemia)

Answer 35

Hepatocellular damage (“hepatocellular pattern”):

Question 36

Cholestasis (“cholestatic pattern”): 1) What is disproportionately elevated? 2) When may serum bilirubin may be elevated?

Answer 36

1) ALP disproportionately elevated compared to aminotransferases (GGT also elevated) 2) Conjugated hyperbilirubinemia

Question 37

AST:ALT ratio ≥2:1 suggests what?

Answer 37

Alcoholic hepatitis

Question 38

What very accurately detects even small degrees of cholestasis?

Answer 38

Gamma-Glutamyl Transferase (GGT/GGTP)

Question 39

True or false: GGT and ALP both rise in cholestasis, but GGT is not elevated in bone disease

Answer 39

True

Question 40

1) What 2 things rise in cholestasis? 2) Which of these is not elevated in bone disease? What is this useful for?

Answer 40

1) GGT and ALP 2) GGT is not elevated in bone disease: helpful in differentiating whether ALP elevations are from liver or bone disease

Question 41

Besides cholestasis, when might both GGT and ALP be elevated?

Answer 41

Chronic alcoholism

Question 42

Ammonia travels to liver by hepatic portal vein and is converted to __________ by the liver

Answer 42

urea

Question 43

Hepatocellular dysfunction does what to urea and ammonia levels in serum?

Answer 43

Decreased urea, increased ammonia in serum

Question 44

PT/INR measures clotting ability of which factors?

Answer 44

1 (fibrinogen), 2 (prothrombin), 5, 7, and 10

Question 45

Liver disease can _____________ PT/INR

Answer 45

increase

Question 46

Give 7 [highlighted] examples of conditions that cause increased PT/INR

Answer 46

1) Deficiency of factors I (fibrinogen), 2 (prothrombin), 5, 7, or 10 2) Liver disease 3) Vitamin K deficiency 4) warfarin 5) Poor fat absorption 6) Biliary obstruction 7) DIC

Question 47

1) Pregnancy/ maternal AFP levels are useful in screening for what? 2) Give an example of when it may be increased

Answer 47

1) Neural tube defects (increased) 2) Hepatocellular carcinoma (HCC) or testicular/ germ cell cancer

Question 48

Lactate dehydrogenase (LDH) indicates what? Give 2 examples where it may be elevated

Answer 48

1) Cell death/ injury 2) Hemolytic or megaloblastic anemia

Question 49

1) What are the viral strains of hepatitis? 2) Which strains have vaccines?

Answer 49

1) Viral: A, B, C, D, and E 2) Hepatitis A and B (and E), but not C (or D)

Question 50

Hepatitis A (HAV): Which can be associated with lifelong immunity, IgM anti-HAV or IgG anti-HAV?

Answer 50

IgG anti-HAV

Question 51

Hepatitis B (HBV): 1) What is the surface antigen? What can we measure? 3) What is the core antigen? Can we measure it?

Answer 51

1) HBsAg; can measure antigen and antibody (anti-HBs) 2) HBcAg; cannot measure antigen but can measure antibody (anti-HBc)

Question 52

Hepatitis B (HBV): Other Tests 1) What is a marker of HBV replication and infectivity? 2) What is more sensitive/precise marker of viral replication/infectivity? 3) What 2 things are most clinically useful in chronic HBV to determine if antiviral therapy is indicated?

Answer 52

1) HBeAg 2) HBV DNA 3) HBeAg and HBV DNA

Question 53

When screening for HBV, the what 3 tests should be included?

Answer 53

1) Hepatitis B surface antigen (HBsAg) 2) Hepatitis B surface antibody (anti-HBs) 3) Total hepatitis B core antibody (anti-HBc)

Question 54

Hep B screening: 1) What indicates an active HBV infection? 2) What indicates **immunity** via vaccination or infection? 3) When is total hepatitis B core antibody (anti-HBc) produced? When does it arise?

Answer 54

1) hepatitis B surface antigen (HBsAg) 2) hepatitis B surface antibody (anti-HBs) 3) Via immune response to HBV infection (not due to vaccination) -Arises during window where HBsAg drops but anti-HBs not detectable* Resolving acute infection

Question 55

What happens to each part of bilirubin?

Answer 55

1) Some is taken up by liver and re-excreted in bile 2) Some bypasses the liver and is excreted by kidney (small amounts in urine) 3) Some is converted to stercobilin in bowel (turns stool brown)

Question 56

What is taken up by liver and re-excreted in bile?

Answer 56

Bilirubin