Gi- Liver Fxn Tests

Front 1

what do liver cells release when they die?

Back 1

AST and ALt

Front 2

how do you assess for cholestatic injury

Back 2

look for toatl indirect direct alk phos and GGT

Front 3

what do you look at to assess how well the liver is fxning?

Back 3

PT INR and Albumin

Front 4

where do liver cancers get their blood supply

Back 4

hepatic artery

Front 5

where is GGT located inthe hepatocyte?
what about AST and ALt?

Back 5

in the membrane
in the cytosol
lot of ast in mitochondria

Front 6

what is AST involved in?

Back 6

gluconeogen and aa metabolism

Front 7

where else is ast found beside liver mitochondria?

Back 7

heat skeletal muscle kdney rbc brain lungs

high AST if somenone has a hemolysis condition
if tank runs over you leg: AST high

Front 8

where is ALT and what does it do?

Back 8

found in cytosol of hepatocytes and invoved in gluconeogenesis adn aa metabolism
measure it for liver cell death

Front 9

how long would it take half the liver to grow back?

Back 9

3 weeks

Front 10

what are AST ALT levels for acute and chronic hepatitis?

Back 10

acute 1000

chronic 60-100

Front 11

what does alcohol do to liver enzymes?

Back 11

since it damages mitochondria, AST will be elevated

Front 12

AST/ALT >2

Back 12

alcoholic hepatits

Front 13

AST and ALT 30-100

Back 13

chronic HBV HCV hemochromatosis, NASH,

Front 14

AST ALT 100-300

Back 14

chronic HBV HCV hemochormatosis, NASH

also think autoimmune hepatitis
wilson's diease (copper overload)

Front 15

AST and ALT >1000

Back 15

acute liver injury:
hep A or B ischemia autoimmune hepatitis, acetaminophen overdose

Front 16

what does UDP-G do?

Back 16

converts indirect billi to direct bili in ER
billirubin then passes into bile canaliculli

Front 17

what can cause increased billirubin production?

Back 17

hemolysis- RBS only last a month
ineffective erythropoesis: dont make RBS adequately; more break down
thalassemia
pernicious anemia
Hematoma: femur facture bili gets high as you reabsorb all the RBCs

Front 18

what can give you eleveated indirect bilirubin?

Back 18

Gilberts syndrome
crigler najjar II- peds extrem gil
crigler najjar I- no udpg; must transplant

Front 19

what is gilbert's syndrome?

Back 19

not enough UDPG
eating replenishes udpg
eyes look yellow in the am before eating

Front 20

what are dubin johnson syndrom and rotor syndrome?

Back 20

direct bilirubin transport pathways are not functional

Front 21

what is primary biliary cirrhosis?

Back 21

autoimmune conditin assoc w/bile dects; molecular mimicry-cells think youre exposed to virus or bateira we selectivly choose on eof those and clear that protien. whit cells attack that proein on bile duct

Front 22

what causes destruction of large bile ducts?

Back 22

primary sclerosing cholangitis

Front 23

what are extrahepatic causes of dec bilirubin clearance?

Back 23

gall stone or cancer

Front 24

is alk phos associ w/ cell death?

Back 24

no! its on the membrane
if you get irritation ot bile canaliculi or ducts it could back up and obstruct mem that leads to a releas of al phos or GGT

Front 25

where is alk phos located?
what tissues

Back 25

liver
osteoblasts
intesinal enterocyte
placental syncytiotophoblasts - always high in preggers
renal epi cells seen w/ damage to kidneys
leukocytes- lymphoma

Front 26

how do peds alk phos values compare to adults?

Back 26

higher in peds bc of bone gorwht and de novo sytnses of hepatocytes

Front 27

what causes elevaed alk phos?

Back 27

biliary injury or obstruction
primary biliary cirrhosis
primary sclerosing cholangitis
extrahepatic causes such as a sotne or cancer

Front 28

alk phos is increased and everythign else is normaL:

Back 28

primary biliray cirrhosis or coming from bone intestines or placenta

Front 29

alk phos and amylase are increase, total bili >3

Back 29

chronic pancreatitis, cancer in head of pancreas

Front 30

alk phos >1000 and bili >3

Back 30

inflitrative liver cancer

Front 31

alk phos decrease

Back 31

Wilson's disease you need zinc to make alk phos, copper replaces zinc in wilsons so you cant make alk phos

Front 32

when do you look for GGT?

Back 32

if alk phos is elevated and you think its coming from the liver

Front 33

when do you have elevated GGT?

Back 33

alcohol, phenytoin, rifampin

GGT falls when quit drinking and come up before AST and ALT when start back

also elevated in pancreatic disease, cardiac disease, renal fail, diabetes copd inflam

not specific!

Front 34

what does PT measure

Back 34

ability to clot

Front 35

what are the half lives of coag proteins?

Back 35

3-12 hrs short; good marker to see how liver is doin acutely

Front 36

INR

Back 36

it is a good liver fxn test

PTpt/PTnormal

Front 37

INR <1.5
INR 1.5-3
INR >3

Back 37

minimal injurt
thin blood, liver not working acutely
sever acture liver injury live less than a month

Front 38

Albumin

Back 38

t1/2 21 days long
marker of chronic liver disease: either you arent makeing enough albumin or your not getting enouh protein to amke albumin

Front 39

when can you have low albumin?

Back 39

malabsorption
proteinuria
malnutrition
inflamm conditions

not specific for liver, but is made by liver