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53 Cards in this Set
- Front
- Back
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What do you check in liver disease?
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direct and total bilirubin, alkalkine phosphatase, transaminases
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Waht is bilirubin?
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breakdown product of heme
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How do you measure unconjugated bilirubin?
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direct - indirect
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What does elevated bilirubin indicate?
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bile duct disease, drugs, febrile illness, severe hepatotoxicity
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Where is alkaline phosphatase?
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bile duct epithelium
bone, ovary, placenta |
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How do you confirm the source of alkaline phosphatase?
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gamma glutamyl transpeptidase, 5' nucleotidase
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When do you see an increase in alkaline phosphatase?
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can be delayed
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What are elevated transaminases associated with?
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injured or dying hepatocytes
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What do you see with low levels of transaminases?
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chronic liver injury with fibrosis, alcoholic hepatitis
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Which transaminase is more specific?
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ALT
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Where else do yous ee AST?
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red blood cells, muscle
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What do lab values do you see with hepatocellular injury?
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TAs > 5-10x elevated
AP < 2x elevated |
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What do you see with cholestatic injury?
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TAs < 5x elevated
AP elevated |
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What else is useful to measure syntehtic function?
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albumin, prothrombin time, fibrinogen
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What do you measure with portal hypertension?
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platelet count, high MCV
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What is a way high level of ALT?
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300
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What is a way high level of bilirubin?
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3.0
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What is a very high level of INR?
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1.4, not responsive to vitamin K
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What kind of illnesses are viral?
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mostly hepatocellular
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What kind of illness is Hep A?
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acute only
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How do you test for Hep A?
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Hep A IgM
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How do you test for Hep A immunity?
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Hep A IgG
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How do you test for active Hep B?
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Hep B sAg
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How do you test for acute Hep B?
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Hep B cAb IgM
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How do you test for immunity to hep B?
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Hep B sAb
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What do you see with EBV infection?
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AP 200-400
TAs 200-400 |
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What do you see with CMV infection?
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AP 200-400
TAs 200-400 |
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Who gets autoimmune hepatitis?
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women, middle years
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Why is autoimmune hepatitis commonly missed?
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attributed to drugs, can wax and wane
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What do you test in autoimmune hepatitis?
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ANA, anti-smooth muscle antibody, F-actin
high globulin fraction |
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What are the macroscopic causes of biliary disease?
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common bile duct stone, malignancy causing obstruction, alcoholic chronic pancreatitis
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what are the immune causes of biliary diseases?
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primary sclerosing cholangitis, primary biliary cirrhosis
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Who gets primary sclerosing cholangitis?
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men
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With what is primary sclerosing cholangitis associated?
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colitis
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Who gets primary biliary cirrhosis?
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women
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What do you test for primary biliary cirrhosis?
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anti-mitochondrial antibody
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What does acetaminophen cause?
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acute illness
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Who cannot take acetaminophen?
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drink or take INH
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Which drugs cause liver toxicity?
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acetaminophen, methotrexate, amiodarone, anti-seizure, aIDS, TB drugs
bromfenac, troglitazone |
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What causes steatohepatitis?
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alcohol, methotrexate, HIV drugs, amiodarone, jejunoileal bypass, Celiac Sprue
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What causes non-alcoholic steatohepatitis?
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obesity, diabetes, hyperlipidemia, thyroid
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What does steatohepatitis lead to?
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cirrhosis
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Which cancers commonly metastasize to the liver?
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colon, breast, lung, pancreatic
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What do you see with systemic bacterial infection?
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mild abnormalities, unconjugated hyperbilirubinemia
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Which systemic diseases are associated with hepatic problems?
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metastatic disease, systemic bacterial infection, hepatic abscesses, systemic inflammatory disease, CV ischemia
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What is the mutation with hemochromatosis?
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HFE on both alleles
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What happens with hereditary hemochromatosis?
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increased iron absorption
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What is Wilson's?
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mutation in copper handling gene
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What is the mutation with Alpha 1 Antitrypsin?
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ZZ mutation
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What do you use to look for obstruction?
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CT scan, ultrasound, magnetic resonance cholangiogram, ERC
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What do you think about with hepatocellular disease?
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rule out viral
think autoimmune, fatty liver, drugs, ischemia |
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What do you look at for cholestatic disease?
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imagining guides you
relieve obstruction: stones, tumor, PSC, cholangitis |
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If imaging is negative with cholestatic disease, what do you think?
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PBC, drugs
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