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55 Cards in this Set
- Front
- Back
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What is LFT and when is it used?
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Liver Function Test
It is not necessarily a good indicator of liver function |
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Should LFT be used to diagnose?
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NO, they should be used in compliment with history and physical
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What is AST? Is it specific for the liver? If not, where else is it found?
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Aspartate aminotransferase: released secondary to necrosis, inflammation of the liver
It is not specific for the liver and is found in the muscles, heart, kidney and brain |
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What is ALT? Is it specific for the liver? If not, where else is it found?
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Alanine aminotransferase: released secondary to necrosis and inflammation
It is specific to the liver |
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What is AST/ALT most helpful in recognizing? What do striking elevations usually indicate?
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helpful to recognize: Acute Hepatocellular diseases.
If levels are over 1000, it can indicate viral hepatitis, ischemic liver injury and toxin/drug induced hepatocellular damage |
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Do AST/ALT help with establishing prognosis?
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NO, but do indicate different diseases
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What is alkaline phosphatase and what does it indicate?
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found in hepatic canicular membrane, bones, intestines and placenta
Increased levels w/biliary tract obstruction of cholestasis of liver (cholelithiasis, cholecystits, etc) |
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What does 5'-NT-5' nucleotidase and GGT have in common?
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They both are VERY SPECIFIC FOR LIVER and can be used to confirm liver problems
some say that GGT can be used to confirm use of alcohol--but evidence doesn't support this |
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What does alk phos, GGT and 5'-NT have in common?
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together they can be used to diagnose CHOLESTASIS
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What is bilirubin and what forms does it come in?
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breakdown product of porphyrin ring of heme-containing proteins
Different forms: -direct (conjugated) -indirect (unconjugated) |
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What does direct bilirubin mean?
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indicative of HEPATIC/BILIARY TRACT DISEASE.
And it is elevated when excretion through the biliary tree is blocked or when hepatic injury prevents prompt excretion of bilirubin |
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What is indirect bilirubin?
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unconjugated bilirubin. when elevated indicates reflex hemolytic process, but also could be seen with crigler-najar syndrome)
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How do you measure the true synthetic function?
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Albumin (synthesized exclusively by hepatocytes)
PT/INR and PTT 1/2 life of factor Vii is 6hrs and INR is single best test to identify the acute measure of liver functions. (measure every 6 hrs) |
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What is the 1/2 life of albumin and how often should you check albumin levels?
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1/2 life: 15-20 days
Don't check it so frequently |
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What is the only clotting factor that is not made by hepatocytes?
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Factor VIII
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In hepatocellular processes, what is elevated?
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aminotransferases
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In cholestatic processes, what is elevated?
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alkaline phosphatase/bilirubin
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What is isolated hyperbilirubinemia?
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elevated bilirubin with near normal levels of AST/ALT/Alk phos
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What are some different hepatocellular conditions?
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-viral hepatitis
-drug ingestion - alcohol, acetaminophen and medicines -auto-immune -NAFLD (nonalcoholic fatty liver disease) vascular (ischemic, CHF, Budd-Chiari) hereditary (emochromatosis, alpha -1 antitrypsin deficiency, wilson's celiac sprue) |
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How do the ratios of AST to ALT indicate diagnosis?
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AST>ALT (2:1) EtOH
ALT>AST (1.15:1) NAFLD AST and ALT>1000 viral hepatits |
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What are the different types of viral hepatitis and their infection process?
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Hep A: (RNA virus) acute, self-limited. Can present with fulminant liver failure.
(fecal-oral transmission) Hep B: (blood borne pathogen) acute and chronic (perinatally, sexually and percutaneously) Hep C: (blood borne pathogen) acute and CHRONIC plague of society! Hep E: fecal/oral (high mortality in pregnant women) |
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How do you treat a tylenol OD?
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N-acetylcysteine: Mucomyst(PO) or Acetadote (IV)
It is a powerful antioxidant and cellular detoxifying agent |
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When is toxicity of tylenol likely to occur?
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when 12g or greater are ingested over a 24hr period
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What is autoimmune hepatitis and who does it affect?
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chronic hepatitis, it is of unknown etiology and has immune and autoimmune components.
It affects women in their 3rd/4th decade of life |
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What is a big concern with autoimmune hepatitis and how do you treat it?
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asymptomatic fulminant liver failure.
Treat autoimmune hepatits with steriods, imuran(azathioprine) |
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What causes NAFLD, what are its symptoms and how do you treat it?
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infammatory fatty change to liver associated with metabolic syndrome (obese, abnormal lipids, HTN and glucose intolerance)
Symptoms: cirrhosis and end-stage liver disease Treat: weight loss, glucose control and insulin-sensitizing agents |
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How can you tell the difference btw NAFLD and alcoholic liver diseaes?
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you can't!
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What is hemochromatosis? How do people usually present?
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iron overload disorder--75% of people present with LFT abnormalities
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What is the classic triad of hemochromatosis?
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CHF, diabetes and bronze skin
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How do you get hemochromatosis and how do you treat it?
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autosomal recessive, chromosome 6 (10% of caucasians are heterozygotes)
Treat it with phlebotomy |
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What is Wilson's disease?
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impairment of copper excretion, which results in overload of copper
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What does wilson's diseae generate and what does that cause?
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generates free radicals and leads to hepatocellular necrosis and then cirrhosis
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What are symptom's of Wilson's disease?
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parkinsonism, dystonia, risus sardonicus (inappropriate and uncontrollable grinning), kayser-fleischer rings
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What is used to diagnose Wilson's disease?
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ceruloplasmin levels
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When looking at cholestatic patterns, what should you consider?
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biliary obstruction
intrahepatic cholestasis biliary epithelial damage infiltrative process |
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What are some examples of biliary obstruction?
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cholecholithiasis, cholangiocarcinoma, pancreatic cancer, sclerosing cholangitis
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What are some examples of intrahepatic cholestasis?
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PBC, medicines, sepsis or post-operative
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What are some examples of biliary epithelial damage?
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hepatitis, cirrhosis
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What are some examples of infiltrative process?
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hepatoma, metastatic lesions, TB, sarcoid, histo, amoebic, bacterial
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What is Primary biliary cirrhosis(PBC)?
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it is an autoimmune disease where the intrahepatic ducts are attacked.
It leads to inflammation and gradual destruction of intralobular bile ducts |
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What is the result of PBC?
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bile acids, bi-products of liver metabolism are unable to be excreted
anti-mitochondrial antibody |
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Who is more likely to get PBC?
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Women > men
middle aged women |
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What are the symptoms of PBC? And how do you treat it?
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pruritis
hepatomegaly hyperpigmentation hyperlipidemia Treat: ursodil (mechanism of action is not understood) |
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What is primary sclerosing Cholangitis?
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It is a chronic progressive inflammatory disorder that causes:
fibrosis stricturing of intra/extrahepatic biliary tree |
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Where does Primary Sclerosing Cholangitis lead? And what other diseases is it associated with?
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Leads to portal hypertension and end-stage liver disease
AND associated with UC and cholangiocarcinoma |
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How do you diagnose primary sclerosing cholangitis and what is the survival rate without a transplant?
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ERCP/MRCP (Chain of Lakes)
10-12 yrs survival without a transplant |
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How do you treat primary sclerosing cholangitis?
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immunosuppressants and Ursodiol
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With isolated hyperbilirubinemia what should you think about with unconjugated and how should you diagnose it?
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Hemolysis: order peripheral smear and LDH and Haptoglobin
Gilbert's: similar to physiologic jaundice (reduced activity of glucuronyl transferase) Crigler-Najar: inability to conjugate bilirubin |
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What should you think about with isolated hyperbilirubinemia and conjugated bilirubin?
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Dubin-Johnson, Rotor's: defective excretion of bilirubin
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What are symptoms of liver disease?
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none
fatigue itching(early:cholestatic, late:hepatocellular) RUQ pain - stretching of liver capsule Abdominal distention bleeding nausea/vomiting |
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What are signs of liver disease?
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none
jaundice RUQ pain splenomegaly hepatomegaly spider angiomate (chest, upper back) palmar erythema -bright red hands gynecomastia testicular atrophy ascites caput medusae asterixis confusion |
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How do most pts present with liver disease?
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pts could present asymptomatically with elevated liver enzymes
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How important is the H and P in diagnosising liver disease?
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able to diagnosis 85% of cases by it
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What are important questions you should ask in your history?
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EtOH, Meds (herbals, tylenol, OCPs), sexual activity, travel, transfusion, occupation, family history, reactional activities
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An initial workup in asymptomatic individual would include what?
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US, PT/INR, albumin, CBC, HEP Panel, iron studies
IF negative: recheck liver panel in 6months: normal:observe abnormal:repeat previous studies and add AMA, Anti-smooth muscle antibody, ANA, ceruloplasmin, ANCA, alpha 1 anti-trypsin, anti-gliadin, anti-endomysial abs Set up biopsy |
