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55 Cards in this Set

  • Front
  • Back
What is LFT and when is it used?
Liver Function Test

It is not necessarily a good indicator of liver function
Should LFT be used to diagnose?
NO, they should be used in compliment with history and physical
What is AST? Is it specific for the liver? If not, where else is it found?
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
What is ALT? Is it specific for the liver? If not, where else is it found?
Alanine aminotransferase: released secondary to necrosis and inflammation

It is specific to the liver
What is AST/ALT most helpful in recognizing? What do striking elevations usually indicate?
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
Do AST/ALT help with establishing prognosis?
NO, but do indicate different diseases
What is alkaline phosphatase and what does it indicate?
found in hepatic canicular membrane, bones, intestines and placenta

Increased levels w/biliary tract obstruction of cholestasis of liver (cholelithiasis, cholecystits, etc)
What does 5'-NT-5' nucleotidase and GGT have in common?
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
What does alk phos, GGT and 5'-NT have in common?
together they can be used to diagnose CHOLESTASIS
What is bilirubin and what forms does it come in?
breakdown product of porphyrin ring of heme-containing proteins

Different forms:
-direct (conjugated)
-indirect (unconjugated)
What does direct bilirubin mean?

And it is elevated when excretion through the biliary tree is blocked or when hepatic injury prevents prompt excretion of bilirubin
What is indirect bilirubin?
unconjugated bilirubin. when elevated indicates reflex hemolytic process, but also could be seen with crigler-najar syndrome)
How do you measure the true synthetic function?
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)
What is the 1/2 life of albumin and how often should you check albumin levels?
1/2 life: 15-20 days

Don't check it so frequently
What is the only clotting factor that is not made by hepatocytes?
Factor VIII
In hepatocellular processes, what is elevated?
In cholestatic processes, what is elevated?
alkaline phosphatase/bilirubin
What is isolated hyperbilirubinemia?
elevated bilirubin with near normal levels of AST/ALT/Alk phos
What are some different hepatocellular conditions?
-viral hepatitis
-drug ingestion - alcohol, acetaminophen and medicines
-NAFLD (nonalcoholic fatty liver disease)
vascular (ischemic, CHF, Budd-Chiari)
hereditary (emochromatosis, alpha -1 antitrypsin deficiency, wilson's celiac sprue)
How do the ratios of AST to ALT indicate diagnosis?
AST>ALT (2:1) EtOH
ALT>AST (1.15:1) NAFLD
AST and ALT>1000 viral hepatits
What are the different types of viral hepatitis and their infection process?
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)
How do you treat a tylenol OD?
N-acetylcysteine: Mucomyst(PO) or Acetadote (IV)

It is a powerful antioxidant and cellular detoxifying agent
When is toxicity of tylenol likely to occur?
when 12g or greater are ingested over a 24hr period
What is autoimmune hepatitis and who does it affect?
chronic hepatitis, it is of unknown etiology and has immune and autoimmune components.

It affects women in their 3rd/4th decade of life
What is a big concern with autoimmune hepatitis and how do you treat it?
asymptomatic fulminant liver failure.

Treat autoimmune hepatits with steriods, imuran(azathioprine)
What causes NAFLD, what are its symptoms and how do you treat it?
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
How can you tell the difference btw NAFLD and alcoholic liver diseaes?
you can't!
What is hemochromatosis? How do people usually present?
iron overload disorder--75% of people present with LFT abnormalities
What is the classic triad of hemochromatosis?
CHF, diabetes and bronze skin
How do you get hemochromatosis and how do you treat it?
autosomal recessive, chromosome 6 (10% of caucasians are heterozygotes)

Treat it with phlebotomy
What is Wilson's disease?
impairment of copper excretion, which results in overload of copper
What does wilson's diseae generate and what does that cause?
generates free radicals and leads to hepatocellular necrosis and then cirrhosis
What are symptom's of Wilson's disease?
parkinsonism, dystonia, risus sardonicus (inappropriate and uncontrollable grinning), kayser-fleischer rings
What is used to diagnose Wilson's disease?
ceruloplasmin levels
When looking at cholestatic patterns, what should you consider?
biliary obstruction
intrahepatic cholestasis
biliary epithelial damage
infiltrative process
What are some examples of biliary obstruction?
cholecholithiasis, cholangiocarcinoma, pancreatic cancer, sclerosing cholangitis
What are some examples of intrahepatic cholestasis?
PBC, medicines, sepsis or post-operative
What are some examples of biliary epithelial damage?
hepatitis, cirrhosis
What are some examples of infiltrative process?
hepatoma, metastatic lesions, TB, sarcoid, histo, amoebic, bacterial
What is Primary biliary cirrhosis(PBC)?
it is an autoimmune disease where the intrahepatic ducts are attacked.

It leads to inflammation and gradual destruction of intralobular bile ducts
What is the result of PBC?
bile acids, bi-products of liver metabolism are unable to be excreted

anti-mitochondrial antibody
Who is more likely to get PBC?
Women > men
middle aged women
What are the symptoms of PBC? And how do you treat it?

ursodil (mechanism of action is not understood)
What is primary sclerosing Cholangitis?
It is a chronic progressive inflammatory disorder that causes:
stricturing of intra/extrahepatic biliary tree
Where does Primary Sclerosing Cholangitis lead? And what other diseases is it associated with?
Leads to portal hypertension and end-stage liver disease


associated with UC and cholangiocarcinoma
How do you diagnose primary sclerosing cholangitis and what is the survival rate without a transplant?
ERCP/MRCP (Chain of Lakes)

10-12 yrs survival without a transplant
How do you treat primary sclerosing cholangitis?
immunosuppressants and Ursodiol
With isolated hyperbilirubinemia what should you think about with unconjugated and how should you diagnose it?
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
What should you think about with isolated hyperbilirubinemia and conjugated bilirubin?
Dubin-Johnson, Rotor's: defective excretion of bilirubin
What are symptoms of liver disease?
itching(early:cholestatic, late:hepatocellular)
RUQ pain - stretching of liver capsule
Abdominal distention
What are signs of liver disease?
RUQ pain
spider angiomate (chest, upper back)
palmar erythema -bright red hands
testicular atrophy
caput medusae
How do most pts present with liver disease?
pts could present asymptomatically with elevated liver enzymes
How important is the H and P in diagnosising liver disease?
able to diagnosis 85% of cases by it
What are important questions you should ask in your history?
EtOH, Meds (herbals, tylenol, OCPs), sexual activity, travel, transfusion, occupation, family history, reactional activities
An initial workup in asymptomatic individual would include what?
US, PT/INR, albumin, CBC, HEP Panel, iron studies

IF negative: recheck liver panel in 6months:

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