Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
Isolated elevation of unconjugated bilirubin indicates what? |
1) HEMOLYTIC DISORDERS 2) Crigler-Najjar 3) Gilbert's syndrome |
|
|
What to do if there's elevated bilirubin? |
Fractionate it to see if conjugated or unconjugated |
|
|
What if >15% of bilirubin is conjugated? |
Dubin-Johnson or Rotor |
|
|
< 15% of bilirubin is conjugated, next step? |
Evalutation for hemolysis, if it's not hemolysis, it's Gilbert's |
|
|
Hemolysis/Gilbert's Bilirubin Aminotransferases Alkaline Phosphatase Albumin |
85% of bilirubin is unconjugated ALT/AST Normal Alk Phos Normal Albumin Normal |
|
|
Acute hepatocellular necrosis (drugs + viral hepatitis, hepatotoxins, acute heart failure) Bilirubin Aminotransferases Alkaline Phosphatase Albumin |
Both bilirubins may be elevated Bilirubinuria ----> higher is worse outcome >500 IU ALT > AST Alk Phos NORMAL to <3x normal Albumin NORMAL |
|
|
Chronic hepatocellular disorder Bilirubin Alkaline Phosphatase Albumin |
Both bilirubins may be elevated Bilirubinuria ALT/AST Elevated, <300 IU Alk Phos Normal to <3x normal Albumin: Often decreased |
|
|
Alcoholic hepatitis, cirrhosis Bilirubin Aminotransferases Alkaline Phosphatase Albumin |
Both bilirubins may be elevated Bilirubinuria AST:ALT >2 Alk Phos normal to <3x normal ALBUMIN DECREASED |
|
|
Intra and extrahepatic cholestasis Bilirubin Aminotransferases Alkaline Phosphatase Albumin |
Both bilirubins elevated AST/ALT normal to moderate ALK PHOS ELEVATED >4x normal Albumin Normal |
|
|
Obstructive jaundice, infiltrative disease (tumor), partial bile duct obstruction Bilirubin Aminotransferase Alkaline Phosphatase Albumin |
Bilirubinuria, levels normal AST/ALT Rarely >500IU ALK PHOS ELEVATED >4x normal, confirm with 5' nucleotidase or y glutamyl transpeptidase Albumin Normal |
|
|
First step if you see cholestatic pattern (bilrubin up, alk phos up, others normal) |
Review drugs Ultrasound |
|
|
Cholestatic pattern, US shows dilated ducts. Next step |
CT/MRCP/ERCP |
|
|
Cholestatic pattern, US shows ducts not dilated |
Check AMA |
|
|
Cholestatic pattern, ducts not dilated, AMA positive |
Liver biopsy |
|
|
Cholestatic pattern, ducts not dilated, AMA negative |
ERCP or Liver Biopsy |
|
|
First step if there's isolated elevation of alkaline phosphatase |
Fractionate alkaline phosphatase OR check GGT or 5' nucleotide to assess where the alkaline phosphatase is coming from |
|
|
Isolated elevation of alkaline phosphatase, bone origin |
Bone eval |
|
|
Isolated elevation of alkaline phosphatase, liver origin |
Ultrasound Review drugs Check AMA |
|
|
Alkaline phosphatase, liver origin, ducts are dilated |
MRCP |
|
|
Alkaline phosphatase, liver origin, ducts are not dilated, and/or AMA positive |
Liver biopsy |
|
|
Of AST and ALT, which is more specific to liver tissue? |
ALT |
|
|
What are the enzymes that reflect damage to hepatocytes when elevated? |
AST/ALT |
|
|
What do we suspect when we see AST/ALT > 1000 IU/L? |
|
|
|
In what rare case do we see aminotransferases elevated in obstructive jaundice? |
Acute phase of biliary obstruction by passage of gallstone into common bile duct. |
|
|
AST:ALT > 2:1 suggests? |
Alcoholic liver disease |
|
|
What three enzymes are elevated in cholestasis? |
|
|
|
Where are alkaline phosphatase and 5' nucleotidase found?
|
Alk phos + 5' nucleotidase = in or near bile canalicular membrane of hepatocytes GGT = ER and in bile duct epithelial cells |
|
|
When is alkaline phosphatase elevated nonpathologically? |
|
|
|
How do we tell the source of alkaline phosphatase? |
First = fractionation by electrophoresis Second = serum 5'-nucleotidase or GGT |
|
|
What is included in the MELD score and what is it used for? |
|
|
|
What is included in the Pugh-Childs score and what is it used for? |
Assesses prognosis for chronic liver disease |
