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64 Cards in this Set
- Front
- Back
Which enzymes are mainly elevated in Hepatocellular disease?
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AST, ALT
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When enzyme is mainly elevated in Cholestatic disease?
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ALP
(alkaline phosphatase) |
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T or F.
ALT, AST, and ALP are always elevated in the presence of liver disease. |
FALSE
ALT, AST, and ALP may be normal even in the presence of liver disease |
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Where are transaminases located, and when are they released?
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Located in hepatocytes
Released after hepatocellular injury |
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Which transaminase is non-specific to the liver?
Which other tissues is this enzyme located in? |
AST
Heart, skeletal muscle, blood |
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Which transaminase is more specific to the liver?
What other conditions may result in elevated levels of this enzyme? |
ALT
Myopathies |
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Very high transaminase elevations (>1000) are indicative of what sort of conditions?
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Acute toxic injury (tylenol, ischemia)
Acute viral disease *Very high elevations are unlikely to be alcohol-related |
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List 3 examples of alcohol-related liver diseases that would result in mild transaminase elevations.
Which transaminase will be predominant? |
1. Alcohol liver disease
2. Steatosis 3. Cirrhosis *AST predominant |
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Which transaminase is specifically seen in higher elevations in alcohol related liver diseases?
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AST
|
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Will alcohol related liver diseases result in mild or marked transaminase elevations?
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Mild elevations
(High elevations are associated with acute toxic injury or acute viral diseases) |
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List 4 examples of non-hepatic conditions that could result in mild transaminase elevations.
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1. Hemolysis
2. Myopathy 3. Thyroid disease 4. Strenuous exercise |
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What would you expect the AST:ALT ratio to be in alcoholic diseases?
How high would you expect the elevation to be? |
2:1 (AST:ALT)
AST should be <500, if it is >500 consider another cause |
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If AST >500 and the patient does not use alcohol, what disease this elevation most likely indicate?
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Cirrhosis
|
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What AST:ALT ratio is considered "mild" transaminitis?
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AST:ALT < 5 x upper limit of normal
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What type of AST/ALT ratio would you expect to find in chronic Hep C or Hep B?
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AST/ALT <5 x upper limit of normal
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Which transaminase predominates in chronic, non-alcohol related hepatic diseases?
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ALT
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What would you expect the ratio of AST/ALT to be in Non-Alcoholic Steatohepatitis (NASH)?
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AST/ALT <1
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What would you expect the AST/ALT and MCV (mean cell volume) ratios to be in alcoholic liver disease?
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AST/ALT >2
MCV >94 |
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What are some clinical signs that are associated with alcoholic liver disease?
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1. Anorexia
2. Fever 3. Jaundice 4. Hepatosplenomegaly |
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Which form of hepatitis is only acute (does not progress to chronic illness)?
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Hepatitis A
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Which form of Hepatitis usually doesn't present acutely--mostly chronic presentations?
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Hepatitis C
*Usually goes undetected in acute phase |
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Which form of Hepatitis often presents acutely and can progress to chronic hepatitis?
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Hepatitis B
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How can you diagnose Hepatitis A?
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Presence of IgM Anti-HAV
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In general, which form of Hepatitis will present the most acutely? (matter of weeks)
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Hepatitis A
(usually presents < 1 month after exposure) *Acute Hepatitis B takes longer to present) |
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Which Hepatitis is usually spread via fecal-oral transmission?
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Hepatitis A
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How is Hepatitis B transmitted?
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Blood transfusions or sexual transmission
*Hep B has highest risk of sexual transmission out of Hep A, B, and C |
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Which individuals are most likely to experience severe symptoms with acute Hepatitis B? (children or adults)
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Adults
(Children are less likely to experience severe symptoms of acute Hepatitis B, but are more likely to develop chronic Hepatitis B) |
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How can you diagnose acute Hepatitis B?
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Presence of:
IgM Anti-HBc HBSag |
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Which antibodies would you expect to find in resolved Hepatitis B?
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HBcAb IgG
HBsAb |
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Which antibody can be detected in an HBV vaccinated individual?
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HBSAb
|
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Which antibodies/antigens can be detected in a person with chronic HBV?
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HBSAg
HBcAb IgG |
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How long does it usually take to start making Anti-HCV antibodies?
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70 days
|
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Is Hemochromatosis autosomal dominant or recessive?
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Autosomal recessive
(mutation of HFE gene) |
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With hemochromatosis, what would you expect the transferrin saturation, ferritin, and genetic testing results to reveal?
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Transferrin saturation >50%
Ferritin >200 Genetic testing C282Y/C282Y |
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Which autoantibodies are tested for to diagnose Autoimmune Hepatitis?
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ANA or ASMA (titer 1:80 or greater)
(IgG will also be elevated >1.5 x normal level) |
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Which disease is autosomal recessive and causes a dysfunction in copper metabolism?
What are some of the clinical features of this disease? |
Wilson's disease
Signs: 1. Neuropsychiatric disease 2. Hemolytic anemia |
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Which disease would show elevated urinary copper and decreased ceruloplasmin?
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Wilson's disease
|
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How does alpha-1 antitrypsin deficiency result in liver disease?
How does it cause lung disease? |
liver --> Accumulation of variant A1At in hepatocytes
lung--> inadequate protease inhibitor activity *Typically presents as neonatal hepatitis |
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Alkaline phosphatase is produced by what cells?
Is this enzyme specific or non-specific to the liver? |
Biliary epithelial cells
Non-specific to the liver (also found in bone, intestine, placenta) |
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What is the female:male ratio in primary biliary cirrhosis?
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9:1 (female:male)
|
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Which autoantibody is assocated with primary biliary cirrhosis?
Which enzyme will be elevated? |
AMA (titer 1:80 or greater)
ALP elevated *Primary biliary cirrhosis is a cholestatic liver disease |
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Biliary duct obstructions can occur due to elevations of which enzyme?
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ALP
|
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Which cholestatic liver disease results in inflammation of the large bile ducts and is often associated with IBD?
Would you expect an elevation of any autoantibodies or antibodies? What enzyme will be elevated? |
Primary Sclerosing Cholangitis
No autoantibodies, no elevated globulins Elevated ALP |
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Which cholestatic liver disease has a 10-15% lifetime risk of cholangiocarcinoma?
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Primary Sclerosing Cholangitis
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Which form of bilirubin is elevated as a result of hemolysis, Gilbert syndrome, or certain medications?
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Unconjugated (indirect)
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Which form of bilirubin is elevated as a result of an obstruction, cholestasis, cirrhosis, hepatitis, etc.?
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Conjugated (direct)
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What are the 2 common symptoms seen in primary biliary cirrhosis?
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Pruritis and fatigue
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Which medication is a frequent culprit of drug-induced liver disease?
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Acetaminophen (Tylenol)
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Besides ALT, AST, and ALP, what other liver labs could you run to tell how much damage has occurred?
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1. Albumin (poor marker--also decreased by trauma, inflammatory conditions, malnutrition)
2. Prothrombin time (insensitve; no change until liver loses 80% capacity) 3. Ammonia (contributor to encephalopathy) |
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At what levels are ALT and AST normally found in the serum?
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<30 to 40 U/L
|
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An isolated elevated AST (normal ALT levels) is usually reflective of what type of disease?
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Cardiac or muscle disease
|
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What kind of transaminase levels would indicate a pyridoxal 5-phosphate deficiency?
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AST/ALT > 2
(same ratio as in ETOH liver disease) *ALT levels are low b/c ALT synthesis requires pyridoxyl phosphate more than AST synthesis does. |
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What is the likely diagnosis of a patient with ALT:LDH ratio <1.5?
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Ischemic hepatitis
(more likely than acute viral hepatitis) |
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What levels of ALP would you expect to find in a female patient late in pregnancy?
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levels may be 2 x normal
|
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If ALP and GGT are both elevated, what type of injury has most likely taken place?
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Most likely injury of hepatic origin and cholestasis at some level.
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Would you expect high or low ALP levels as a result of hyperthyroidism, lymphoma, and hypernephroma?
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High ALP
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What levels of ALP would you expect to find in children?
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Levels up to 3x normal
|
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What sort of levels of ALP would you expect to find as a result of hypothyroidism, Wilson's disease, or hemolysis?
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Low ALP
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Is GGT sensitive or specific for hepatobiliary disease?
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Very sensitive, but poor specificity
|
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What is GGT used primarily for?
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To confirm hepatic origin of elevated ALP
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What type of bilirubin do direct and indirect approximate?
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Direct--> conjugated bili
Indirect --> unconjugated bili |
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More than 80% of bilirubin is indirect or direct?
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Indirect
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Increased bilirubin production will result in what type of hyperbilirubinemia?
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Unconjugated
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List 3 causes of Unconjugated hyperbilirubinemia.
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1. Increased bilirubin production
2. Decreased hepatocellular uptake 3. Decreased conjugation |