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DM Lecture 32: Liver Function Tests
Terms in this set (48)
Functions of the Liver
In Patients with Liver disease check History
alpha-1 antitrypsin --> COPD, Asthama
Findings that indicate Liver disease in Physical Exam
Physical signs/manifestations of Chronic Liver cirrhosis include ...... angioma, palmar ..... , ..... and ..... atrophy?
What is the Liver function test that tests for Excretory function?
Serum Bilirubin (total, conjugated and unconjugated bilirubin)
The 3 Liver function test that tests for Enzyme levels in Serum include enzymes that indicate .... damage, enzymes that indicate ..... and finally .... levels?
Gamma Glutamyl Transferase (GGT)
The 3 Liver function tests that test for Synthetic functions are ?
1- Serum Albumin
2- Clotting factors (Prothrombin time)
3- Serum Alpha Feto Protein (AFP)
The 3 Liver function tests that test for Metabolic functions are ?
1- Serum Ammonia (Hepatic encephalopathy)
2- Plasma Glucose
3- Lipid Metabolism
In patients with Hepatocellular disease we find elevated levels of ..... bilirubin, ..... bilirubin and .... bilirubin?
-Elevated Unconjugated bilirubin: Lower capacity for uptake and conjugation
Elevated Conjugated Bilirubin in patients with Hepatocellular disease occurs as a result of ..... and can lead to ....? Conjugated bilirbuin also enters the ...?
- blockage of bile ducts which forces conjugated bilirubin into the blood and urine
In Cholestatic disease (extrahepatic cholestasis) Serum ..... bilirubin is elevated?- it is not excreted into ..... and regurgitates into blood and appears in urine?
-Urobilinogen and stercobilin not formed (clay/pale feces)
-Urobilinogen absent in urine
-Fecal stercobilin and urine urobilinogen depend on extent of cholestasis
-Prolonged cholestasis, mild elevation of serum unconjugated bilirubin (liver cell damage)
•Serum bilirubin difficult to distinguish hepatocellular from cholestatic disorder
Intrahepatic Cholestasis (obsutrction inside Liver) occurs as a result of ....... compression as a result of Hepatocyte inflammation or Chronic cirrhosis? Extrahepatic cholestasis (obstruction outside the liver) can occur as a result of ..... blocking the Common bile duct or ..... in the head of the Pancreas? Any time there is an obstruction (in both of these cases) ..... bilirubin levels will be elevated?
Serum Conjugated Bilirubin can be elevated in Intrahepatic Cholestasis as a result of Viral ..... , drug ...... and Chronic ....?
Serum Conjugated Bilirubin can be elevated in Extrahepatic Cholestasis as a result of ...... in the Common bile duct or by ..... around the Common bile duct or head of pancreas?
Isolated hyperbilirubinemia (Conjugated or unconjugated) is inherited and has Normal enzyme levels of ... , .... and ...?
unconjugated: Criglar-Nijjar I and II and Gilbert
conjugated: Dublin Johnson
Serum Enzyme levels can differentiate between .... damage and ....?
•Degree of rise indicates extent and severity of damage
What are the 2 enzymes that indicate Liver damage (Hepatocellular injury)? Which one is Cytosolic and which one is Mitochondrial respectively?
1- ALT (alanine aminotransferase): Cytosolic
2- AST (aspartate aminotransferase): Mitochondrial
•Elevated in Acute viral hepatitis, drug induced hepatitis, and long- standing liver disease (Acute and chronic)
In Acute Liver disease ..... levels are much higher than ..... levels?
In Long standing Chronic Alcoholic cirrhosis ..... levels are much higher than ..... levels?
ALT >>> AST
AST >> ALT
- appx 2:1
•Note: Enzyme levels normal in Gilbert syndrome
What are the 2 enzymes that indicate Cholestasis (Intra-hepatic and Extra-hepatic) aka Obstructive Jaundice?
1- ALP (Alkaline phosphatase)
2- GGT (Gamma glutamyl transferase)
ALP (Alkaline phosphatase) is secreted by Bile ....? It is Elevated in Intra-hepatic and Extra-hepatic cholestasis but is much more elevated in ..... cholestasis?
ALP is also elevated during ...., in normal .... children and in .... diseases?
GGT (Gamma glutamyl transferase) is secreted by Biliary ....? GGT secretion is stimulated by ...... and thus GGT is a marker of ...... consumption?
In Biliary Stasis (Intra and Extra hepatic) there are increased levels of ... and ...? Intra and Extra hepatic can be differentiated by the fact that ..... hepatic Cholestasis will have very high levels of ..... and .... ?
ALP and GGT
ALP and GGT
Elevated ALP with normal GGT indicates non- ..... problems? Isolated elevation in GGT and normal ALP indicates recent .... use or drugs that induce GGT synthesis?
eg: Bone, Placenta
Cholestasis can also be identified by assessing the ...?
Dilation of the Biliary tree indicates ..... cholestasis? No Biliary tree dilation indicates ...... cholestasis?
Extrahepatic (Very high ALP and GGT)
Intrahepatic (slight increase in ALP and GGT; Very high ALT and AST)
Serum Albumin is synthesized only in the ....? It functions in maintaining ..... osmotic pressure and it affects the binding of ..... , ....... and drugs?
remember, albumin is major transport protein
In Long standing Chronic Liver disease Serum Albumin levels are .....? Serum Albumin is responsible for the occurrence ..... and ..... in long standing Liver disease?
Pedal Edema (edema of the feet)
•In Acute hepatitis, normal serum albumin levels
Low Serum beta globulins are elevated in Cirrhosis (IgA) resulting in ....... bridging in serum protein electrophoresis indicating Chronic liver disease?
Synthesis of Clotting factors mostly occurs in the ....? Post-translational Gamma-carboxylation of glutamic acid require ....... dependent clotting factors?
Vitamin K (II, VII, IX, X)
Increased Prothrombin time is seen in liver disease (Factor VII is most sensitive)
- can give patient Vitamin K to improve symptoms
Problems in Coagulation and increased Bleeding tendency in patients with Liver disease occur as a result of reduction in production of ...... and impaired modification of ..... factors?
Vitamin K dependent Clotting
Coagulation problems can also occur as a result of ....? Reduced Bile salt entry impairs ...... reabsorption- this leads to impaired post-translation modification of ...... factors?
Vitamin K Dependent clotting factors -(II, VII, IX and X)
•Monitor prothrombin time (INR) if Liver biopsy or surgery planned
Chronic Liver disease can alter Plasma Glucose levels and cause ....?
The Liver functions in detoxifying Ammonia (NH3) to ...?
Advanced End Stage Liver disease (fulminant) leads to impaired ....... formation and a rise in blood ..... levels?- this results in the occurrence of Hepatic ...... and Altered ......?
Ammonia (NH3) is toxic due to the fact that it causes an imbalance of ...... and also due to the fact that it depletes .... from the TCA cycle?
•GI Bleeding (hematemesis) in long-standing liver disease precipitates hepatic encephalopathy
The Liver secretes .... and transports TAGs to Peripheral tissues? ..... liver occurs as a result of excessive TAG deposition in Liver cells?
Chronic Consumption of .... can lead to the formation of a Fatty liver? Consumption of this substance can also lead to decreased ...... due to increased NADH: NAD+ ratio, increased .... and ..... synthesis and decreased ..... secretion?
VLDL (hepatotoxic action of Ethanol)
Serum ..... can be used as a Tumor marker for Liver cancer?
AFP (Alpha fetoprotein)
Wilson disease disease occurs as a result of decreased Serum ....?
Inherited Alpha-1 antitrypsin deficiency occurs as a result of decreased Serum ......?
Algorithm for Patient with Jaundice
Case Report 1
Case Report 2
Case Report 3
obstructive jaundice aka Cholestasis --> elevated ALP and GGT
C --> acute liver disease
Summary of laboratory findings in common liver diseases
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