Term
What are the Markers for:
Liver Injury
Synthetic Function
Hepatic Transport |
|
Definition
Injury: ALT (more Specific), AST, ALP, GGTP
Synthetic: Albumin, Prothrombin Time
Transport: Bilirubin |
|
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Term
What is the pattern of liver function tests in:
Hepatocellular injury
Cholestasis |
|
Definition
Hepatocellular: More ALT, AST elevation
Cholestatic: More ALP, GGTP elevation |
|
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Term
Why is ALT more specific than AST
If AST is more than double the ALT, what is the most likely cause of liver damage? |
|
Definition
AST is found in liver, heart, muscle, kidney brain, pancreas, lung leukocytes, erythrocytes
AST/ALT ratio high=Alcoholic Hepatitis
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|
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Term
| What is the cause of elevated ALP with normal GGTP? |
|
Definition
|
|
Term
| What is the sensitivity and specificity of GGTP and how is it used clinically? |
|
Definition
Sensitive, but not specific
Used to Evaluate high ALP or
when AST/ALT ratio>2 |
|
|
Term
| What are non-immune causes for decreased serum albumin |
|
Definition
Renal Loss
Hormones
Nutritional Status |
|
|
Term
| Which marker for hepatic synthetic function is sensitive to acute liver changes? |
|
Definition
|
|
Term
| Discoloration of what area of the body is most specific to jaundice |
|
Definition
|
|
Term
| When is Bilirubin formed and how is it excreted |
|
Definition
Formed by breakdown of Senescent RBCs and hemeproteins by heme oxygenase forming biliverdin then biliverdin reductase forms bilirubin
Bilirubin is bounded to ligandin then conjugated by UDP-glucuronyl transferase forming Conjugated billirubin
Conjugated bilirubin is transported into the canaliculi by MRP2 transport protein |
|
|
Term
What are some hemolytic diseases causing Jaundice?
What are some causes of ineffective erythropoesis presenting as jaundice? |
|
Definition
Hemolytic:
G6P deficiency
Thalassemias
Sickle Cell
Ineffective Erythropoietic
Pb
Fe deficiency
B12 |
|
|
Term
| Causes of Neonatal jaudice |
|
Definition
Physiological
ABO mismatch
Hypothyroid
Breast Milk |
|
|
Term
Crigler Najjar syndrome cause
Gilbert's cause
Dubin-Johnson cause and sign
Rotor's Syndrome cause |
|
Definition
Type 1: AR UDP glucuronyl transferase absence
Type 2: AD UDP glucuronyl transferase deficiency
Gilbert's: inefficient UDP glucuronyl transferase
Dubin-Johnson:AR MRP2 transport protein, black liver
Rotor's: AR Storage disease |
|
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Term
| Symptoms of cholestasis and how do you determine if it is intra or extra-hepatic |
|
Definition
Jaundice
Pruritis
Dark urine
Steatorrhea
Night Blindness, Osteomalacia, Coagulopathy
Xanthomas
INTRA vs ERTRA: extra has biliary distention on ultrasound |
|
|
Term
| How do you work up a patient with Increased ALP and GGTP, but low ALT and AST |
|
Definition
Ultrasound
Followed by CT, MRCP or ERCP
(CP=cholangiopancreatography) |
|
|
Term
| What are major extra hepatic causes of Cholestasis |
|
Definition
Choledocholithiasis
Pancreatic Head tumor
Bile Duct tumor
Gallbladder tumor |
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