LIVER LAB VALUES Pathological Conditions of the Liver

slides 1-26 of pathological conditions of the liver pt 1

what are the 7 liver functions

1. formation of bile

2. activity of reticuloendothelial tissue

3. metabolism

4. storage

5. blood resevoir

6. heat production

7. detoxification

list some signs, symptoms, and indications for a liver exam

1. anorexia

2. fatigue and weakness

3. abdominal discomfort/ RUQ pain

4. fever

5. abnormal LFTs

6. jaundice

7. hepatomegaly

8. findings on other image modalities

9. surveillance/screening for chronic hepatitis/cirrhosis or hepatocellular carcinoma

10. suspicion for stenosis, thrombosis of the hepatic vasculature

Enzymes are protein catalysts used for the _____ processes.

metabolic

These enzymes can escape into the bloodstream in the presence of ____ or ______

damaged or diseased hepatocytes

The increase presence of liver enzymes in the blood stream are indicators of ____

hepatocellular disease or disorder

what are the three liver enzymes

AST, ALT, Alkaline Phosphate

what are the 8 LFTs (maybe delete)

1. AST or SGOT (aspartate aminotransferase)

2. ALT or SGPT (alanine aminotransferase)

3. LDH (lactice acid dehydrogenase)

4. Alk Phos (alkaline phosphatase)

5. Bilirubin (direct, indirect, and total)

6. PTT (prothrombin time)

7. Albumin and Globulins (gamma globulin)

8. AFP (alpha fetoprotein)

AFP is associated with ____

liver cancer

there will be high levels of _____ when there is death or injury (Hepatitis & Cirrhosis)

AST (SGOT / aspartate aminotransferase)

AST levels are proportional to the _____

damage

AST can be ____ in alcoholic hepatitis

higher

____ is an enzyme present in tissues that have a “high metabolic rate” not just the liver

AST

____ is an enzyme that is more specific than AST for evaluating liver function and liver cell destruction

ALT (SGPT / alanine aminotransferase)

____ is elevated in acute cirrhosis, hepatic metastasis, pancreatitis & obstructive jaundice

ALT

ALT will have a _____ increase with hepatocellular disease & ___ increase with obstruction and metastasis

moderate to severe, mild

Which enzyme level stays elevated longer, AST or ALT

ALT

____ is an enzyme found in the kidneys, heart, skeletal muscle, brain, liver & lungs

LDH (lactic acid dehydrogenase)

Cellular injury & death cause the enzyme ____ to increase.

LDH

which enzyme is primarly used to dect myocardial or pulmonary infarction

LDH

LDH is ____ elevated in hepatitis, cirrhosis & obstructive jaundice and ____ elevated with mononucleosis

mildly, moderately

which enzyme is produced by the liver, biliary tract, bones, intestine & placenta

Alk Phos (alkaline phosphatase)

which enzyme is an indicator of intrahepatic or extrahepatic obstruction, hepatic carcinoma, & abscess

alk phos (alkaline phosphatase)

Alkaline phophatase is ____ elevated in hepatitis and cirrhosis

moderatley

_____ is the liver enzyme that is part of the blood clotting mechanism

PTT (prothrombin time)

production of prothrombin depends on adequate intake of ____

vitamin k

prothrombin time is _____ with cellular damage (cirrhosis, malignancy, malabsorbtion of vitamin k, and clotting failure)

increased

normal clotting time is ____ seconds

10-15

____ are the assessment of depressed synthesis of proteins, sensitive test for metabolic derangement of the liver

serum albumin and plasma coagulation factors

A ____ serum albumin suggests decreased protein synthesis

low

Gamma globulins are a class of proteins in the ____.

blood

Chronic Liver Disease = _____ of gamma globulins.

elevation

______ is the breakdown product of hemoglobin in old red blood cells..

bilirubin

The liver detoxifies bilirubin and excretes it into the gut via the _____.

biliary tree

Red blood cells survive for about ____ days; then they are trapped and broken down by reticuloendothelial cells, primarily within the spleen

120

Hemoglobin released from the red blood cells is converted to _____ by the reticuloendothelial system and is then released into the bloodstream

bilirubin

what is the pathway of bilirubin

hemoglobin breaks down to become bilirubin > uncojugated in the bloodstream > attaches to albumin to travel towards the liver > bilirubin seperates from the albumin > conjugated to form bilirubin diglucronide > liver secretes the bilirubin to the bile canaliculi > bile ducts > bowel > feces

what 3 things can disrupt the cycle of bilirubin

1. excess RBC destruction

2. malfunction of liver cells

3. blockage of ducts leading from cells

disruption of the bilirubin cycle causes a rise in serum bilirubin which leaks into the tissues and skin causing ____

jaundice

when there is a biliary obstruction, ______ bilirubin is elevated

direct/conjugated

____ is the excretory product of the liver

bile

bile is formed continuously by the ______, collects in the bile canaliculi adjacent to these cells, and is transported to the gut via the bile ducts

hepatocytes

what are the 2 primary functions of bile

1. emulsification of intestinal fat

2. removal of waste products excreted by liver

what is the medical word for jaundice - yellow coloration of the skin, sclera and body secretion

hyperbilirubinemia

hyperbilirubinemia is due to the excess presence of _______ often found first in the whites of the eyes

serum bilirubin

_____ is itching associated with jaundice

pruritis

when hematologic disease is present and large number of RBCs are broken down, the liver mayb not be able to detoxify it all which causes _______ bilirubin to become elevated

indirect/unconjugated

what does BUN stand for

blood urea nitrogen

______ is a toxic product of nitrogen metabolism which gets converted into nontoxic urea in the liver

ammonium

urea is excreted through the ___

kidneys

BUN can be ___ with decreased urea production in liver disesase patients

low

low levels of BUN in liver disease patients can result in increased _____ accumulation

ammonium

low BUN and high ammonium with liver disease can cause patients to have ____ (fruity pungent breath)

fetor hepaticus

Excessive amounts _____ can lead brain dysfunction (confusion, coordination, disturbances, tremor and coma)

ammonium

a patient can become ___ due to excessive amounts of ammonium which can cause brain dysfunction

encephalopathic

Agenesis of the liver is ___

incompatible with life

with agenesis of the right, left, or caudate lobe, _____ of the other lobes develops

hypertrophy

what are the 2 main anomalies of liver position

1. situs inversus

2. congenital diaphragmatic hernia or omphalocele

which liver vessel is common to have many variations as it arises from the celiac axis

hepatic artery

at least ___% of patients have a type of hepatic artery variation

45

Variations in the portal venous anatomy are _____

uncommon

Variations in the branching of the hepatic veins are ______

common

what is the most common variation in the branching of the hepatic veins

accessory vein drains the superoanterior segment of the right lobe