Hepatic & Coagulation Laboratory parameters

what are the 3 types of liver injury?

1. hepatocellular

2. cholestatic

3. hepatobiliary

what values look for hepatocellular injury?

• aminotransferases (AST/ALT)

• LDH

what values look for cholestatic injury ?

• ALP (alkaline phosphates)

• GGT (gamma-glutamyl transferase)

what values look for hepatobiliary injury?

• bilirubin

elevated AST/ALT may indicate…

a) cholestatic injury

b) problems with liver detoxification

c) hepatocellular injury

d) hepatobiliary injury

c) hepatocellular injury

if ALT > AST, it usually indicates..

a) alcoholism

b) liver disease

c) hemolytic disease

d) hepato encephalopathy

b) liver disease

if AST>ALT in a 2:1 ratio, it usually indicates..

A. Viral hepatitis
B. Non-alcoholic fatty liver disease (NAFLD)
C. Alcoholic liver disease
D. Drug-induced liver injury

C. Alcoholic liver disease

elevated ALP may indicate…

a) cholestatic injury

b) problems with liver detoxification

c) hepatocellular injury

d) hepatobiliary injury

a) cholestatic injury

what is the purpose of GGT?

• confirms origin of increased synthesis of ALP is from the liver B not the bone

• used only if increased ALP with normal AST/ALT

hyperbilirubinemia may indicate…

a) cholestatic injury

b) poor liver function

c) hepatocellular injury

d) hepatobiliary injury

d) hepatobiliary injury

if a patient has only increased indirect bilirubin, what type of problem may that indicate?

a) cholestatic injury

b) alcohol liver disease

c) hepatobiliary disease

d) hemolytic disease

d) hemolytic disease

if a patient has only increased direct bilirubin, what type of problem may that indicate?

a) cholestatic injury

b) alcohol liver disease

c) hepatobiliary disease

d) hemolytic disease

c) hepatobiliary disease

if a patient has dark urine, what lab parameter is increased?

a) ALP

b) AST

c) conjugated bilirubin

d) unconjugated bilirubin

c) conjugated bilirubin

what values are used to look at synthetic liver function?

1. albumin

2. coagulation

T/F: albumin looks at acute liver function?

• false

  • albumin indicates long term liver function

if PT (prothrombin time) is increased, what does it indicate?

• increased bleeding risk

if INR is increased, what does it indicate?

• increased risk of bleeding

what value looks for detoxification function of the liver?

• ammonia

if there is an increase in ammonia, what type of condition might that indicate?

• hepato encephalopathy (liver function problem)

AA is a 28 year old woman who developed pruritus within 4 days of starting oral contraceptives and stopped them after a week. One week later (14 days after starting), she had darkening of the urine and 4 weeks later was jaundiced. She was taking no other medications and had no risk factors for viral hepatitis.
– ALT 309 U/L, AST 288 U/L
– ALP 352U/L, Bilirubin 4.5mg/dL

Based on her labs and clinical picture, which of the following is likely her liver injury
pattern?

A. Hepatocellular
B. Cholestatic/Biliary
C. Hepatobiliary
D. Alcoholic

C. Hepatobiliary

• darkening of urine + increased ALT/AST

B is a 45 yo obese male with elevated transaminases (140s)
discovered on admission to the hospital for a respiratory
infection. No past medical history of alcohol or drug abuse.

Normal results for bilirubin, ALP, GGT, albumin, PT/INR

• Ultrasound reveals large liver with fatty infiltrates
• Liver biopsy reveals severe fatty liver, steatohepatitis, no
cholestasis, normal architecture

• Based on BB’s clinical picture and laboratory values, which of the
following statements is true?
A. BB has hepatocellular injury
B. BB has cholestatic/biliary injury
C. BB has hepatobiliary injury
D. BB has poor liver function

A. BB has hepatocellular injury

• elevated transaminases

Which of the follow lab value abnormalities may indicate a
decline in liver function?
A. Increased albumin
B. Decreased LDH
C. Increased PT/INR
D. Decreased ammonia

C. Increased PT/INR

Which of the follow lab value abnormalities would indicated
cholestatic injury?
A. Decreased albumin
B. Increased LDH
C. Decreased unconjugated bilirubin
D. Increased conjugated bilirubin

D. Increased conjugated bilirubin

• liver or biliary (cholestatic)
  is unable to clear the conjugated bilirubin

Elevations in both conjugated and unconjugated bilirubin are
associated with…

• jaundice,

• itching

• nausea,

• vomiting

• light colored stool

Which laboratory marker is most specific for hepatocellular injury?
A. Alkaline phosphatase (ALP)
B. Alanine aminotransferase (ALT)
C. Gamma-glutamyl transferase (GGT)
D. Bilirubin (Total)

B. Alanine aminotransferase (ALT)

Which of the following lab values is most indicative of impaired liver detoxification function?
A. Elevated ALT
B. High Ammonia
C. High GGT
D. Elevated indirect bilirubin

B. High Ammonia

Which lab value is most useful for assessing acute changes in liver synthetic function?
A. Albumin
B. AST
C. PT/INR
D. Bilirubin (Indirect)

C. PT/INR

hepato encephalopathy is caused from an increase in…

• ammonia