Hepatic and Coagulation Lab Parameters

Early signs/symptoms of liver injury

• absent

• fatigue

• nausea/loss of appetite

• RUQ abdominal pain

Late signs/symptoms of liver injury

• jaundice

• dark urine

• light colored stools

• pruritis

• swelling

• cognitive changes

Hepatocellular injury is related to the ____

liver

Cholestatic injury is related to the ____

biliary system

Hepatobilliary injury is related to ____

BOTH liver and billiary system

What are some important components a Comprehensive Metabolic Panel (CMP) tests for?

• albumin

• alkaline phosphatase

• ALT

• AST

• total bilirubin

• total protein

AST is _____ aminotransferase

aspartate

ALT is ____ aminotransferase

alanine

What do elevated aminotransferases indicate?

irritation to liver

What are possible causes of elevated aminotransferases?

• drug induced

• NAFLD (non-alcoholic fatty liver disease)

• hepatitis

• cirrhosis

• autoimmune

T/F: In most types of liver disease, ALT is higher than AST

TRUE

T/F: In alcoholic hepatitis, AST is HIGHER than ALT

TRUE

An AST to ALT ratio >2 suggests:

• alcoholic liver disease

  • pyridoxine 5 phosphate → active vit B6

  • alc increases release of mitochondrial AST

Elevations in lactate dehydrogenase (LDH) reflects what?

tissue injury

Elevated LDH is a possible marker for ____ due to decreased _____

hypoxic liver injury; perfusion

What is cholestasis?

slowing of bile flow from liver

Cholestasis stimulates the synthesis and release of what?

Alkaline Phosphatase (ALP)

ALP is present in the ____ tract

billiary

Elevated ALP can indicate:

extrahepatic and intrahepatic obstructive biliary disease and cirrhosis

What is Gamma-Glutamyl Transferase (GGT)?

• sensitive indicator for hepatobiliary disease

• can be increased by enzyme inducing drugs and other meds

What is bilirubin?

• its unconjugated form is conjugated in the liver

  • excreted in bile

• any bilirubin found in urine is conjugated → hepatobiliary disease → dark urine

Unconjugated bilirubin is ____ and _____

indirect, insoluble

Conjugated bilirubin is ____ and ____ soluble

direct; soluble

Bilirubin found in the urine would appear as

dark urine

Hemolytic disease is characterized by an isolated elevation of ____ bilirubin

indirect

Hepatobiliary disease is characterized by elevations of ___ bilirubin

direct

Elevations in BOTH indirect and direct bilrubin can be indicative of:

• hepatitis

• cirrhosis

• post hepatic obstruction

• drug induced cholestasis

What is the function of albumin?

• maintains oncotic pressure

• binds drugs and hormones

Albumin is slow to fall after hepatic dysfunction, which is reflective of what?

long term liver dysfunction

Decreased albumin levels can be caused by:

• liver disease

• malnutrition

• burns

• overhydration

• nephrotic syndrome

Increased albumin levels can be caused by

• anabolic steroids

• dehydration

What is the function of coagulation?

• monitors rapid changes in liver function

  • short term/long term dysfunction

• measures the time it takes for blood to clot

What is prothrombin time (PT)?

• measures function of extrinsic and common pathways of coagulation

What is activated partial thromboplastin time (aPTT)?

• measures function of intrinsic and common pathways of coagulation

The liver produces ____ dependent clotting factors

vit K

Decreased production of clotting factors results in ____ PT time, which ____ bleeding risk

increases;increases

What is ammonia?

• detoxified by liver to urea to be excreted by kidneys

A decreased metabolism of ammonia results in ____ ammonia levels

increased

Increased ammonia levels can result in:

hepatic encephalopathy (TOXIC)

Symptoms of hepatic encephalopathy

• mood and personality changes

• cognitive impairment

• balance problems

• coma

What are important characteristics of acute injury?

• elevated AST/ALT (hepatocellular)

• elevated ALP (cholestatic)

• elevated total bilirubin

• elevated PT/INR

What are important characteristics of chronic injury?

• Increased/decreased AST/ALT

• elevated ALP

• elevated total bilirubin

• elevated PT/INR

• decreased albumin

• increased ammonia

Which of the following lab value abnormalities may indicate a decline in liver function?

a. increased albumin

b. decreased LDH

c. increased PT/INR

d. decreased ammonia

C

• decreased clotting factors = decreased liver function

Which of the following lab value abnormalities may indicate a cholestatic injury?

a. decreased albumin

b. increased LDH

c. decreased unconjugated bilirubin

d. increased conjugated bilirubin

D

• liver/biliary tract unable to clear conjugated bilirubin

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

An AST:ALT ratio greater than 2 is most suggestive of which condition?
A. Viral hepatitis
B. Non-alcoholic fatty liver disease (NAFLD)
C. Alcoholic liver disease
D. Drug-induced liver injury

C

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

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