Liver and GI tests

I swear I can smell when a patients ammonia is high

albumin

A major plasma protein produced by the liver that has a 20 day half live and is slow to fall after the onset of hepatic dysfunction.

hypoalbuminia

A patient presents to the ER with peripheral edema. In your BMP you note a low total calcium but free calcium is in range. This could be a sign of

maintain plasma oncotic pressure, bind and transport hormones/anions/drugs/fatty acids

Functions of albumin

abnormalities in protein synthesis/distribution/excretion

Aside from liver disease low albumin levels could be a result of

albumin shifts out of intravascular, liver makes less albumin

In the case of systemic inflammation, why do some severely ill hospitalized patients develop peripheral/pulmonary edema or ascites?

excretion/decrease production, parenteral nutrition/malnutrition, infection, pregnancy

What causes hypoalbumemia

dehydration, high protein intake, iatrigenic, metabolic syndrome, anabolic steroids, tourniquets

What causes Hyperalbuminemia

II, V, VII, X

The liver also produces clotting factors, which ones are measured in PT?

liver damage

An increased PT/INR is consistent (note not specific to)

INR (international normalized ratio)

What test of synthetic liver function is a standardized range based on global data and is used to monitor warfarin patients, assess bleeding risk, and measure liver damage?

cholestasis

Impaired synthesis or excretion of bile that can show up in lab work as elevated ALP, GGT, and bilirubin early on. (AST/ALT later)

Intrahepatic

Cholestasis in which the issue is in the synthesis of the bile that can be caused by infiltrative disease, medications, and toxins

extrahepatic

Cholestasis in which the issue is not in the liver but the bile ducts usually due to gallstones in the common bile ducts, tumor blocking bile ducts, pancreatitis, strictures

Alkaline phosphatase (ALP)

What test associated with the excretory liver function and cholestasis measures a group of isoenzymes with an unknown function and varies primarily with age?

they go up

If bile goes up, what happens to ALP levels?

liver, bone, small intestine, kidneys, placenta, neoplasms

Where can you find ALP

high, low

Describe the sensitivity and specificity of ALP

No (4x normal suggest cholestatic disorder)

Can you use ALP alone to distinguish between extrahepatic and intrahepatic disorders?

High, high

Describe the sensitivity and specificity of 5’-Nucleotidase for hepatobiliary cholestatic disorders

5’ nucelotidase

A enzyme that is found in the liver, brain, heart, and blood vessels but is only elevated in the presence of liver disease

GGT, 5’ nucelotidase

What labs can we use to determine if an elevated ALP is due to a liver issue?

Gamma glutamyl transaminase (GGT)

A biliary excretory enzyme found in the liver, kidneys, heart, spleen, pancreas and brain however, it is rarely elevated in conditions other than liver disease

high, low

Describe the sensitivity and specificity of GGT for hepatobiliary cholestatic disorders

alcohol abuse

GGT can also be used to monitor what

before the liver

High unconjugated (indirect) bilirubin is a problem

after the liver

High conjugated (direct/water soluble) bilirubin is a problem

urobilinogen

A colorless end product of bilirubin metabolism that is oxidized by intestinal flora to brown pigment

stercobilin

Urobilinogen is excreted in the feces as

urobilin

Urobiliogen is excreted in the urine as

No (prehapatic)

A patient presents with icterus and jaundice. Labs are as follows total bilirubin elevated, Direct bilirubin low, indirect bilirubin elevated. Is this a disease of the liver?

Yup (hepatocellular issue)

A patient presents with icterus and jaundice. Labs are as follows total bilirubin elevated, Direct bilirubin high, indirect bilirubin elevated, AST/ALT high, ALP/GGT high. Is this a disease of the liver?

Posthepatic (cholestasis or hepatobilliary)

A patient presents with icterus and jaundice. Labs are as follows total bilirubin elevated, Direct bilirubin high, indirect bilirubin low, AST/ALT high, ALP/GGT high. Is this a disease of the liver?

unconjugated (indirect)

Prehepatic jaundice results in an increased of what type of bilirubin?

AST/ALT

What labs are used to assess hepatocellular injury because they are release in greater quantities when there is hepatocyte damage?

hepatocellular injury that interferes with bile secretion

If both aminotransferases (ALT/AST) and cholestatic test are elevated what does this suggest

AST, GGT

A patient presents to the clinic with a history of alcohol abuse, if he has been drinking which labs should be elevated

ALT

Which is more specific to the liver injury, AST or ALT?

high, low

Describe the sensitivity and specificity of AST?

High, high

Describe the sensitivity and specificity of ALT?

heart, kidneys, brain, lungs, intestines, muscles, RBCs

Where besides the the liver can you find AST

24-48 hr

AST and ALT rise within _________ after active liver damage but decline rapidly

Hepatitis

Inflammation of the liver that can be caused by viral infection, alcohol, drugs, toxins, bacterial, immunologic/genetic issues, etc

B, C

Which forms of hepatitis are blood and STD related

ALT/AST very high, ALP/GGT not high initially, Total/direct bilirubin high much later

In acute hepatitis what are your labs going to look like?

Ammonia

What metabolic process occurs only in the liver and whose waste product is used to form urea in the kidneys but provides very little diagnostic information?

hepatic encephalopathy

If ammonia builds up in the brain what are we looking at

Pancreatitis

Patient presents to the ER with epigastric pain that radiates to her back. Lipase and amylase are 3x the normal limit. What alarm bells are ringing?

alcohol abuse, gallstones

Most common causes of pancreatitis?

low, low

Describe the sensitivity and specificity of amlylase

amylase

What pancreatic enzyme rises within 2-6 hours after onset, peaks 12-30 hours, and returns to normal in 3-5 days?

pancreas, salivary glands

Where can you find amylase

lipase

An enzyme that helps breakdown fats and is secreted by the pancreas, rises within 2-6 hours after onset, peaks 12-30 hours, and returns to normal in 8-14 days?

high, high

Describe the sensitivity and specificity of lipase

Lactate dehydrogenase (LD, LDH)

What enzyme catalyzes the interconversion of lactate and pyruvate and is used to check for tissue damage, monitor condition, assess severity, and monitor treatment?

liver, heart, kidney

Where is LD found

high, low

Describe the sensitivity and specificity of LDH