Lab M 1
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- Where are four cytoplasmic markers of tissue injury?
- AST (50%), ALT, LDH, and CK (90%)
- What are two cell membrane markers of tissue injury?
- GGT, AP (which show increase synthesis in injury)
- What are two lysosomal markers of tissue injury?
- acid phosphatase, N-acetyl-B-glucosaminidase
- What are two mitochondrial markers of tissue injury?
- CK (10%), AST (50%)
- Liver function tests are actually tests of what?
- Liver dysfunction
- What are four causes of cholestasis?
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1. Gallstones – usually consist of cholesterol but may also contain pigment.
2. Tumors can block the biliary tract.
3. Biliary cirrhosis (rare).
4. Biliary atresia (rare). - What level in a LFT is high with extra hepatic blockage of the biliary tree?
- AP’s synthesis is increased in cases of extrahepatic obstruction of the biliary tree. The increase is usually 2, 3 fold, although it may demonstrate a 10-12 fold increase.
- With cholestasis, which bilirubin is high?
- Direct bilirubin
- High levels of indirect bilirubin is indicative of what?
- Hemolytic disease
- What happens to the levels of GGTs with cholestasis? What else can cause this?
- GGT’s synthesis is induced by cholestasis, alcohol, and certain drugs (such as phenobarbitol).
- What are the lab values that indicate biliary obstruction?
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Increased GGT and AP. It is unclear why AP’s synthesis is increased. An intrahepatic block would only give a 2-3 fold increase in AP, while a greater increase is seen with a complete extrahepatic block.
Mild increase in AST and ALT, though not as great as in hepatitis. - What sex is more predisposed to gall stones?
- Women
- Whats saying helps you remember where elevated AP originated.
- Heat the sample and "liver lives, bone burns".
- For obstructive cholestatic disease, what lab values are seen in AST, ALP and albumin?
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1. AST less than 3x the URL
2. ALP greater than 2x the URL
3. If albumin is low, the state is chronic - For hepatocelluar diease, what lab values are seen in AST, ALP and albumin?
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1. AST greater than 3x the URL
2. LP less than 2x the URL
3. Decreased albumin means the state is chronic - What are the four F's that predispose one to gall stones?
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1. Fat
2. Female
3. Forty
4. Fertile - What is Wilson's disease?
- A copper overload due to a genetic defect
- In acute hepatitis, what levels are increased? Are these levels higher or lower than you would see in chronic hepatitis?
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1. ALT
2. AST
3. Much higher - What test is specific good for hepatitis B? What other markers can be used?
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1. HepB surface antigen
2. HepB viral DNA
3. HepBE antigen - What test for hepatitis b is very specific but tough to do and expensive?
- HepB Viral DNA
- What are two signs of chronic liver disease?
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1. Decreased albumin
2. Decreased levels of clotting factors - What is absent in people who have chonic hepatitis?
- People who do not develop antibodies to the hepatitis virus have chronic heptatitis.
- High hepatitis antibodies are indicative of what?
- Recovery
- What are the recovery rates for hepatitis A, B and C?
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1. A = 100%
2. B = 90%
3. C = 20% - When are transaminase levels the highest in hepatocellular disease?
- At the height of infection