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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?
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?
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?
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?
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?
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?
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?
1. ALT
2. AST
3. Much higher
What test is specific good for hepatitis B? What other markers can be used?
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?
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?
What are the recovery rates for hepatitis A, B and C?
1. A = 100%
2. B = 90%
3. C = 20%
When are transaminase levels the highest in hepatocellular disease?
At the height of infection

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