Notes in hepatic testing

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Published	09/08/2024	CMP tests the {{c1::liver function}} and {{c1::electrolytes}} while hepatic function panel only tests the {{c1::liver }}
Published	09/08/2024	the hepatic function panel includes {{c1::direct bilirubin}} which is not included in a CMP
Published	09/08/2024	GGT and hepatitis test must be ordered {{c1::separately }}
Published	09/08/2024	proteins are broken down into {{c1::ammonia}} which is processed into {{c2::BUN}} and secreted through the urine. If the liver is having a hard time p…
Published	09/08/2024	LDH helps convert {{c1::pyruvate}} to {{c2::lactate}} by cells that are experiencing hypoxia when cells are under stress. If LDH is elevated, it is us…
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Published	09/08/2024	bilirubin is {{c1::unconjugated}} in the blood
Published	09/08/2024	Byproduct of hemolysis = {{c1::unconjugated bilirubin}}
Published	09/08/2024	Unconjugated bilirubin aka {{c1::Indirect}} Bilirubin –straight bilirubin that has not been processed
Published	09/08/2024	{{c2::unconjugated}} bilirubin is not {{c1::water-}}soluble
Published	09/08/2024	unconjugated bilirubin is {{c1::Neurotoxic}} -> b/c its fat soluble and cant get outside of the kidneys or go into the stool and can have collect i…
Published	09/08/2024	unconjugated bilirubin binds to {{c1::albumin}} which carries it to the {{c2::liver}} for conjugation
Published	09/08/2024	unconjugated bilirubin + {{c1::glucuronic acid}} = conjugated (direct) bilirubin -> water soluble and can be secreted
Published	09/08/2024	Most Conjugated bilirubin secreted into {{c1::Bile}}
Published	09/08/2024	Small amts of conjugated bilirubin will be secreted back into the bloodstream → {{c1::kidney}} → majority reabsorbed at {{c2::proximal tubu…
Published	09/08/2024	Conjugated bilirubin is {{c1::undetactable}} and should not be in the {{c2::urine }}
Published	09/08/2024	Conjugated bilirubin is stored in the {{c1::gallbladder}} and secreted in bile during {{c2::digestion}}.
Published	09/08/2024	in the SMALL intestine: bacteria convert conjugated bilirubin → {{c1::urobilinogen}} and {{c1::stercobilinogen}}
Published	09/08/2024	Urobilinogen (90%) and Stercobilinogen → {{c1::urobilin}} and {{c1::stercobilin}}. Brown pigment in stool
Published	09/08/2024	Bilirubin metabolismUnconjugated bilirubin (insoluble in water) is released into the blood by macrophages → binds to {{c1::al…
Published	09/08/2024	prehepatic jaundice is due to something before the liver. It is from an excess of {{c1::unconjugated}} bilirubin
Published	09/08/2024	prehepatic jaundice will have:{{c1::↑}} indirect (unconjugated) bilirubin in serum{{c2::↔}} direct (conjugated) bilirubin in serum {{c3::↑ }}&n…
Published	09/08/2024	causes of {{c1::prehepatic}} jaundice are: Hemolysis, genetic disorders (Gilbert’s or Crigler Najjar (fatal)), neonatal jaundice
Published	09/08/2024	prehepatic jaundice typically is {{c1::without elevations}} in AST or ALT
Published	09/08/2024	{{c1::hepatic}} jaundice will have:{{c2::↑}} indirect (unconjugated) bilirubin in serum due to impaired conjugation {{c3::↑}} direct (conjugated) b…
Published	09/08/2024	hepatic jaundice will have {{c1::elevated}} AST, ALT
Published	09/08/2024	causes of {{c1::hepatic}} jaundice are: hepatitis (viral, drug, alcoholic), cirrhosis
Published	09/08/2024	{{c4::post hepatic}} jaundice will have:{{c1::↔}} indirect (unconjugated) bilirubin in serum {{c2::↑} }direct (conjugated) bilirubin in serum due to …
Published	09/08/2024	{{c1::post hepatic}} jaundice will have {{c2::itching}} due to deposition of bile salts in the skin
Published	09/08/2024	{{c1::post hepatic}} jaundice causes are: Gallstones, biliary or pancreatic cancer, sclerosing cholangitis, and many more…
Published	09/08/2024	{{c1::bilirubin}} in the urine is never normal
Published	09/08/2024	{{c1::trace urobilinogen}} is normal in the urine
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Published	09/08/2024	{{c1::UV light}} for neonatal jaundice > makes bilirubin more water soluble  as if it was conjugated
Published	09/08/2024	total bilirubin includes {{c1::direct}} and {{c1::indirect}}
Published	09/08/2024	transaminases include {{c1::aspartate aminotransferease (AST)}} and {{c2::alanine aminotransferase (ALT)}}
Published	09/08/2024	{{c1::AST}} is found in theheart, liver, skeletal muscle, kidney
Published	09/08/2024	{{c1::ALT}} is found primarily in the liver
Published	09/08/2024	{{c1::AST/ALT}} will be released into blood when liver is damaged
Published	09/08/2024	what does increased fecal fat indicate?pancreatic {{c1::failure}} as an exocrine organ, for example in chronic pancreatitis
Published	09/08/2024	{{c1::fecal elastase}} is an enzyme produced by the pancreas that we can test for in the stool, where it is largely not broken down (sensitive an…
Published	09/08/2024	pancreatitis labs include{{c1:: amylase}} and {{c1::lipase}} elevation
Published	09/08/2024	{{c1:: amylase}} is not specific to the pancreas but {{c1::lipase}} is produced only by the pancreas
Published	09/08/2024	tests for obstructive and cholestatic disease include {{c3::total bilirubin}} and {{c1::alkaline phosphatase}} and {{c2:: GGT}}
Published	09/08/2024	{{c1::Alkaline Phosphatase (ALP)}} is found in bone, liver, intestine, kidney, leukocytes, and placenta. One of first enzymes elevated in bile duct ob…
Published	09/08/2024	{{c1::Gamma-Glutamyltransferase (GGT)}} is specific for liver. Particularly sensitive to alcohol ingestion. Most sensitive enzyme in liver disease
Published	09/08/2024	if elevated ALP, order a {{c2::GGT}} or {{c1::5'-nucleotidase }}. These are released only by hepatobiliary tissue (specific for liver d…
Published	09/08/2024	•Increased GGT or 5’-Nucleotidase and ALP = {{c1::hepatobiliary obstruction}}
Published	09/08/2024	{{c1::viral hepatitis}} symptoms include Fever, malaise, nausea, hepatomegaly, Jaundice, +/- RUQ pain
Published	09/08/2024	nonspecific viral hepatitis labs are:Increased {{c1::ALT}} and {{c2::AST}} Increased {{c1::Total bilirubin}} UA:  {{c3::dark}} urine, +bilirub…
Published	09/08/2024	hepatitis {{c1::A}} is caused by fecal-oral transmission. Usually from travel or daycare. it is mild, self limiting (ACUTE).
Published	09/08/2024	Specific laboratory diagnosis of hepatitis A:  Virus or antigen detected in stool 1-2 weeks before symptoms (not used for diagnosis) Total Anti-…
Published	09/08/2024	hepatitis {{c1::E}} is caused by fecal-oral transmission, usually from water or seafood. It is self-limiting most of the time but can be life-threaten…
Published	09/08/2024	Hepatitis {{c1::E}} is Not in Acute Hepatitis Panel! Special order: +HEV IgM = Active, +HEV IgG = recovery from previous infection
Published	09/08/2024	hepatitis {{c1::C}} is usually caused by:Blood TransmissionIV drug use Transfusion, transplant from infected donor Occupational (needlestick) Peri…
Published	09/08/2024	70-80%  acute Hep C pts → {{c1::chronic Hep C}}
Published	09/08/2024	if hepatitis C is left untreated, could develop {{c1::fibrosis}} of the liver and {{c2::cirrhosis}} and {{c3::hepatocellular carcinoma (HCC)}}
Published	09/08/2024	Hepatitis C {{c1::Antibody (HCV IgG) EIA}} (Screening) -detect >95% of infected patients -Does not distinguish acute vs chronic vs resolved Sero…
Published	09/08/2024	Hepatitis C{{c1::RNA }} -Quantitative (amount) – confirm + therapeutic response -If levels gradually decreasing = resolving infection -If lev…
Published	09/08/2024	Major routes of transmission of hepatitis {{c1::B}}: Percutaneous, mucous membrane exposure, sexual and perinatal
Published	09/08/2024	20% acute hep B → Chronic Chronic linked to {{c1::HCC}}
Published	09/08/2024	Antigens and Antibodies found in HBV (in order of appearance): HB{{c1::sAg}} – surface antigen HB{{c2::eAg}} – E/early antigen – released with DNA…
Published	09/08/2024	chronic HBV is described as persistence of HB{{c2::sAg}} >{{c1::6 months}}, lack of {{c3::anti-HBs}}, elevated {{c4::ALT}}.HB{{c5::eAg}}, HB{{c6::V…
Published	09/08/2024	Hepatitis B carriers:Chronic, no symptoms +HB{{c1::sAg}}, +{{c2::Anti HBc}} Negative {{c3::HBeAg}}, {{c4::HBV DNA}}, normal {{c5::ALT}} Stil…
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Published	09/08/2024	an infection of hepatitis D and HBV at the same time = {{c1::co-infection}}. Increases severity of acute HBV infection
Published	09/08/2024	an infection with HDV after initial HBV = {{c1::superinfection }}Usually develop chronic HDV infection High risk of severe chronic liver diseas…
Published	09/08/2024	consider testing for hepatitis D in {{c1::+HBsAg}} with severe symptoms of hepatitis
Published	09/08/2024	hepatitis {{c1::E}} and {{c1::D}} are NOT included in a viral hepatitis lab panel
Published	09/08/2024	Acute Hepatitis Panel: Total {{c1::HAV}} antibody HB{{c2::sAg}} Anti-{{c3::HBs}} Anti-{{c4::HBc}}. Reflex to Anti-HBc IgM → r/o Acute infect An…
Published	09/08/2024	alcoholic hepatitis will have {{c1::elevated}} total bilirubin, direct and indirect bili; AST and ALT {{c2::elevated}}; AST:ALT ratio ≥{{c3::2}}; {{c4…
Published	09/08/2024	Clinical symptoms of {{c1::alcoholic hepatitis}} include jaundice, RUQ pain, anorexia
Published	09/08/2024	NAFLD – {{c1::non-alcoholic fatty liver disease }}
Published	09/08/2024	NASH = {{c1::fatty infiltrates + inflammation}}
Published	09/08/2024	fatty liver disease will have {{c1::mildly elevated}} AST & ALT
Published	09/08/2024	order an {{c1::US}}  for fatty liver disease
Published	09/08/2024	{{c1::liver biopsy}} helps distinguish NASH vs NAFLD
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Published	09/08/2024	Chronic Liver Disease & Cirrhosis wil have:Decreased {{c1::platelets}} Increased {{c2::PT/INR, PTT}} Decreased {{c3::albumin}} Increased {{c4:…
Published	09/08/2024	diagnostics for portal hypertension are {{c1::abdominal ultrasound}}, CBC, CMP, {{c2::paracentesis}} if ascites, {{c3::endoscopy}} to evaluate fo…
Published	09/08/2024	{{c1::portal hypertension}} symptoms include esophageal varices, ascites, peripheral edema, caput medusa
Published	09/08/2024	a {{c1::paracentesis}} is used to analyze body fluid. It is both diagnostic and therapeutic.
Published	09/08/2024	fluid analysis tests for paracentesis include: Appearance Cell count and differential Cell staining and cytology Total protein Albumin Gram stai…
Published	09/08/2024	Serum Albumin – Ascites Albumin = {{c1::SAAG}}
Published	09/08/2024	If difference of SAAG is: >1.1 g/dL = {{c1::portal hypertension}} <1.1 g/dL = {{c1::no portal hypertension}}
Published	09/08/2024	{{c1::spontaneous bacterial peritonitits}} is:Infection of ascitic fluid PMN count (≥250 cells/mm3), Positive bacterial culture SAAG >1.1
Published	09/08/2024	{{c1::lipase}} is more specific for the pancreas
Published	09/08/2024	{{c1::Exocrine pancreatic Insufficiency}}: Maldigestion of fat and protein and B12 deficiency
Published	09/08/2024	{{c1::pancreas}} lab testing includes: amylase, lipase, exocrine pancreatic insufficiency, fecal elastase, and fecal fat
Published	09/08/2024	{{c1::fecal elastase}} is the most sensitive and specific.-Enzymatic product of pancreatic secretion -Low in pancreatic insufficiency due to chronic
Published	09/08/2024	the window period means that neither the {{c1:: surface Ag}} or {{c2::Ab}} is detectable in a hepatitis B
Published	09/08/2024	causes of {{c1::portal hypertension}} are:Cirrhosis, R. Side HF, portal vein thrombus
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