29 Questions
In cirrhosis, what does the diffuse fibrosis with nodular regeneration represent?
End stage of scar formation
Which of the following conditions can cause an increase in AST/ALT ratio greater than 1?
Cirrhosis
Which enzyme is more sensitive but less specific to canalicular injury of the liver?
GGT
In obstructive/cholestatic disease, which enzyme is noted to be increased more than ALP?
GGT
For patients with chronic alcohol abuse, which enzyme shows a significant increase that remains elevated for about a month after cessation of alcohol intake?
GGT
In liver tumors, which enzymes are noted to be highly elevated?
GGT and ALP
Which enzyme is more commonly elevated than AST in chronic hepatocyte infection?
ALT
What type of hyperbilirubinemia is associated with pre-hepatic jaundice?
Indirect hyperbilirubinemia
Which tests are used to evaluate excretory function in the liver?
Dye Excretion Tests
Which antibody is associated with autoimmune liver diseases like primary biliary cirrhosis?
Anti-mitochondrial antibody
Which enzyme has the longest half-life among the listed cytoplasmic enzymes?
ALT
In which type of liver disease is Alpha-fetoprotein (AFP) most diagnostically important?
Hepatocellular carcinoma (HCC)
Which liver autoantibody is commonly detected in cases of primary biliary cirrhosis?
ANTI-MITOCHONDRIAL ANTIBODY
Which liver function alteration involves destruction of both intrahepatic and extrahepatic bile ducts?
Primary sclerosing cholangitis
Which type of hepatitis is Alpha-fetoprotein (AFP) elevated in?
Chronic viral hepatitis
What is a common marker used for detecting Hepatocellular Carcinoma?
Alfa-fetoprotein (AFP)
Which of the following is a characteristic alteration observed in Acute Hepatitis?
Increased Conjugated bilirubin
What is a common tumor marker used for detecting Cholangiocarcinoma?
CA 19-9
In which liver condition would you expect to find decreased Cholesterol levels?
Cirrhosis
Which biomarker is typically elevated in cases of Space Occupying Lesions in the liver?
Direct bilirubin
What is a distinguishing feature of toxic hepatitis compared to ischemic hepatitis?
Predictable toxic reactions
In acute alcoholic hepatitis, how much is AST typically increased compared to the upper limit?
8 times
What is the most common cause of toxic hepatitis?
Acetaminophen
Which condition is associated with mild elevation in cytoplasmic enzymes and acute febrile illness?
Acute alcoholic hepatitis
Which enzyme activity is higher than AST in most liver diseases except for alcoholic hepatitis, hepatic cirrhosis, and liver neoplasia?
ALT
In acute hepatocellular injury, why is ALT eventually higher than AST within 24-48 hours of ongoing damage?
ALT has a longer half-life than AST
Which enzyme is a transiently increased marker in acute hepatocellular injury but returns to normal by the time clinical manifestations are observed?
Lactate dehydrogenase
In the context of jaundice types, which enzyme appears normal or minimally elevated in acute hepatocellular injury cases?
ALP
Which enzyme is significantly increased in acute hepatocellular injury, showing higher activity initially than ALT?
AST
Study Notes
Inherited Liver Disease
- Hemochromatosis, Wilson's disease, and Alpha-1-antitrypsin deficiency are types of inherited liver disease
- Cirrhosis is the end stage of scar formation and regeneration in chronic liver injury, characterized by diffuse fibrosis with nodular regeneration
Chronic Hepatitis
- Chronic hepatitis can lead to cirrhosis, which is a rare cause of symptoms in early stages
- Lab features appear first before clinical findings, including:
- Decreased platelet count
- Increased prothrombin time
- Decreased A:G ratio
- Increased AST/ALT ratio >1
- Decreased liver function
- Symptoms include:
- Fatigue
- Nausea
- Unintended weight loss
- Jaundice
- Bleeding from GI tract
- Intense itching
- Swelling in legs and abdomen
Carcinoma
- Primary malignancy of the liver, often occurring in patients with underlying chronic liver disease and cirrhosis
- Alpha-fetoprotein (AFP) is the most widely used tumor marker
Enzyme Increase in Hepatic Injuries
- Canalicular injury: ALP and GGT are increased, with GGT being slightly more sensitive than ALP
- Obstructive/Cholestatic disease: GGT > ALP
- Space-occupying lesions: GGT > ALP
- Chronic alcohol abuse: GGT is increased, but activity declines slowly with abstinence
- AST and ALT are increased in chronic hepatitis, with AST > ALT
Liver Tumors
- GGT and ALP are highly elevated in liver tumors
Jaundice
- Prehepatic jaundice: Unconjugated bilirubin is increased, with normal or decreased conjugated bilirubin
- Hepatic jaundice: Unconjugated and conjugated bilirubin are increased
- Posthepatic jaundice: Conjugated bilirubin is increased, with normal or decreased unconjugated bilirubin
Tests for Liver Disease
- Alpha-fetoprotein (AFP): elevated in acute hepatic injury, chronic viral hepatitis, and hepatocellular carcinoma
- Liver autoantibodies: anti-mitochondrial antibody (AMA) and anti-neutrophil cytoplasmic antibody (ANCA) are elevated in primary biliary cirrhosis and primary sclerosing cholangitis, respectively
Liver Function Tests
- Excretory function tests: evaluate the liver's ability to excrete substances
- Metabolic function tests: evaluate the liver's ability to metabolize substances
- Synthetic function tests: evaluate the liver's ability to synthesize substances
Enzyme Release in Liver Diseases
- Most liver diseases: ALT activity is higher than AST
- Exceptions: Alcoholic hepatitis, Hepatic cirrhosis, and Liver neoplasia
- Cytoplasmic AST increases first, followed by ALT in acute hepatic injury
- LDH is transiently increased in acute hepatic injury
Learn about the observed test results in different types of liver diseases including Acute Hepatitis, Cholestatic/Obstructive Jaundice, Cirrhosis, Space Occupying Lesions, and Liver Tumors. Discover the key indicators such as serum bilirubin, prothrombin time, lipoprotein X, ammonia, and AFP.
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