GASTROENTEROLOGY ARTICLE OF THE WEEK
November 10, 2005
Goessling W, Friedman LS. Increased liver chemistry in an asymptomatic patient. Clin Gastroenterol Hepatol 2005;3:852-58
1. Potential causes of GGT elevations include
a. liver disease
b. alcohol abuse
c. renal failure
d. diabetes
e. COPD
f. chronic inflammatory disorders
g. Pregnancy
2. AST is typically higher than ALT in alcoholic liver disease because:
a. alcohol contains AST
b. deficiency in pyridoxial 5’ phosphate, decreasing ALT activity
c. most alcoholic have cirrhosis
d. preferential location of AST in the mitochondria, which is damaged by alcohol
e. alcohol metabolites inhibit synthesis of ALT by hepatocytes
True or False
3. Typically, serum AP levels are increased 3-4x ULN in Wilson’s disease.
4. An AST:ALT ration of 1:1 4 days after a patient suffered rhabdomyolisis implies liver inflammation.
5. A rise in alkaline phosphatase levels can usually be detected within 2-3 hours after an insult that produces biliary injury.
6. 5’ nucleotidase levels are preferred to alkaline phosphatase fractionation to determine if the alkaline phosphatase elevation is from hepatic origin.
7. Ultrasound is more sensitive than CT for the detection of gallstones, but CT is better for detection of bile duct obstruction.
8. The most common cause of liver enzyme elevations is alcohol use.
9. Initial studies in an asymptomatic 40 y/o patient with an ALT of 75 IU/ml should include
a. Acute hepatitis panel
b. HBsAG, anti HCV, anti-HAV
c. iron, TIBC, ferritin
d. abdominal CT
e. HBsAG, anti-HCV
f. ceruloplasmin, ANA, anti-smooth muscle antibody, TTG-IgG, A-1-AT
phenotype, HIV, serum protein electrophoresis