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Assessment of Liver Function

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Liver Diseases

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Abstract

This chapter explores various liver pathologies and their respective laboratory test abnormalities. Particular emphasis is placed on viral hepatitis, in addition to alcohol-induced, metabolic, and cholestatic liver disease. The chapter concludes with a discussion on the numerous complications of chronic liver disease with a focus on diagnosis and management, followed by a brief look into the future of hepatobiliary diagnostic workup.

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Author information

Authors and Affiliations

  1. Department of Medicine, UC Irvine Health, Orange, CA, USA

    Zain Moosvi, Felix H. Lui & Douglas Nguyen

Authors
  1. Zain Moosvi
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  2. Felix H. Lui
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  3. Douglas Nguyen
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Corresponding author

Correspondence to Zain Moosvi .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Which statement is true?

    1. (a)

      Bilirubin is exclusively synthesized in the liver.

    2. (b)

      Unconjugated hyperbilirubinemia will result in bilirubin in the urine.

    3. (c)

      Hyperbilirubinemia is caused by overproduction of bilirubin, impaired uptake, conjugation, or excretion, or leakage from hepatocytes or bile ducts.

    4. (d)

      Hyperbilirubinemia is always accompanied by elevated transaminases.

  2. 2.

    Which statement is true?

    1. (a)

      An AST/ALT ratio of less than 2 is consistent with alcoholic liver disease.

    2. (b)

      ALP elevation in the setting of normal GGT level is suggestive of liver disease.

    3. (c)

      An elevated INR is suggestive of increased liver synthetic function.

    4. (d)

      While elevated serum AFP levels are suggestive of HCC, they can also be elevated in other malignancies as well as hepatitis.

  3. 3.

    Which statement is true?

    1. (a)

      Hepatitis A is treated with antiviral therapy.

    2. (b)

      Hepatitis C is the most prevalent of all viral hepatitides worldwide.

    3. (c)

      All patients with chronic hepatitis B should receive antiviral therapy.

    4. (d)

      Sustained virologic response (SVR) is defined as undetectable hepatitis C virus RNA 6 months after the completion of antiviral therapy.

  4. 4.

    Which statement is true?

    1. (a)

      Pentoxifylline is first-line treatment of alcoholic hepatitis.

    2. (b)

      Hepatic steatosis is reversible with cessation of alcohol consumption.

    3. (c)

      Five-year transplant-free survival rate is not affected by the cessation of alcohol consumption.

    4. (d)

      Patients with alcoholic hepatitis are usually asymptomatic.

  5. 5.

    Which statement is true?

    1. (a)

      Drug-induced liver injury is most commonly caused by antibiotics.

    2. (b)

      A serum ALT to LDH ratio of greater than 1.5 is suggestive of ischemic hepatitis.

    3. (c)

      Serum transferrin levels are elevated in hereditary hemochromatosis.

    4. (d)

      Antibodies to liver/kidney microsomes are suggestive of primary sclerosing cholangitis.

  6. 6.

    Which statement is true?

    1. (a)

      The presence of antimitochondrial antibodies are suggestive of primary biliary cholangitis.

    2. (b)

      Wilson’s disease is characterized by low ceruloplasmin levels.

    3. (c)

      Primary biliary cholangitis is strongly associated with inflammatory bowel disease.

    4. (d)

      The malignancy that is most strongly associated with primary sclerosing cholangitis is hepatocellular carcinoma.

1.2 Answers

  1. 1.

    Which statement is true?

    1. (a)

      Bilirubin is made both in the bone marrow and in the liver. It is exclusively conjugated in the liver.

    2. (b)

      Conjugated hyperbilirubinemia will result in bilirubin in the urine. Unconjugated bilirubin is bound to albumin, and is not filtered by the glomerulus into the urine.

    3. (c)

      Correct: Hyperbilirubinemia can be caused by a variety of pathologies but all are related to overproduction, reduced excretion, impaired conjugation, or leakage.

    4. (d)

      Hyperbilirubinemia can be caused by a multitude of etiologies. Only liver disease such as cirrhosis will cause elevated transaminases as well.

  2. 2.

    Which statement is true?

    1. (a)

      An AST to ALT ratio greater than 2 is consistent with alcoholic liver disease. An AST to ALT ratio less than 2 is suggestive of NASH and Wilson’s disease.

    2. (b)

      GGT is found in hepatocytes, in addition to a myriad of other cells. ALP is found in liver, bone, and placenta. Therefore, an elevated ALP in the setting of an elevated, not normal GGT, is suggestive of liver disease.

    3. (c)

      INR is a marker for coagulation function. It is affected by coagulation factors, which are made in the liver. Therefore, reduced, not elevated synthetic function, would cause an elevated INR.

    4. (d)

      Correct: AFP is not specific to HCC. It can also be elevated in gastric cancer, germ-cell tumors, and non-germ cell tumors.

  3. 3.

    Which statement is true?

    1. (a)

      Hepatitis A is a self-remitting illness and therefore should be treated with supportive care only.

    2. (b)

      Hepatitis B, not hepatitis C, is the most common of the viral hepatitides worldwide.

    3. (c)

      Patients with chronic hepatitis B should only receive antiviral treatment if serum ALT is elevated and HBV DNA is less than 10,000 IU/mL.

    4. (d)

      Correct: Sustained virologic response is a term used to define successful antiviral treatment of hepatitis C and is based on HCV viral load.

  4. 4.

    Which statement is true?

    1. (a)

      Prednisone, not pentoxifylline, is first-line treatment for alcoholic hepatitis. Pentoxifylline should be used in the setting of infection, variceal hemorrhage, or acute kidney injury.

    2. (b)

      Correct: Hepatic steatosis, the first stage of alcohol-induced liver disease, is reversible with cessation of alcohol consumption, as no fibrosis has occurred at this point.

    3. (c)

      Five-year transplant-free survival rate is doubled from 30% to 60% if patients cease alcohol consumption.

    4. (d)

      Patients with alcoholic hepatitis usually present with anorexia, jaundice, hepatomegaly, and abdominal pain. Patients with hepatic steatosis are usually asymptomatic.

  5. 5.

    Which statement is true?

    1. (a)

      Drug-induced liver injury is most commonly caused by acetaminophen, not antibiotics.

    2. (b)

      A serum ALT to LDH ratio of less than, not greater than 1.5 is suggestive of ischemic hepatitis.

    3. (c)

      Correct: Serum transferrin levels are the best initial screening test for hereditary hemochromatosis. Transferrin saturation values greater than 45% in men and 35% in premenopausal women necessitate further workup.

    4. (d)

      Antibodies to liver/kidney microsomes are suggestive of primary biliary cirrhosis, not primary sclerosing cholangitis.

  6. 6.

    Which statement is true?

    1. (a)

      Correct: Antimitochondrial antibodies are present in between 90% and 95% of patients with PBC.

    2. (b)

      Serum ceruloplasmin can be elevated or normal in Wilson’s disease. Serum copper levels will be low.

    3. (c)

      Primary sclerosing cholangitis, not primary biliary cholangitis, is strongly associated with inflammatory bowel disease.

    4. (d)

      The malignancy that is most strongly associated with primary sclerosing cholangitis is cholangiocarcinoma, not hepatocellular carcinoma.

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Moosvi, Z., Lui, F.H., Nguyen, D. (2020). Assessment of Liver Function. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_35

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