Question

A client is admitted with abdominal trauma from a motor vehicle accident. Which lab finding/findings indicates damage to the liver? A. Increased WBC B. Increased amylase, lipase C. Increased ALT, AST D. Decreased hematocrit

Short answer

Answer: Increased ALT, AST.

Step-by-step solution

Understand the options and their relation to liver damage

Before going through each option, it is important to know the significance of WBC, amylase, lipase, ALT, AST, and hematocrit, and their relation to liver damage. White Blood Cells (WBC) - They help our body to fight infections. An increase in WBC count may indicate inflammation or infection but not specifically liver damage. Amylase and Lipase - Amylase and Lipase are enzymes primarily produced by the pancreas to help digest and break down food. An increased level of these enzymes may indicate pancreatitis. ALT (Alanine Aminotransferase) and AST (Aspartate Aminotransferase) - These are enzymes found in the liver, and their levels can be measured in a liver function test. An increase in these enzyme levels indicates liver damage or injury. Hematocrit - It is the ratio of the volume of red blood cells to the total volume of blood. Lower hematocrit levels can indicate blood loss, but it is not specific to liver damage.

Analyze Option A - Increased WBC

Increased WBC count indicates an infection or inflammation but it's not specific to liver damage. So, option A is not the correct answer.

Analyze Option B - Increased amylase, lipase

Increased levels of amylase and lipase suggest pancreatitis but not liver damage. So, option B isn't the correct answer either.

Analyze Option C - Increased ALT, AST

Increased levels of ALT and AST are associated with liver damage or injury. So, option C is the correct answer for this case.

Analyze Option D - Decreased Hematocrit

Decreased hematocrit levels may indicate blood loss but are not specific to liver damage. Hence, option D is not the correct answer.

Conclusion

The correct answer to the question is C. Increased ALT, AST. These increased enzyme levels are an indicator of liver damage or injury in a patient with abdominal trauma from a motor vehicle accident.

Key concepts

Liver Damage Indicators

Understanding liver damage indicators is crucial in diagnosing and managing conditions that may impair liver function. While the liver is a resilient organ, it can be damaged by trauma, infection, toxins, and various diseases. Indicators of liver damage include clinical symptoms such as jaundice, fatigue, and discomfort in the upper right quadrant of the abdomen. However, to confirm liver damage, medical practitioners rely on more objective measures.

Laboratory tests often look for elevated levels of certain enzymes in the blood that leak out of the liver when its cells are damaged. These enzymes include ALT (alanine aminotransferase) and AST (aspartate aminotransferase), which are highly concentrated in the liver. Other indicators might include bilirubin, albumin, and prothrombin time, among others. It's also important to consider the context of the patient's overall health, other labs and imaging findings when interpreting these indicators as they can also be elevated in non-liver related conditions.

Liver Function Test

A Liver Function Test (LFT) is a blood test used to assess the state of the liver and biliary system. The LFT encompasses various tests that measure specific proteins and enzymes' levels in the blood:

• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transpeptidase (GGT)
• Total bilirubin and direct bilirubin
• Albumin

High levels of these substances might suggest liver damage or liver disease. However, an important aspect of LFTs is that they do not measure the liver's function directly but instead measure enzyme and protein levels that can indicate a problem with the liver. For example, elevated ALT and AST can signal acute liver cell damage, but they do not provide information about the liver's functional capacity. Therefore, LFTs are often used in conjunction with other tests and imaging studies to diagnose and monitor liver conditions.

ALT and AST Levels

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes found in the liver that play a critical role in amino acid metabolism. When liver cells are damaged, these enzymes are released into the bloodstream, causing elevated blood levels that can be detected through a liver function test.

An isolated increase in AST could also be associated with damage to muscles, heart, or kidneys, and therefore, it is important to look at both ALT and AST levels in conjunction. Typically, the ratio of AST to ALT can provide additional clues about liver health. A higher ALT relative to AST level is commonly associated with liver conditions, such as hepatitis or liver trauma, as seen in the case presented in the exercise. Knowing these levels helps healthcare providers assess the extent of liver injury and monitor the progression of liver diseases. It's essential to interpret these levels in the context of the patient's clinical condition and other diagnostic findings for accurate diagnosis and optimal management.