205: LFTs

Question 1

previously well 21yo man develops general malaise and becomes jaundiced.
Albumin ( 41 (36-53)
Alkaline Phosphate 144 (30-130)
ALT 3140

Answer 1

hepatocellular damage (jaundice and >ALT, plus bilirubin on the rise)
small increase in unconjugated bilirubin due to functional reduction in liver's ability to conjugate it. 
Viral Hep, acute alcoholic hepatitis, drug reaction (amoxycillin, paracetamol), chemicals, herbal remedies, recent travel.

Question 2

A 27yo teacher has had recurrent episodes of asymptomatic jaundice. He presents to his GP with flu-like symptoms.
Albumin 48 (36-53)
Alkaline phosphatase 34 (30-130)
ALT 22 (

Answer 2

isolated unconjugated hyperbilirubinaemia. ( you get jaundice when it hits 40).

most likely to be Gilberts Syndrome - autosomal dominant - reduced conjugation of bilirubin at the liver.

Question 3

a 16 yo girl with splenomegaly due to spherocytosis ( spherical red cells with increased haemolysis).

total bilirubin 54 (

Answer 3

haemolytic anaemia due to spherocytosis. splenomegaly is a reflection of the rate of red cell breakdown.
unconjugated bilirubin isn’t water soluble - slow to get into the urine.

Question 4

an 87 y o woman develops painless jaundice with dark urine and pale stools. she had lost 1 stone in weight in 2 months.
alkaline phosphatase 1236 (30-250)
ALT 83 (

Answer 4

cholestatic. dark urine = bilirubin in it ( conjugated). pale stools = no bile acid. raised Alkaline phosphatase with normal ALT supports this.

obstruction - gallstones, stricture, malignancy.
‘painless’ indicates pancreas neoplasm.

Question 5

42 y o woman with chronic pancreatitis has a test for stool elastase.
feacal elastase 15 (>200)
what does this indicate?

Answer 5

pancreatic insufficiency.

Question 6

a 75yo woman presents with a 2week history of weight loss, anorexia and long standing pain i nthe left hip and knee joints. one examination she was hyper pigmented and had a large liver. she was diagnosed with diabetes 4 years earlier, initially controlled with sulphonylurea, but has recently changed to insulin.

total protein 64 (62-78)
albumin 37 (36-53)
alkaline phosphatase 187 (30-250)
ALT 234 (

Answer 6

osetoarthritis, gout, hepatitis, liver disease. haemochromatosis

ALT associated with obesity and diabetes and osteoarthritis in older patients.

Haemochromatosis - indicated by the tetrad of diabetes M, pigmentation, liver disease and arthritis.