3: LFTs Flashcards
Which levels give an indication of the liver’s function?
Albumin
Prothrombin time
The albumin level gives an indication of the liver’s ability to synthesise ___.
protein
The INR gives an indication of the liver’s ability to produce ___ ___.
clotting factors
What are the enzymes included in a liver function (damage?) test?
ALP (alkaline phosphatase)
ALT/AST
GGT
Bilirubin (not an enzyme…)
What are key things to ask about in the history of someone with liver disease?
Alcohol?
Drugs?
Medication?
Travel history?
Sexual history?
Any tattoos? Blood transfusions?
Recent tattoos from a foreign country indicate what cause of liver disease?
Hepatitis C
Recent dodgy blood transfusion indicates what cause of liver disease?
Hepatitis C
Which medications can induce liver disease?
Antibiotics
NSAIDs
Methotrexate
Which particular antibiotics can trigger liver disease?
Flucloxacillin
Co-amoxiclav
Broadly, which viruses can cause liver disease?
Hepatitis viruses (A, B, C, D, E)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
The presence of particular antibodies can indicate the cause of liver disease. Which diseases are diagnosed based on the presence of…
Anti smooth muscle antibody (ASMA)
Anti mitochondrial antibody (AMA)
ASMA ⇒ autoimmune hepatitis, primary sclerosing cholangitis
AMA ⇒ primary biliary cholangitis
LFT derangements indicate three broad categories of disease. What are they?
Hepatitic disease
Cholestatic disease
Mixed disease
What is hepatitis?
What happens to hepatocytes?
Inflammation of the liver
Hepatocytes are damaged
Which liver enzymes are elevated in hepatitic disease?
ALT
AST
Which three diseases cause hepatitic LFT changes?
Non-alcoholic fatty liver disease
Viral hepatitis
Autoimmune hepatitis
How do bilirubin, ALP and GGT appear in hepatitic disease?
Normal
Because there’s no bile duct obstruction
Autoimmune hepatitis is common in (males / females) aged 20-40 and 55-65.
females
Autoimmune hepatitis comes in waves. What terms are used to describe this?
Relapsing and remitting
Which:
liver enzyme
specific antibody
broad class of antibody
are raised in autoimmune hepatitis?
ALT
Anti smooth muscle antibody (ASMA)
IgG
Which immune cells are found on biopsy of someone with autoimmune hepatitis?
Plasma cells
(produce antibodies)
What are some symptoms of autoimmune hepatitis?
Fatigue
Weight loss
RUQ pain
How is autoimmune hepatitis treated?
Prednisolone (steroid)
Azathioprine / Mercaptopurine (steroid-sparing immunosuppressants)
Who is at risk of catching Hepatitis C?
PWID
People who get tattoos and blood transfusions
Pakistani / Indian people
Which:
liver enzyme
antibody
is raised in Hepatitis C infection?
ALT
HCV antibody
How is Hepatitis C treated?
Refer to a hepatologist
What is the most common hepatitis seen in the West?
What is the cause?
Non-alcoholic fatty liver diseae (NAFLD)
Obesity
NAFLD exists on a spectrum. What is:
simple steatosis
steatohepatitis
cirrhosis?
Simple steatosis - fat in the liver
Steatohepatitis - fat and inflammation in the liver
Cirrhosis - irreversible fibrosis of the liver due to chronic inflammation
NAFLD is usually (symptomatic / asymptomatic).
asymptomatic
goes undetected for ages
Which liver enzyme is raised in NAFLD?
ALT
modestly
What is cholestatic disease?
Disease in which bile is stationary, so
obstruction / disease of the bile ducts
Which components of an LFT are raised in cholestatic disease?
ALP
GGT
Bilirubin
ALT is mildly elevated too.
When is ALP elevated?
Bile duct obstruction
Bone growth (normal and abnormal)
Breast disease
so you need to be careful diagnosing something based off ALP alone
Which liver enzyme is used to confirm cholestatic disease indicated by an elevated ALP?
GGT
Why may the bile ducts be obstructed?
Gallstones
Obstructing tumours (pancreatic tumours, cholangiocarcinomas)
Primary biliary cholangitis
Primary sclerosing cholangitis
Primary biliary cholangitis is an autoimmune disease caused by the body’s production of which antibody?
Anti mitochondrial antibody (AMA)
Who tends to develop primary biliary cholangitis?
Older women
Which bile ducts are inflamed in primary biliary cholangitis?
Microscopic ones within the liver
What are the symptoms of PBC?
Fatigue
Itch
Jaundice
Hyperlipidaemia
What is the classic presentation of PBC?
Old lady who is itchy, jaundiced, tired and has high cholesterol on investigation
Which components of an LFT are raised in PBC?
ALP
Bilirubin
ALT modestly raised too.
Patients with primary biliary cholangitis will be positive for which antibody?
Anti mitochondrial antibody (AMA)
How is primary biliary cholangitis treated?
Ursodeoxycholic acid (to help bile flow by making it less sticky)
Itching relief (baths, lotions etc.)
What causes mixed cholestatic and hepatitic disease?
Alcohol
Obstructive tumours
Drugs
diagnosed by taking a good history.
