Abnormal LFTs

Question 1

what determines the size of the liver

Answer 1

metabolic requirements

Question 2

what is ‘splanchinic steal’

Answer 2

when the body tries to increase blood supply to the liver which results in low BP in the rest of the body and eventually reduces blood supply everywhere else

Question 3

which clotting factor is not made in the liver

Answer 3

factor 8

Question 4

lack of what clotting factor causes haemophilia and how much needs to be lost to cause disease

Answer 4

factor 8
95%

Question 5

can you have normal LFTs in liver cirrhosis

Answer 5

yes

Question 6

what is found in liver sinusoids

Answer 6

mixed arterial and portal blood

Question 7

what needs to and doesn’t need to be considered in liver transplants

Answer 7

needs to match blood group
don’t need to consider HLA antigens - hepatocytes don’t have any

Question 8

why is some urobilinogen reabsorbed in the gut

Answer 8

due to microbes

Question 9

what is Gilberts syndrome

Answer 9

an isolated rise in bilirubin with no adverse consequences

Question 10

an isolated rise in bilirubin could be gilberts or

Answer 10

haemolysis

Question 11

at what bilirubin level will you start to jaundice

Answer 11

> 50

Question 12

at what bilirubin level will you have obvious jaundice

Answer 12

> 100

Question 13

where does conjugated bilirubin become urobilinogen

Answer 13

in the intestine

Question 14

is ALT and AST more liver specific

Answer 14

ALT

Question 15

what are ALT and AST

Answer 15

enzymes

Question 16

how do ALT and AST change in advanced NAFLD

Answer 16

AST increases relative to ALT

Question 17

when do AST and ALT increase

Answer 17

when hepatocytes die and leak them into the blood

Question 18

average ALT or AST in NAFLD

Answer 18

75-100

Question 19

what would ALT or AST be if all hepatocytes die and give example of when this could occur

Answer 19

10,000
paracetamol overdose

Question 20

what do increased alkaline phosphatase levels indicate

Answer 20

there’s something wrong with your bile ducts

Question 21

what do you need to check in addition to alkaline phosphatase when you suspect a problem with the bile ducts

Answer 21

gamma GTP

Question 22

is gamma GTP liver specific

Answer 22

no

Question 23

does a sole rise in GGTP without other LFT abnormalities likely indicate early or late stage disease

Answer 23

late

Question 24

what is the most abundant protein in the body

Answer 24

albumin

Question 25

what type of substances does albumin carry and give an example

Answer 25

water soluble substances
including unconjugated bilirubin

Question 26

what is albumin levels in dehydration

Answer 26

high

Question 27

why might albumin levels be low

Answer 27

due to dilution (e.g. increased body volume in pregnancy or oedema)
due to reduced synthesis

Question 28

what are albumin levels like in cirrhosis

Answer 28

often normal until liver is failing

Question 29

what type of liver disease is prothrombin time good for

Answer 29

acute liver failure

Question 30

why is prothrombin time rarely very abnormal in cirrhosis

Answer 30

because there is enough reserve in the liver

Question 31

possible cause of increased prothrombin time

Answer 31

paracetamol poisoning

Question 32

what is NASH

Answer 32

non alcoholic steroid hepatitis

Question 33

caeruloplasmin tests for

Answer 33

wilsons disease

Question 34

what investigations are usually triggered after abnormal LFTs

Answer 34

a ‘liver screen’

hepatitis viruses
autoantibodies (ANA, AMA and antiSMAb)
ferritin
caeruloplasmin
alpha-1-antitrypsin
immunoglobulins
ultrasound scan
referral

Question 35

what is ferratin a marker for

Answer 35

haemachromotosis