C - LFTs Flashcards
7 functions of the liver
Intermediary metabolism
Protein synthesis
Xenobiotic metabolism
Hormone metabolism
Bile synthesis
BR metabolism and transport
Reticuloendothelial function - eg Kupffer cells
Examples of intermediary metabolism done in liver (3)
Ammonium / AAs
Lactic acid
Glycogenolysis and storage
2 examples of xenobiotic metabolism in liver
P450 enzyme system
Conjugation
Name the LFTs
AST, ALT, AFP, BR, ALP, albumin
Which LFTs are markers of damage
ALT, AST, ALP, GGT
Which LFTs are markers of synthetic function
PTT, albumin
Which LFT is a tumour marker
AFP
Where are AST / ALT found
Hepatocyte cytoplasm
What do AST / ALT do
AA metabolism
When are AST/ ALT released
Hepatocyte damage / death
Where else are AST and ALT found
Muscle
Kidney
Brain
Pancreas
Which enzyme is raised most in liver damage
ALT
Which enzyme is raised most in alcohol / cirrhosis
AST
What ratio of AST:ALT indicates severe liver cirrhosis
> 2:1
Where is GGT found (2)
Hepatocytes
Gallbladder
What causes raised GGT
Alcohol
When is ALP released
Bile duct injury
Obstructive jaundice
Where else is ALP found
Bone
SI
kidney
WBCs
Placenta
What does a really high ALP indicate
Mets
Pregnancy
What is the half life of albumin
20 days
Purpose of albumin
Increase oncontic pressure
Binds steroids / drugs / BR / calcium
What does a low albumin indicate
Chronic liver disease
Malnutrition
Sepsis - 3rd spacing
Half life of PTT
Hours
What does deranged PTT show
ACUTE liver dysfunction
What does a raised AFP indicate (3)
Hepatocellular carcinoma (70-80%)
Pregnancy
Testicular cancer
What BR level would cause jaundice
> 20 - 30
Which type of BR appears in urine
Conjugated
Causes of high BR with normal LFTs
Haemolysis
Gilbert’s
Where is the pathology if high BR with high AST/ALT
Hepatocellular
Where is the cause if high BR with high ALP
Cholestatic
Causes of cholestatic high BR with dilated ducts
Gallstones
Cancer
Causes of cholestatic high BR with undilated ducts
PBC
PSC
pregnancy
What BR product appears in urine physiologically
Urobillinogen
What causes high urobilinogen in urine
Haemolysis
Hepatitis
Sepsis
List other components in a liver panel (9)
Fasting lipids / glucose
Coeliac serology
Hepatitis serology
Alpha 1 antitrypsin
Caeraloplasmin
Liver ABs - aSMA / AMA
Igs
Ferritin
ANCA
What is the marker for Wilson’s
Caeraloplasmin
What level of caeraloplasmin indicates Wilson
LOW - high is normal
Name some super specialised liver tests
Tumour markers
Iron studies
Liver biopsy
Viral DNA / RNA
24hr urinary copper
CT / MRCP / MRI
endoscopic USS
When would you measure serum bile acids
Obstetric cholestasis
Gold standard for diagnosing liver pathology
Biopsy (++ invasive and bleeding)
Alternative to liver biopsy for assessing fibrosis
Fibroscan - vibrating USS
Which ABx can cause hepatic Sx
Augmentin - given for UTI
Courvoisier’s law & indication
Painless jaundice is pancreatic cancer
Causes of ALT in the thousands
Toxins
Viral
Ischaemia
What is a good marker of acute liver injury
INR
