Case Based learning including Liver function tests

Question 1

ALT normal level

Answer 1

under 40

Question 2

Billirubin normal level

Answer 2

under 20

Question 3

What are the 8 I’s you can ask yourself when presented with a patient?

Answer 3

Infection
Infarction ( cell death)
Inflamation
Infiltration (kidney issues?)
Iatrogenic (inc. drugs given for other causes)
Inbibition (alc./recreational drugs)
Immunologic
Ingestion

Question 4

Common drugs for causing liver failure

Answer 4

NSAIDS
Flucloxacillin
Nitrofuratoin (used in UTIs)
Coamoxiclav
Statins
diclofenac
PARACETAMOL - esp if given with a higher dose thna should be given for the weight of the patient

Question 5

Imbibition causes

Answer 5

ALCOHOL, Coccaine, ectstasy, anabolic steroids (body builder ones)

Question 6

Common cuase of hep E infection

Answer 6

undercooked raw pork sausages ( 1/8 sausages cont. hep E), present most commonly in men inn their 50s wiht fatty liver disease who’ve eaten raw sausages from the bbq

Question 7

How do hep A and E spread?
How do hep B and C spread?

Answer 7

AE = faecal oral
BC - body fluids

Question 8

Who must be contacted in the case of a hep B infection?

Answer 8

Contact tracing, to try and figure out if they ar espreading it to otehers or if they have causght it off someone. Often sexually transmitted so might want to also perform other sti tests

Question 9

What are the causes of pruritis?

Answer 9

Often billiary causes, because the bile salts back up and end up in the blood and cna go arpound under he skin and this is what causes the itching. Treated with Colestyramine

Question 10

Hep B liver function tests, normal vs abnormal for acute/chronic infections?

Answer 10

Chronic may be completely normal
Acute will be different

Question 11

What does ALT measure?

Answer 11

Liver cell death, so liver cell damage

Question 12

What is ALP an indirect marker of? What can the other causes of a raised ALP be?

Answer 12

Cholestasis
Other causes include:
-Bony metastases or primary bone tumours (e.g. sarcoma)
-Vitamin D deficiency
-Recent bone fractures
-Renal osteodystrophy

Question 13

What is a high GGT a sign of?

Answer 13

Either:
-biliary damage/obstruction
-alcoholism, drugs eg phenytoin

Question 14

Jaundiced but normal ALP and ALT levels

Answer 14

Look at bilirubin. Will probably be a pre-hepatic cause.

Causes of an isolated rise in bilirubin include:

Gilbert’s syndrome: the most common cause.
Haemolysis: check a blood film, full blood count, reticulocyte count, haptoglobin and LDH levels to confirm.

Question 15

Would unconjugated bilirubin be presented in the patients urine? What does this mean in terms of how we can see what has gone wrong with the biliary system?

Answer 15

No, because unconjugated bilirubin is insoluble duh, as obviously it has to go through he whole process of becoming conjugated to be excreted. If urine is normal colour and not darker than must be unconjugated bilirubin and therefore a prehepatic cause

Question 16

Darker urine, how can we distinguish between the hepatic and post hepatic causes of jaundice

Answer 16

If post hepatic then there is also going to be issues twith the pancreatic juices being released in to the suodenum and so the fats won’t be digested. Therefore will present as steratohrea

Question 17

Why can the prothrombin time tell you about the liver function? In what other situations would they be reduced?

Answer 17

Because the liver produces the clotting factors. So if liver damage and the liver is unable to make them, then the clotting time will be increased.

Also increased hwen on anticoagulation or with vitamin K deficincy

Question 18

What is an ANA test and when would levels be increased?

Answer 18

antinuclear antibodies - suggestive of autoimmune disease

Question 19

AFP normal values and elevated levels are a sign of what?

Answer 19

under 10 (7).

Produced in the foetal liver. (Alpha fetoprotein) - raised is suggestive of cancer (liver, non-s testis and ovary) and Chirrosis, viral hepatitis.

Question 20

What does an MVC measure?

Answer 20

red blood cell size

Question 21

Signs of an alcoholic on liver function tests

Answer 21

Raised MCV, AST, GGT
Lowe Urea and platelet (due to bone marrow suppression)

Question 22

Fibroscan cut off for no significant liver dmaage

Answer 22

under 13