Chemical Pathology 18 - LFT cases Flashcards
What 2 LFT results are very suggestive of alcoholic liver disease?
AST: ALT > 2.0
High GGT
When is ALP most markedly elevated?
Bile duct damage/ obstructive jaundice
What is the half life of albumin?
20 days
Systematically recall some reasons why albumin may be low
- Low production (chronic liver disease/ malnutrition)
- Loss (gut/ kidney (nephrotic))
- Sepsis, “3rd sponge” - due to endothelial leaking
What is the best measure of acute liver function?
Prothrombin time
Recall 4 scenarios in which AFP is raised
- Pregnancy (physiolgically)
- Hepatocellular carcinoma
- Testicular cancer
- Hepatic damage/ regeneration
What are the 2 possible causes of jaundice when LFTs are normal?
Gilbert’s
Haemolysis
In a jaundiced patient with a raised ALP, what should your diagnostic approach be?
Do a USS
If dilated ducts: gallstones/ cancer
If undilated ducts: drugs/ PSC/PBC/ pregnancy
What in the LFTs would indicate that jaundice had a hepatocellular origin?
Raised ALT/AST as opposed to ALP
How can you identify obstructive jaundice clinically without measuring bilirubin?
Pale stool and dark urine
ALT> AST =
AST : ALT in a 1:1 ratio =
ALT increased more than AST = chronic liver disease for whatever cause
AST same ratio to ALT = viral hepatitis
Which common drug is often implicated in cholestasis?
Augmentin (co-amoxiclav)
Which type of hepatitis is most common cause of acute viral illness in returning travellers?
Hepatitis A (water-borne)
What USS finding is very suggestive of liver cirrhosis?
Coarse liver
Which type of hepatitis is most likely to be transmitted by IV drug use?
Hep C