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
What is the ELF score, and how is it calculated?
Enhanced liver fibrosis score
Combines TMIP-1, P11 NP and HA in a clever algorithm
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