Chempath - liver function test + cases Flashcards
Which tests is useful in understanding if liver damage is acute or chronic
Albumin and clotting time
If clotting time is abnormal but albumin is normal, this indicates acute damage
Albumin will only be affected if liver damage is chronic
High Br
Normal other LFTs
^give 2 causes?
Haemolysis
Gilbert’s
Low albumin
high Br
vv high AST:ALT ratio
chronic alcoholic liver disease
If high Br + high ALP, what investigation would you like to do to determine the cause?
Why?
Renal USS, to see if bile ducts are dialted
High Br
High ALP
USS shows normal bile ducts
^what 3 Dx can cause these results?
PBC
PSC
drugs
Name a drug which can cause cholestasis?
Augmentin
24 year old male Yellow sclera No PMH single binge drinker denies drugs No bilirubinuria on dipstick testing All other LFTs normal
Gilbert’s
38F Itch, jaundice, dark urine PMH - benign breast lump, UTI 5/7 earlier treated by GP 21 units of alcohol/week Smokes 15/day No Sx of CLD Bilirubin in urine. Raised serum Br. Raised ALT>AST. ALP 1024. GGT 59. - Renal USS: no bile duct dilatation.
Dx?
Drug induced cholestasis due to augmenting
74 year old publican
3/52 Hx of itch, pale stools, dark urine, yellow sclera. 2/12 Hx of weight loss
PMH - cardiomyopathy, periph neuropathy
O/E - jaundiced, epigastric fullness, palpable GB
Bilirubin in urine
Low alb, high AST, ALP, GGT
Pancreatic adenocarcinoma
18F
Trip to Goa 1/52 ago
10/7 Hx of fevers, diarrhoea, arthralgia, jaundice
Taken some ‘tablets’ in night club + had small tattoo
No PMH
Jaundiced, no IVDU, no CLD Sx
High Br, ALT and AST in thousands, high ALP
Hepatitis A virus
How to diagnosis HAV?
IgM anti-HAV positive
54M Asymptomatic PMH hernia repair 2 units alcohol/day Palmar erythema + 5 spider naevi High Br, low albumin, high ALT + AST USS showed coarse liver texture + large spleen
Hepatitis C infection
19F
taken 32g paracetamol + alcohol intake
Alert, vomiting, RR 28
High Br, AST and ALT in 1000s, high ALP and GGT, low INR, Acidotic
What tx is needed?
N-acetylcysteine
Absent urobilinogen in urine?
Obstructive jaundice
Marker of chronic alcohol use
GGT
When to suspect alcoholic liver disease?
AST:ALT is 2:1
Raised conjugated Br. No change in other markers
Dublin Johnson syndrome (increased conjug Br secretion into bile)
Raised unconjugated Br. No change in other markers
Crigler- Najjar
Isolated rise in GGT?
acute alcohol intoxication
LFT derangement seen in non-alcoholic fatty liver disease?
AST and ALT raised (AST
Crigler-Najar disease
Glucoronyl transferase defect –> cannot transport Br into hepatocytes –> jaundice
Gilberts - what is the key defect?
UGT1A1 deficiency
