Chempath - liver function test + cases

Question 1

Which tests is useful in understanding if liver damage is acute or chronic

Answer 1

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

Question 2

High Br
Normal other LFTs

^give 2 causes?

Answer 2

Haemolysis

Gilbert’s

Question 3

Low albumin
high Br
vv high AST:ALT ratio

Answer 3

chronic alcoholic liver disease

Question 4

If high Br + high ALP, what investigation would you like to do to determine the cause?
Why?

Answer 4

Renal USS, to see if bile ducts are dialted

Question 5

High Br
High ALP
USS shows normal bile ducts

^what 3 Dx can cause these results?

Answer 5

PBC
PSC
drugs

Question 6

Name a drug which can cause cholestasis?

Answer 6

Augmentin

Question 7

24 year old male
Yellow sclera 
No PMH
single binge drinker denies drugs
No bilirubinuria on dipstick testing
All other LFTs normal

Answer 7

Gilbert’s

Question 8

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?

Answer 8

Drug induced cholestasis due to augmenting

Question 9

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

Answer 9

Pancreatic adenocarcinoma

Question 10

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

Answer 10

Hepatitis A virus

Question 11

How to diagnosis HAV?

Answer 11

IgM anti-HAV positive

Question 12

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

Answer 12

Hepatitis C infection

Question 13

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?

Answer 13

N-acetylcysteine

Question 14

Absent urobilinogen in urine?

Answer 14

Obstructive jaundice

Question 15

Marker of chronic alcohol use

Answer 15

GGT

Question 16

When to suspect alcoholic liver disease?

Answer 16

AST:ALT is 2:1

Question 17

Raised conjugated Br. No change in other markers

Answer 17

Dublin Johnson syndrome (increased conjug Br secretion into bile)

Question 18

Raised unconjugated Br. No change in other markers

Answer 18

Crigler- Najjar

Question 19

Isolated rise in GGT?

Answer 19

acute alcohol intoxication

Question 20

LFT derangement seen in non-alcoholic fatty liver disease?

Answer 20

AST and ALT raised (AST

Question 21

Crigler-Najar disease

Answer 21

Glucoronyl transferase defect –> cannot transport Br into hepatocytes –> jaundice

Question 22

Gilberts - what is the key defect?

Answer 22

UGT1A1 deficiency