GI: LFTs, Investigations + Antibodies Flashcards
What are the LFTs?
Bilirubin ALT/AST ALP GGT Prothrombin (PT) Time Albumin
Which tests measure the liver synthetic function?
PT Time
Albumin
What is bilirubin? Where is it made?
The breakdown product of haemoglobin, made in the spleen
What causes an isolated rise in bilirubin? (All other LFTs normal)
Gilbert’s disease (congenital bilirubin defect) is most likely
Haemolysis is another potential cause
What are ALT/ASTs? What does their presence in the blood indicate?
Enzymes found within hepatocytes
Liver damage
What is a rise in GGT associated with?
Alcohol excess
What does a rise in bilirubin and ALP indicate?
Cholestatic jaundice
Could be intra-hepatic (originating within the liver) or extra-hepatic (originating out-with the liver)
What are some intra-hepatic causes of cholestatic jaundice?
Cirrhosis Viral hepatitis Alcoholic hepatitis Drugs Pregnancy
What are some extra-hepatic causes of jaundice?
Gall stones in the common bile duct Carcinoma Biliary stricture sclerosing cholangitis pancreatitis
What other symptoms are experienced with both intra and extra-hepatic jaundice?
Dark urine and pale stools
What can increase PT time?
Warfarin use, low vitamin K, liver disease
What can cause a decreased serum albumin and what does decreased serum albumin lead to?
Liver disease (hepatitis, cirrhosis), Crohn's disease Coeliac's disease Whipple's disease Low serum albumin leads to oedema *In cirrhosis, a combination of portal hypertension and low albumin leads to ascites
What can cause an increased serum albumin?
Dehydration
What is the first line investigation for suspected liver and biliary disease?
Ultrasound
What is the most sensitive investigation for focal liver disease?
MRI
Which investigation best diagnoses fatty liver disease?
Ultrasound
What invasive investigation is done for patients with primary biliary cirrhosis?
A liver biopsy
Which investigations are performed to diagnose primary sclerosing cholangitis?
MRCP
Liver biopsy
What is the first line investigation for Budd-Chiari syndrome?
Doppler ultrasound
What investigations would show a hepatocellular carcinoma?
CT scan
Ultrasound
What is the best modality for imaging gall stones?
Ultrasound
What is the definitive investigation for acute cholangitis?
ERCP - shows site, cause and allows bile to be sampled
Which investigation is performed to diagnose pancreatitis?
CT scan
Which investigation is performed to diagnose a carcinoma of the pancreas?
Ultrasound
