Hepatobillary Tests Flashcards
What could an isolated rise in bilirubin suggest?
Metabolism of bilirubin eg Gilbert’s disease
Or increased destruction of RBCs - haemolysis
A combination of high bilirubin and abnormal LFTs indicts what?
Billary obstruction
What can a raised AST (aspartate aminotransferase) be caused by?
Hepatocelluar damage eg acute hepatitis
Heart - following a MI
Skeletal muscle damage
Which aminotransferase is more specific for the liver?
Alanine aminotransferase
What liver problems cause a rise in ALP?
Cholestasis
Within the liver- hepatitis, alcoholic diseas, PBC, cirrhosis, drugs, cancer
Extra hepatic - stone in a bile duct, stricture, cancer or pancreatic inflammation
Where is ALP situated in the liver?
In the canalicular and sinusoidal membranes ,
They rise in Cholestasis
How do you work out if the rise in ALP is liver or bone related?
Look at gamma-GT levels, it should rise in parallel in liver disease (cholestasis) due to the similar excretion pathway.
Bone problems look at cal, phos, and vit
D, and PTH.
What does rise in GGT (gamma) in the liver caused by?
It is induced by alcohol and enzyme-inducing drugs.
What tests would confirm the diagnosis of hep c?
HCV antibodies, and HCV RNA in serum
What tests would indicated a dx of Primry billary cirrhosis?
Serum anti mitochondrial antibodies
Raised serum IgM
What serology would you find in someone with a hep b infection?
HBsAg +- HBeAg/DNA in serum
What serological markers are present in acute and chronic hep B infection,?
Acute and chronic have
+ve HBsAg and +ve anti-HBc IgG
They both have -ve anti-HBs
IgM anti-HBc is +ve in acute and -be in chronic
What serology for hep B would someone have if they were immunised by vaccination,
Anti - HBs would be positive
All others would be negative
Which are the best markers of liver function?
Prothrombin time an serum albumin
What’s the current investigation of choice for liver cirrhosis?
Transient elastography (2016 nice) also called fibroscan
Measures the stiffness of the liver.
