Interpretation- LFTs

Question 1

Aminotransferases

Answer 1

ALT and AST

Question 2

Source of ALT

Answer 2

Specific to liver

Question 3

Marked increase in aminotransferases (1000s)

Answer 3

Hepatitis (toxin/drug/viral)

Liver ischaemia

Question 4

Modest increase in aminotransferases (300-500)

Answer 4

Chronic/alcoholic/autoimmune hepatitis

Biliary obstruction

Question 5

Sources of alkaline phosphatase

Answer 5

Biliary ducts

Bone (Paget’s disease, bony mets, fractures)

Question 6

> 4x increase In ALP

Answer 6

Cholestasis e.g. gallstones, PBC, PSC, pancreatic cancer)

Question 7

Usefulness of gamma GT

Answer 7

Mirrors ALP- confirms hepatic origin of ALP increase

Question 8

Unconjugated hyperbilirubinaemia

Answer 8

Increased RCC breakdown (haemolysis)

Impaired conjugation

Question 9

Conjugated hyperbilirubinaemia

Answer 9

Cholestasis

Hepatocellular dysfunction

Question 10

Decreased albumin

Answer 10

Cirrhosis; alcoholism; chronic inflammation; renal/skin/gut loss
Infection
Myeloma

Question 11

Raised INR

Answer 11

Liver disease
Vitamin K deficiency
Warfarin

Question 12

Further tests to investigate cause of liver damage

Answer 12

Viral assays (Ig, PCR)
Autoimmune screen
Tumour markers
Toxins

Question 13

1st line imaging

Answer 13

Abdominal ultrasound

Question 14

Imagining to confirm pancreatitis/CT

Answer 14

Abdominal CT

Question 15

Common drugs which can derange LFTs

Answer 15

Analgesics (paracetamol, NSAIDs)
Flucloxacilin/co-amoxiclav)
Amiodarone
Methotrexate
Statins