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Year 3 OSCE > Interpretation Of LFT's > Flashcards

Interpretation Of LFT's Flashcards

1
Q

Acute hepatitis

A

ALT/AST in 1000 (massive increase), ALP mildly raised

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2
Q

Chronic hepatitis

A

ALT/AST in 100’s (milder increase)

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3
Q

Cholestatic/ obstructive picture

A

ALP markedly raised, ALT/AST mildly raised, increased bilirubin

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4
Q

Alcoholic picture

A

Increased gamma GT, increased MCV, AST/ALT mildly elevated, increased bilirubin in acute alcoholic hepatitis

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5
Q

Cirrhosis/ chronic liver disease (not chronic hepatitis)

A

Liver enzymes may be normal, decreased albumin, abnormal coagulation profile

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6
Q

Marked increases ALP (>4x normal)

A

Cholestasis (gallstones, PBC, PSC, pancreatic cancer)

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7
Q

Moderate increase ALP (<3x normal)

A

Hepatitis, infiltration, cirrhosis

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8
Q

Gamma GT

A

Mirrors ALP so can be used to confirm if a raised ALP is hepatic in origin

Also raised with alcohol abus

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9
Q

Unconjugated hyperbilirubinaemia

A

Pre hepatic jaundice

Increased RBC breakdown eg. Sickle cell or thalassaemia
Impaired hepatic uptake eg. Heart failure
Impaired conjugation eg. Physiological neonatal jaundice

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10
Q

Conjugated hyperbilirubinaemia

A 
Hepatocellular dysfunction (liver disease)- hepatic jaundice
Impaired hepatic secretion (cholestasis)- post hepatic jaundice
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11
Q

Decreased albumin decreased protein

A

Advanced cirrhosis, alcoholism, protein malnutrition, chronic inflammation, gut/ renal loss

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12
Q

Decreased albumin and normal protein

A

Infection (albumin is a negative acute phase protein)

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13
Q

Decreased albumin and increased protein

A

Myeloma, chronic inflammation (autoimmune condition), acute infection

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14
Q

Drugs that cause hepatitis

A

TB antibiotics, sodium valproate, methotrexate, amiodarone, statins, paracetamol, nitrofurantoin, sulfonylureas

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15
Q

Cholestasis drugs

A

Co amoxiclav, clarithromycin, carbamazepine, sulfonylureas, COCP

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16
Q

Red urine

A

Haematuria, haemoglobinuria, porphyria, beetroot, rifampicin

17
Q

Brown urine

A

Bile pigments, myoglobin, metronidazole, nitrofurantoin

18
Q

Green/ blue urine

A

Pseudomonas UTI, biliverdin, amitryptilline

19
Q

Orange urine

A

Bile pigments

20
Q

Aminotransferases

A

ALT- liver specific
AST- liver, heart, skeleton, kidney,pancreas

Marked increase (>1000): drug induced hepatitis, acute viral hepatitis, liver ischaemia 
Modest increase (300-500): chronic viral, alcoholic, autoimmune, biliary obstruction 
Mild increase (<300): cirrhosis, NA steatohepatitis, HCC, haemachromatosis, Wilson’s

ALT>AST: chronic liver disease
AST>ALT: greater in established cirrhosis and much greater in alcoholic liver disease

21
Q

Alkaline Phosphatase (ALP)

A

Main source is biliary ducts and bone (Pagets, bony metastasis, fracture, osteomalacia, renal bone disease)

Lesser source- placenta (pregnancy), small intestine (fatty meals) and kidneys (CKD)

NB- if ALP is hepatic in origin yGT will also rise (isosnzyme analysis)

22
Q

Viral tests to find liver abnormality cause

A

Viral hepatitides
CMV serology
EBV serology

23
Q

Autoimmune liver screen to identify liver abnormality

A 
Anti smooth muscle (autoimmune hepatitis type 1)
Anti mitochondrial (PBC)
Anti liver kidney microsomal (autoimmune hepatitis type 2, hepatitis CD, drug induced hepatitis) 
Anti nuclear (autoimmune hepatitis type 1, SLE)
24
Q

Tumour markers to identify liver abnormality

A

Alpha fetoprotein (HCC)

25
Q

Tests to discover infiltrative cause in liver abnormality

A

Ferritin and transferrin saturation (haemachromatosis)- careful as ferritin is an acute phase protein
Fasting glucose and lipids- fatty liver disease

26
Q

Metabolic investigations for liver abnormality

A

Alpha 1 antitrypsin
TTG antibody- coealic disease
Immunoglobulins- PBC, alcoholic liver disease, autoimmune hepatitis

27
Q

Liver biopsy

A

CT guided, but done transjugularly if there is ascites or coagulopathy

28
Q

Non hepatic causes of deranged LFT

A

Hepatitis- TB antibiotics, valproate, methotrexate, methyldopa, amiodarone, statin, paracetamol, nitrofurantoin, sulfonylurea
Cholestasis- coamoxiclav, flucloxacillin, sulfonylurea, clarithromycin, contraceptives

RHS heart failure
Sepsis
Coeliac disease
Haemolysis
Hyperthyroidism 
Right lower lobe pneumonia
29
Q

Pre hepatic jaundice (non-liver aetiology)/

A

High unconjugated bilirubin
Normal conjugated billirubin
Normal liver enzymes

30
Q

Hepatic jaundice (liver aetiology)

A

Normal unconjugated bilirubin
High conjugated billirubin
High ALT/AST
Mild ALP increase

31
Q

Post hepatic jaundice (Obstructive cause)

A

Normal unconjugated bilirubin
Mildly increased conjugated bilirubin
Mildly increased ALT AST
High ALP

32
Q

Stool/urine in types of jaundice

A

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Year 3 OSCE (61 decks)

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