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Interpreting bloods Flashcards

1
Q

LFTs

Why might we order LFTs?

4

A
  • investigate patients for liver disease
  • monitor patients confirmed liver disease
  • monitor the effects of medications
  • baseline’ screening panel
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2
Q

LFTs

A
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3
Q

LFTs

ALT

A

Alanine aminotransferase

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4
Q

LFTs

AST

A

aspartate aminotransferase

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5
Q

LFTs

What are ALT and AST?

What do raised levels indicate?

A
  • enzymes found within liver cells at high concentrations
  • liver cell (hepatocyte) inflammation or damage.
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6
Q

LFTs

What can we assess using the ratio between AST and ALT?

A

The AST:ALT ratio can help determine the aetiology of hepatocellular injury, with a >2:1 ratio classical of alcoholic liver disease.

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7
Q

LFTs

What are some common causes of hepatocellular injury?

A
  • Hepatitis (viral, alcoholic, ischaemic)
  • Liver cirrhosis
  • Drug / toxin-induced liver injury (e.g. paracetamol overdose)
  • Malignancy (hepatocellular carcinoma)
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8
Q

LFTs

ALP

A

alkaline phosphatase

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9
Q

LFTs

GGT

A

Gamma-glutamyltransferase

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10
Q

LFTs

Where is ALP derived from?

What do raised levels indicate?

A

biliary epithelial cells

cholestasis or bone disease

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11
Q

LFTs

Where is GGT found?

How do we interpret its levels?

A

hepatocytes and also biliary epithelial cells

It is a non-specific but highly sensitive marker of liver damage and cholestasis.

ALP and GGT are interpreted together to localise the source of raised ALP in the blood

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12
Q

LFTs

How do we interpret ALP and GGT together?

3

A
  • high ALP + normal GGT => bone disease
  • high ALP rise + high GGT => cholestasis
  • normal ALP + high GGT => alcohol excess
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13
Q

LFTs

Bilirubin is a waste product of ____

A

haemoglobin breakdown

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14
Q

LFTs

Raised levels of bilirubin in the blood will lead to ____

A

jaundice

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15
Q

LFTs

Jaundice is usually absent until the bilirubin level exceeds ____ micromol/L.

A

50 micromol/L

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16
Q

LFTs

Describe the bilirubin metabolism/excretion pathway.

A
  • RBC breakdown -> unconjugated bilirubin -> binds to albumin in the bloodstream
  • Hepatocytes take up unconjugated bilirubin -> conjugated bilirubin
  • conjugated bilirubin -> biliary tract -> bowel lumen (bile)
  • Gut bacteria + bile -> urobilinogen -> stercobilinogen (stool)

A small amount of urobilinogen is reabsorbed from the intestine into the portal venous system, and as urobilinogen is water-soluble, the kidney is able to excrete some of this into the urine.

17
Q

LFTs

In pre-hepatic jaundice, patients are often anaemic due to excess red blood cell breakdown. The diagnosis may be ____ if no anaemia is present.

A

Gilbert’s syndrome

18
Q

LFTs

Causes of predominantly unconjugated hyperbilirubinaemia:

2

A
  • Pre-hepatic jaundice (e.g. haemolysis)
  • Gilbert syndrome
19
Q

LFTs

Causes of predominantly conjugated hyperbilirubinaemia:

2

A
  • Cholestasis
  • Hepatocellular jaundice (!)

! Hepatocellular jaundice can initially cause a mixed conjugated/unconjugated jaundice, but at its most severe, unconjugated hyperbilirubinaemia is seen.

20
Q

LFTs

What is the role of albumin?

A

helps to bind water, cations, fatty acids and bilirubin. It also plays a crucial role in maintaining the oncotic pressure of blood

21
Q

LFTs

How is albumin used to assess the liver?

A

as a non-specific marker of the synthetic function of the liver.

22
Q

LFTs

Albumin levels can fall due to:

2

A
  • Decreased albumin production: malnutrition, severe liver disease
  • Increased albumin loss: protein-losing enteropathies, nephrotic syndrome
23
Q

LFTs

A decrease in the synthetic function of the liver indicates ____.

A

severe liver disease

24
Q

LFTs

Severe liver disease leads to decreased production of clotting factors and an increased____ / ____ in the absence of other causes of coagulopathy.

A

prothrombin time (PT) / INR

25
Q

LFTs

A greater than 10-fold increase in ALT and a less than 3-fold increase in ALP suggests a predominantly ____

A

hepatocellular injury

26
Q

LFTs

A less than 10-fold increase in ALT and a more than 3-fold increase in ALP suggests ____

A

cholestasis

27
Q

LFTs

An isolated ALP rise without a GGT rise should raise your suspicion of ____.

A

bony pathology

28
Q

LFTs

An isolated bilirubin rise without further LFT derangement suggests ____ or ____ .

A

pre-hepatic jaundice or Gilbert’s disease

29
Q

LFTs

How might LFTs appear in chronic hepatocellular pathology?

A

the ALT / AST may return to within the normal range, however synthetic function of the liver can be markedly impaired.

Y3 other (7 decks)

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