Investigations

Question 1

What do results of LFTs show in liver disease?

Answer 1

• Rise in ALT, AST&raquo_space; rise in ALP and very high bilirubin = hepatocellular damage
• Rise in ALT, AST &laquo_space;risk in ALP and high bilirubin= obstructive cause

Question 2

Red flags for cancer

Answer 2

• Unintentional weight loss
• Cachexia
• Lymphadenopathy
• Craggy liver edge
• Risk factors predisposing to cancer

Question 3

When do you think of pancreatic cancer?

Answer 3

Carcinoma of head of pancreas is most common. Should be actively excluded in patients over 40 yrs who have painless, obstructive jaundice.

Question 4

What is the most common liver cancer?

Answer 4

Hepatocellular carcinoma is common in patients with liver cirrhosis - check serum alpha-fetoprotein levels.

Question 5

What is the most common gallbladder cancer?

Answer 5

Cholangio-carcinoma is rare but palpate the gallbladder on examination to check.

Question 6

What do blood tests show in acute hepatitis?

Answer 6

• Raised ALT/AST (often >1000)
• High bilirubin
• Renal impairment

Question 7

What do tests show in chronic hepatitis?

Answer 7

• Mild elevation in ALT
• Screening people at risk
• Presents with cirrhosis

Question 8

What do blood tests for hepatocellular jaundice show?

Answer 8

Unconjugated bilirubin increased so increased ALT

Question 9

How would you diagnose cholecystitis?

Answer 9

• Ultrasound
• ERCP (endoscopy and fluoroscopy)
• MRCP (cholangiopancreatography)

Question 10

Why would MRCP (cholangiopancreatography) be used to diagnose cholecystitis?

Answer 10

If ultrasound hasn’t detected any stones but bile duct is dilated and/or LFTs are abnormal.

Question 11

What does transudate SAAG result mean?

Answer 11

SAAG > 1.1g/L

• Liver cirrhosis with portal hypertension
• Congestive cardiac failure
• Nephrotic syndrome

Question 12

What does exudate SAAG result mean?

Answer 12

SAAG < 1.1g/L

• Malignancy (liver peritoneal metastases)
• Inflammation e.g. peritoneal TB