Investigations in Liver Disease Flashcards
What blood tests are done in liver disease?
LFTs
Liver Screen
Haemolysis Screen if indicated
What imaging is done?
US/Fibroscan
CT
MRI/MRCP
Apart from bloods and imaging what other Ix are done?
Liver biopsy
Endoscopy - diagnostic, ERCP
ALT
Alanine Aminotransferase
Liver specific
What does AST stand for?
Aspartate Aminotransferase
What does ALP stand for?
Alkaline Phosphatase
What does GGT stand for?
Gamma glutamyl transpeptidase
What is AST?
Mitochondrial
Heart/muscle/kidney
Raised in hepatitis
What is ALP?
Bone/placenta
Bine canalicular and sinusoidal membranes
Cholestasis = intra/extrahepatic
What is GGT?
Hepatocellular conditions
cholestasis
Alcohol excess
What other things are done in LFTs apart from enzymes
Bilirubin
PT - prothrombin time
Albumin
When are liver enzymes raised?
Inflammation
Hepatitis
When are other liver function measures raised?
Chronic liver disease - synthetic problem
What viral screens are done?
HbsAg
HCV Ab
IgM HAV
IgM HEV
What immunoglobulins are looked for?
IgA = alcoholic liver disease IgM = PBC IgG = autoimmune hepatitis
(cirrhosis may have elevated all 3)
Auto-antibodies
PBC = AMA subtype M2 AIH = ANA, SMA, SLA PSC = ANCA
Metabolic liver disease blood tests
NAFLD = high lipids, high fasting sugar Haemochromatosis = high ferritin, HFE genotype Wilsons = caeruloplasmin in <40 yrs A1AT = co-factor in adults
What is the blood test pattern of a cholestatic condition?
High ALP
With or without high bilirubin (high if more severe)
What is the blood test pattern of a hepatic condition?
High enzymes
High bilirubin if more serious
What is the blood test pattern of a synthetic condition?
Low albumin
Long PT
Low platelets
What is the blood test pattern of a mixed condition?
High bilirubin
High enzymes
High ALP
Causes of a synthetic condition
Cirrhosis
Causes of a hepatic condition
NAFLD Alcohol liver disease Drugs Autoimmune hepatitis Viral
Causes of a cholestatic condition
Common bile duct Stones
Drugs - microscopic biliary tree damage
PBC/PSC
Causes of mixed conditions
Alcoholic liver disease
Drugs
NAFLD
What is the first imaging step?
Always ultrasound
Signs of cirrhosis on US
Nodular Ascites Enlarged spleen Dilated portal vein Reverse portal vein flow
Signs of biliary/duct dilatation on US
Pancreatic tract stones or cancer
Common bile duct stones
Space occupying lesions in liver US use
Primary HCC or metastases
What further imaging would you do after US?
CT triple phase - nature of lesion
MRI/MRCP
What is MRCP good for?
To look at biliary tree better
Percutaneous liver biopsy
Diagnostic + staging
Bleeding risk
Transjugular liver biopsy
Reduced risk of bleeding
Less pain
Smaller size of specimen
Hepatic vein pressure readings
When is a biopsy required?
Confirm scarring
Detect cancer
When can transjugular liver biopsy be better?
Cirrhosis - impaired clotting not good with risk of bleeding & ascites
Fibroscan
- measures liver stiffness
- elevated score = scarring
- non invasive so less need for biopsies
- diagnosis and monitoring
Use of endoscopy
Varices screening - detect bleeding risk - grade 1-4 Treatment of varices - oesophageal ligation or banding -injection of glue for gastric varices Surveillance of varies
ERCP
Endoscopic Retrograde Cholangio Pancreaticography
- fluoroscopic guidance
- diagnostic and therapy
- visualise pancreatic and biliary tree
- strictures/blocks detect
- crush stones
- stents to restore bile flow
Transjugular Intrahepatic Portosystemic Shunt
Small shunt between portal vein and hepatic vein via catheter through jugular vein
Reduced portal pressure
To embolise varices in recurrent variceal bleed
For ascites refractory to medical therapy
Downside of transjugular intrahepatic portosystemic shunt
Forces portal into systemic circulation via manmade shunt so increases risk of hepatic encephalopathy
