Jaundice and LFTs

Question 1

What vitamin does the liver activate?

Answer 1

D- helps absorption of calcium

Question 2

Why would someone with liver disease bruise more easily?

Answer 2

Reduced production of clotting factors

Question 3

Why do we use LFTs?

Answer 3

To confirm liver disease/damage

Allows to differentiate between hepatocellular injury (direct injury to the liver) and cholestasis (decrease in bile secretion - normally due to bile obstruction)

Question 4

What are the “true” LFTs?

Answer 4

Albumin
Bilirubin
PT (prothrombin time)

Measure of protein synthesis

Question 5

What are the other (non-true) LFTs?

Answer 5

ALT - alanine aminotransferase
AST - aspartate aminortransferase
ALP - alkaline phosphate
GGT - gamma - glutamyltransferase

Measure of enzyme activity

Question 6

You diagnose someone purely on AST and ALT levels. True/false?

Answer 6

False

Question 7

What LFTs increase due to hepatocellular damage?

Answer 7

ALT

AST

Question 8

What LFTs increase due to cholestasis?

Answer 8

ALP

GGT - (used to show that increase ALP is due to biliary obstruction and not to do with bones)

Question 9

What LFT increases due to large alcohol intake/drugs?

Answer 9

GGT

Question 10

What is the only LFT enzyme to be found solely in the liver?

Answer 10

ALT

Question 11

If experiencing v.high levels of aminotransferase (>1000 U/l) what is this almost always caused by?

Answer 11

Hepatitis

Question 12

How would you expect increase in ALT and ALP to be to confirm more hepatocellular injury/ cholestasis (remember it can be a mixed cause)

Answer 12

> 10x increase in ALT and <3x increase in ALP = hepatocellular injury

<10x in ALT and >3x increase in ALP = cholestasis

Question 13

Will a patient has higher AST or ALT levels if they have acute damage?

Answer 13

AST > ALT

AST is a marker of acute damage - acute alcoholic hepatitis/ cirrhosis

Question 14

ALT> AST levels is indicative of what?

Answer 14

Chronic liver disease

Question 15

Chronic liver disease will never cause AST levels to be higher than what?

Answer 15

1000 U/l

Question 16

What would LFTs look like in chronic hepatocellular damage?

Answer 16

Raised or normal

Question 17

What is the role of albumin? What effect does cirrhosis have on its production?

Answer 17

Maintain intravascular osmotic pressure (opposes filtration)

Decrease (acute phase of inflammation also causes albumin to temporarily drop)

Question 18

What is prothrombin time?

Answer 18

A measure of the time taken for blood to clot

will sometimes increase due to decrease in clotting factor production

Question 19

What is bilirubin?

What happens to it in the liver?

Answer 19

A breakdown product of Hb

It becomes conjugated

Question 20

What are the 3 causes of jaundice and what kind of Hyperbilirubinemia is associated with each

Answer 20

Pre-hepatic - UCB
Hepatocellular - CB and UCB
Post-Hepatic - CB

Question 21

Describe the stool changes assoc. with each kind of jaundice and briefly explain why this happens?

Answer 21

Pre-hepatic - normal urine and normal stools
Hepatic - dark urine and normal stools
Post-hepatic - dark urine and light stools (Steatorrhea)

UCB is insoluble in water and hence increase has no effect on urine
CB is soluble and makes urine darker

CB is released with bile and lipases into small intestine - these all help stool to form normally. If problem with obstruction of biliary tree we get steatorrhea

Question 22

Give 2 examples of causes of each type of jaundice

Answer 22

Pre-hepatic

• Gilbert’s syndrome
• Haemolytic anaemia

Hepatocellular

• Cirrohsis
• Alcoholic liver disease
• Viral hepatitis

Post-hepatic

• Gallstones
• Cancer
• Drug-induced cholestasis

Question 23

If a patient presents with high UCB and normal LFTs what should be suspected?
Under what circumstances may the patient be presented with jaundice?

Answer 23

Gilbert’s syndrome (a genetic condition which causes a decrease in function of enzyme which conjugates bilirubin)

Stress
Alcohol binge
Infection/illness

Question 24

At what level of bilirubin would you begin to see jaundice?

Answer 24

When hits excess of 35 u/mol