L1: LFTs Flashcards
Tests of liver cell integrity (Injury)
- ALT
- AST
Tests of biliary tract Integrity (Cholestasis)
- ALP
- GGT
- 5’-nucleotidase
Tests of Liver cell Function
- Albumin
- Bili
- INR
Liver Biochemestries
Aminotransferases
ALT
AST
Degree of elevation of → AST and ALT are useful in distinguishing ….
acute and chronic liver diseases.
ALT and AST → are the most widely ordered liver chemistries that reflect injury to the liver.
….
aminotransferase levels < 300 iu ml
- alcoholic hepatitis
- non-alcoholic fatty liver disease
- Chronic viral hepatitis (hepatitis B and C).
patients with levels between 500 iu ml and 5,000 iu ml
- acute viral hepatitis
- autoimmune hepatitis
- drug reaction Viral
- drug induced hepatitis will raise aminotransferase levels steadily and peak in the low thousands within 7-14 days, return to normal over weeks
high levels (greater than 5,000 iu ml)
- acetaminophen related liver failure
- ischemia
- herpes simplex hepatitis
what to suspect when ALT > AST?
Typical for most liver conditions, including chronic viral hepatitis and NAFLD
what to suspect when ALT < AST?
AST > ALT Ratio results from ……
Def of Cholestasis
- impairment in bile flow.
- Cholestasis liver profile characterized by -an elevation in alkaline phosphatase with or without an elevation in bilirubin.
Normal alk phosphate level
125 IU/ml
When SAP elevation is detected, …..
- Repeat the test.
- Confirm the hepatic origin: Serum GGT - 5’Nucleotidase.
causes of elevated Serum alkaline phosphate
Albumin
PT
Bilirubin
Child-Turcotte-Pugh Classification for Severity of Cirrhosis
Isolated elevated indirect (unconjugated) bilirubin
- Hemolysis
- Drugs
- Gilbert’s Disease
- Crigler-Najjar type Il
Drugs
Isolated elevated indirect (unconjugated) bilirubin
Probenecid, Rifampicin
Gilbert’s Syndrome
Isolated elevated indirect (unconjugated) bilirubin
CNJ Type II
Isolated elevated indirect (unconjugated) bilirubin
A. Caused by gene mutation
B. Reduced activity of Bilirubin UDP glucuronosyl
Causes of Intrahepatic Cholestasis
Causes of Extrahepatic Cholestasis
Causes of hepatocellular injury
Etiology of PBC
Unknown
pathology of PBC
Injury of the interlobular or septal bile ducts.
CP of PBC
Investigations for PBC
- LFTS: Raised serum ALP
- Serology positive AMA in 95% of patient, high serum IgM.
- Liver biopsy: Injury of the interlobular or septal bile ducts.
TTT of PBC
Symptomatic TTT of PBC
Causes of Pruritis
- Obstructive jaundice
- Cholestasis of pregnancy
- Renal failure
- Lymphoma
- PBC
- DM
- Leukemia
- Polycythemia Rubra Vera
Def of PSC
- chronic progressive disorder of unknown etiology that is characterized by inflammation, fibrosis, and structuring of medium size and large ducts in the intrahepatic and extrahepatic biliary tree
Incidence of PSC
90% have inflammatory bowel disease, especially ulcerative colitis
Symptoms of PSC
Pruritus, fatigue, RUQ pain
Dx of PSC
- Ultrasound
- Cholangiogram: multifocal stricturing and dilation of intrahepatic
Prognosis of PSC
- Poor; average life expectancy after diagnosis is -12 years
- 10-15% risk of developing cholangiocarcinoma
what is the ultimate TTT of PSC?
Transplant
