LFT bloods Flashcards

1
Q

Functions of the liver

A

conjugates and eliminates bile
clotting factor production
albumin synthesis
detox- fats, chemicals, meds
iron storage
bile production

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2
Q

What causes a low/ high albumin level in the blood?

A

Albumin- protein made in liver to maintain oncotic pressure

Hyper- servere dehydration

Hypo (2 categories)
-synethis (liver damage, inflammation, malnutrition, malignancy)
- excess loss (nephrotic syndrome, burns)

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3
Q

Name the LFT biomarkers.
Presence elsewhere in the body?

ALT
AST
ALP
GGT
Bilirubin
Albumin
Amylase
Clotting- PT
Autoimmune- Ig

A
  1. Bilirubin- break down of haem
    Isolated rise -> Gilberts of haemolysis
  2. ALT- liver only
    AST- skeletal and cardiac muscle
  3. ALP- present in biliary epithelial cells and bone.
    Isolated increase may be bone pathology/ Paget’s disease
  4. GGT- isolated rise indicates alcohol abuse
    Can be used to monitor progression of liver disease
  5. INR/ PT- assess clotting (fibrinogen, factors II, V, VII, X)- checked in warfarin, paracetamol OD
  6. Albumin- protein made in liver to maintain oncotic pressure
    Hyper- server dehydration
    Hypo- synethis (liver damage, inflammation, malnutrition)
    excess loss (nephrotic syndrome, burns)
  7. Autoimmune liver disease screening immunoglobulins- raised levels of IgM (PBC), IgA (alcohol), IgG (hepatitis)
  8. Amylase- check for pancreas function/ pancreatitis
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4
Q

What does an isolated AST mean?

A

MI- AST present in heart muscles

Haemolysis (malaria, sickle cell, thalassemia)

Biliary obstruction

Liver disease- jaundice

Renal failure- oedema

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5
Q

What does an isolated bilirubin rise mean in pre, hepatic and post-hepatic jaundice?

A

Pre-hepatic (usually unconjugated)- Haemolysis, Ineffective erythropoiesis

Hepatic (usually conjugated)- due to hepatitis or very severe liver failure
Chronic liver disease.

Post-hepatic- Obstructive jaundice secondary to intra- or extrahepatic causes

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6
Q

How is jaundice determined clinically?

A

Dark urine
Pale stool
Increased serum bilirubin

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7
Q

Causes of hepatocellular jaundice?
Pre-hepatic
Hepatic
Post-hepatic

A

Pre-hepatic: haemolytic anaemia

Hepatic- enzyme defects (gilberts syndrome, Crigler-syndrome), hepatitis, cirrhosis, drug-induced, alcohol

Post-hepatic- cholangitis, cholestasis, pancreatitis, cholangiocarcinoma

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8
Q

Causes of isolated ALP rises?

A

Paget’s disease- bone disorder, bones grow larger and become weaker

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9
Q

Causes of isolated GGT rises?

A

Alcohol abuse
Viral hepatitis
Epstein-Barr virus-
Enzyme-inducing drugs- statins, antiepileptics, antidepressants, PPIs

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10
Q

Low PT causes?

A

Warfarin medication
Liver clotting factor synthesis issue
Paracetamol OD

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11
Q

What is the fatty-liver pattern and its causes?

A

GGT 2-10 x ULN
Raised AST > ALT

Raised IgA
ALP normal
Macrocytosis- large RBC and higher MCV
Bilirubin normal
Albumin normal

Causes:
Obesity
Type-2 diabetes
Excessive alcohol

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12
Q

Explain the hepatocellular injury LFT ratios.

Which LFTs are raised in a hepatitic pattern?

Causes of hepatocellular injury?

A

AST:ALT ratio >2:1 indicative of acute alcohol related hepatitis.

AST:ALT >1 indicative of cirrhosis.

AST:ALT <1 suggestive chronic hepatitis/cholestatic syndromes.

Causes:
Hepatitis
Cirrhosis
Malignancy
Hepatotoxicity- meds OD/ SE

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13
Q

What is cholestasis?
Causes?

A

Impediment of bile flow through the biliary system- dark urine/ pale stools

Gallstones
Malignancy- strictures
Pregnancy
Medication
Intra/ extramural
PSC/ PBC

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14
Q

What LFTs are raised in a cholestatic picture?

A

ALP/ GGT
Bilibrubin

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