LFTS

Question 1

what are these markers?
Alanine transaminase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma-glutamyltransferase (GGT)

Answer 1

Enzymes (Liver Injury):
ALT and AST are markers of hepatocellular injury.
ALP and GGT are markers of cholestasis.

Question 1

Raised AST/ALT ratio 2:1

Answer 1

classical of alcoholic liver disease.

Question 2

Common Causes of raised AST: CABI

Answer 2

Cirrhosis
Alcohol
Budd-Chiari syndrome
Ischemic liver injury

Question 3

raised alt + range

Answer 3

0-32
Viral hepatitis
Autoimmune diseases
Medications
Pregnancy
Hemochromatosis
NAFLD
Toxins

Question 4

raised ALP + range

Answer 4

physio: (CAPG )
1. chlid growth
2. preg
3. 60 years
4. blood group O/B
5. fatty acid

patho:
1. intrahepatic: bile formation
- cholestatic:
PBC, PSC. - infiltrate: lymphoma, Amyloid - granulomatous hepatitis: TB, sarcoid

2.extrahepatic: bile obstruction.
- pancreatic ca
- gallblader/ stricture

Question 5

high GGT (Car phd)

Answer 5

6-42
· alcohol
· anticonvulsant
· liver disease
· COPD
· renal
· DM
· hyperthyroidism
· RA
· pancreatic ca

Question 6

Albumin. –> CNS (range)

Answer 6

35-50
1. CKD, CLD, CHD
2. Nephrotic syndrome
3. Sepsis
CNS

Question 7

bilirubin (range)

Answer 7

jundice
0-21

Question 8

prothrombin/INR (more senstive)

Answer 8

INR: <1
On warfarin 2-3
If high give vit K/ FFP

Question 9

prolonged PT:

Answer 9

vit K deficiency,
warfarin, heparin bolus,
-DIC, hypothermia.

Question 10

how to evaluate: LFTS

Answer 10

1. pattern: hmt
   - hepatocellular: (ALT +AST)
   - cholestatic (GGT, ALP)
   - isolated hyperbilirubinemia:
2. magnitude of abnormal liver test: 100 or 1000 the amount
3. timing: when was it last normal (acute/ chronic)
4. population (disease)
5. lab investigation

Question 11

investigation of abnormal lfts

Answer 11

history:
medical history, RF, alcholol use disorder +collateral , herbal remedies, dietary, OTC, med

clinical exam
CLD
tattos—→ hep b
IVDU—> hep C
weight —> NLFD

1. Fbc, U&E, LFT, TFT,
2. Us abdomen —> nodular liver (cirrhosis) —> portal hypertension (ascites, splenomegaly)
3. fibroscan: assess(severity)quantifies amount of fats (mild, mod, sever), (reversibility)stages liver disease reversible (IE fibrosis / irreversible cirrhosis), staging
4. liver/ blood/spleen screen
5. liver biopsy
6. liver causes/aeitiology screen: VAMP Hint
   - viral infection: hep b, c , CMV, EBV, HIV, HSV, anti-hbsAg/ anti-hbcAg, hb core antibody
   - PCR
   - autoimmune: ANA, ANCA, AMA, ASMA, anti-LKM
   - alpha-AT level +phenotype
   - iron over load: ferritin, transferrin sats >45%—→ hematochromatosis genetic test
   - wilson’s disease: >40 years old : 24 urine collection cu, caerulplasmin
   - NAFLD: weight, glucose, HBA1c, lipids
   - drug toxin
   - hellp syndrom

Question 12

ALP is high