LFTs Flashcards
What are the hepatocellular LFT markers?
ALT
AST
What are the cholestatic LFT markers?
ALP
GGT
What are the synthetic function LFT markers?
albumin
prothrombin time/INR
Where is ALT produced?
liver
Where is AST produced?
liver
heart
skeletal muscle
kidney
brain
RBC
Where is ALP produced?
liver and bone predominantly
bile ducts
kidneys
placenta
intestines
Where is GGT produced?
liver
bile ducts
Where is bilirubin produced?
bone marrow
liver
Where is albumin produced?
exclusively by liver
Albumin usual function
protein involved in maintaining blood oncotic pressure
Why can albumin still be normal in severe acute liver disease?
has a half life of 20 days so will still be in circulation
Why is a raised INR concerning if the patient is not on warfarin therapy?
indicates impairment of liver synthetic function
Hepatocellular injury LFTs
raised ALT
and/or raised AST
with or without raised bilirubin
Hepatocellular injury acute causes
acute viral hepatitis
acute ischaemic hepatitis
autoimmune
drug-induced liver injury
Hepatocellular injury chronic causes
Hep B + C
alcohol-related liver disease
autoimmune hepatitis
rarer genetic causes
Cholestatic LFTs
raised ALP
raised GGT
with or without raised bilirubin
Acute causes of cholestatic LFTs
gallstones
choledocholithiasis
acute cholecystitis
drug-induced injury to bile ducts
Chronic causes of cholestatic LFTs
PBC
PSC
bile duct stricture
malignancy (HOP)
high ALT
high AST
healthy young man
?viral hepatitis (from mother at birth)
Chronic Hep B/C
high ALT
high AST
high INR
prev. LFTs normal
ischaemic heart disease
syncopal episode
ischaemic hepatitis
high ALT
high AST
T2DM
HTN
NAFLD (as risk factors present)
hepatocellular injury pattern
low Hb
high MCV
high ALT
high AST
AST/ALT>2
ask about alcohol history
hepatocellular injury pattern
valproate
high bilirubin
high ALT
high AST
normal LFTs before
drug-induced liver injury
hepatocellular injury pattern
fever
sore throat
jaundice
high bilirubin
high AST
high ALT
low platelets
splenomegaly
EBV infection
What factors would be present in a Hep E history?
travel
gastroenteritis (transmitted faecal-oral route)
muscle aches
high ALT
significantly high AST
muscle damage
AST is released from muscles
80y
frail
#NOF
high bilirubin
very high ALT
high AST
high ALP
high GGT
high INR
more hepatocellular picture as ALT very raised
drug-induced liver injury (paracetamol toxicity post surgery)
Acute liver failure triad
jaundice
altered mental status
coagulopathy
RUQ pain
fevers
raised ALP
raised GGT
gallstones, cholecystitis
high ALP
high GGT
xanthelasma
LFTs been abnormal for a while
primary biliary cholangitis
What is the autoantibody present in primary biliary cholangitis?
anti-mitochondrial
IBD
raised ALP
raised GGT
primary sclerosing cholangitis
What would an MRCP show in primary sclerosing cholangitis?
stricturing of bile ducts
What autoantibodies are present in primary sclerosing cholangitis?
ANCA (p-ANCA)
weight loss
abdo pain
jaundice
high bilirubin
high ALT
high AST
high ALP
high GGT
(mostly cholestatic picture)
?cancer
gallstones
urinary issues
high ALP
normal GGT
bone cause (do bone profile, PSA, Vit D)
high ALP
high GGT
pneumonia
drug-induced (eg. co-amoxiclav)
cholestasis of sepsis
isolated high unconjugated bilirubin cause
Gilbert’s
