LFTs

Question 1

What are the hepatocellular LFT markers?

Answer 1

ALT
AST

Question 2

What are the cholestatic LFT markers?

Answer 2

ALP
GGT

Question 3

What are the synthetic function LFT markers?

Answer 3

albumin
prothrombin time/INR

Question 4

Where is ALT produced?

Answer 4

liver

Question 5

Where is AST produced?

Answer 5

liver
heart
skeletal muscle
kidney
brain
RBC

Question 6

Where is ALP produced?

Answer 6

liver and bone predominantly
bile ducts
kidneys
placenta
intestines

Question 7

Where is GGT produced?

Answer 7

liver
bile ducts

Question 8

Where is bilirubin produced?

Answer 8

bone marrow
liver

Question 9

Where is albumin produced?

Answer 9

exclusively by liver

Question 10

Albumin usual function

Answer 10

protein involved in maintaining blood oncotic pressure

Question 11

Why can albumin still be normal in severe acute liver disease?

Answer 11

has a half life of 20 days so will still be in circulation

Question 12

Why is a raised INR concerning if the patient is not on warfarin therapy?

Answer 12

indicates impairment of liver synthetic function

Question 13

Hepatocellular injury LFTs

Answer 13

raised ALT
and/or raised AST
with or without raised bilirubin

Question 14

Hepatocellular injury acute causes

Answer 14

acute viral hepatitis
acute ischaemic hepatitis
autoimmune
drug-induced liver injury

Question 15

Hepatocellular injury chronic causes

Answer 15

Hep B + C
alcohol-related liver disease
autoimmune hepatitis
rarer genetic causes

Question 16

Cholestatic LFTs

Answer 16

raised ALP
raised GGT
with or without raised bilirubin

Question 17

Acute causes of cholestatic LFTs

Answer 17

gallstones
choledocholithiasis
acute cholecystitis
drug-induced injury to bile ducts

Question 18

Chronic causes of cholestatic LFTs

Answer 18

PBC
PSC
bile duct stricture
malignancy (HOP)

Question 19

high ALT
high AST
healthy young man

Answer 19

?viral hepatitis (from mother at birth)
Chronic Hep B/C

Question 20

high ALT
high AST
high INR
prev. LFTs normal
ischaemic heart disease
syncopal episode

Answer 20

ischaemic hepatitis

Question 21

high ALT
high AST
T2DM
HTN

Answer 21

NAFLD (as risk factors present)
hepatocellular injury pattern

Question 22

low Hb
high MCV
high ALT
high AST
AST/ALT>2

Answer 22

ask about alcohol history
hepatocellular injury pattern

Question 23

valproate
high bilirubin
high ALT
high AST
normal LFTs before

Answer 23

drug-induced liver injury
hepatocellular injury pattern

Question 24

fever
sore throat
jaundice
high bilirubin
high AST
high ALT
low platelets
splenomegaly

Answer 24

EBV infection

Question 25

What factors would be present in a Hep E history?

Answer 25

travel
gastroenteritis (transmitted faecal-oral route)

Question 26

muscle aches
high ALT
significantly high AST

Answer 26

muscle damage
AST is released from muscles

Question 27

80y
frail
#NOF
high bilirubin
very high ALT
high AST
high ALP
high GGT
high INR

Answer 27

more hepatocellular picture as ALT very raised
drug-induced liver injury (paracetamol toxicity post surgery)

Question 28

Acute liver failure triad

Answer 28

jaundice
altered mental status
coagulopathy

Question 29

RUQ pain
fevers
raised ALP
raised GGT

Answer 29

gallstones, cholecystitis

Question 30

high ALP
high GGT
xanthelasma
LFTs been abnormal for a while

Answer 30

primary biliary cholangitis

Question 31

What is the autoantibody present in primary biliary cholangitis?

Answer 31

anti-mitochondrial

Question 32

IBD
raised ALP
raised GGT

Answer 32

primary sclerosing cholangitis

Question 33

What would an MRCP show in primary sclerosing cholangitis?

Answer 33

stricturing of bile ducts

Question 34

What autoantibodies are present in primary sclerosing cholangitis?

Answer 34

ANCA (p-ANCA)

Question 35

weight loss
abdo pain
jaundice
high bilirubin
high ALT
high AST
high ALP
high GGT
(mostly cholestatic picture)

Answer 35

?cancer
gallstones

Question 36

urinary issues
high ALP
normal GGT

Answer 36

bone cause (do bone profile, PSA, Vit D)

Question 37

high ALP
high GGT
pneumonia

Answer 37

drug-induced (eg. co-amoxiclav)
cholestasis of sepsis

Question 38

isolated high unconjugated bilirubin cause

Answer 38

Gilbert’s