LFTS Flashcards
If your AST + ALT have a marked increase >1000, What does this normally signify? [TIA}
- Toxin/drug induced or acute viral hepatitis
* Liver ischaemia
If your ALT + AST have a moderate increase ~300 - 500, What does this normally signify? [AABC]
- Chronic/alcoholic/autoimmune hepatitis
* Biliary obstruction
If your AST + ALT have a mild rise <300, what could this signify? [CHIN]
- Cirrhosis
- Non alcoholic fatty liver disease
- Hepatocellular carcinoma
- Haemochromatosis/ Wilson’s
If your ALP has a marked increase (>4 X normal), What does this normally signify?
• Cholestasis → Gallstones eg.
If your ALP has a moderate increase (<3x normal), what does this normally signify?
• Hepatitis, cirrhosis, infiltration
What does GGT do to confirm if rise in ALP is of hepatic origin?
It mirrors ALP.
What does a rise in GGT signify?
Raised with alcohol abuse and enzyme inducing drugs
What is a rise in unconjugated bilirubin symptomatic of?
- Increased RBC breakdown
- Impaired hepatic uptake
- Impaired conjugation
What is a rise in conjugated bilirubin symptomatic of?
- Hepatocellular dysfunction
* Impaired hepatic secretion
If you have ↓albumin ↓protein, what is this symptomatic of?
- Advanced cirrhosis,
- alcoholism,
- protein malnutrition,
- chronic inflamation,
- renal/gut/skin loss
If you have ↓albumin but normal protein, what is this symptomatic of?
infection
If you have ↓ albumin but ↑ protein, what is this symptomatic of?
Myeloma
What is prothrombin time/INR dependent on?
Vit K dependent clotting factors and fibrinogen. → all made in the liver
what is a raised INR symptomatic of?
- Liver disease
- Vit K deficiency
- Consumptive coagulopathy
What is a raised urea symptomatic of?
- Dehydration,
- GI bleed,
- increased protein breakdown,
- high protein intake
- drugs
What is a Low urea symptomatic of?
- Malnutrition
- liver disease
- pregnancy
What is the A,B,C,D,E,F,G,H,I,M of raised ALT + ASP?
A → Autoimmune hepatitis
B → Hep B
C → Hep C
D → Drugs or toxins (paracetamol overdose!!!)
E → Ethanol
F → Fatty liver
G → Growths (tumours)
H → Haemodynamic disorder (congestive heart failure)
I → Iron (haemochromotosis/wilsons)
M → Muscle injury
What are some causes of raised hepatic LFT’s?
- Viral hepatitis
- Autoimmune hepatitis
- Drugs and Toxins
- Alcohol
- Metabolic disorders → Wilsons disease
- Fatty liver
- Malignancy
- Congestive cardiac failure
What are some causes of of an obstructive picture in LFTS?
- Bile duct gallstone
- Bile duct stricture
- Cholangiocarcinoma
- Pancreatic carcinoma
- Nodes on the porta hepatis
- Ampullary carcinoma
What happens when hepatocytes are damaged?
They spill out transaminases → ALT, AST
What would you expect in an obstructive picture LFT’s?
- ↑ ALP
* ↑ GGT
What 2 findings would you expect in a failing liver?
- Synthetic function is impaired so you will have less albumin and clotting factors:
- ↓ Albumin
- ↑ prothrombin time
painless jaundice with an obstructive picture, what is the most likely cause?
• Pancreatic cancer
