LFTs

Question 1

What are the tests of liver function?

Answer 1

albumin
clotting (prothrombin time)
blood glucose

Question 2

What history is relevant to liver disease?

Answer 2

alcohol
tattoos
blood transfusions
medications (OTC, herbal, prescribed)
illicit drug use
travel history
sexual history

Question 3

What constitutes the liver screen?

Answer 3

LFTs
virology (HCV, HBV, EBV, CMV)
immunology (ASMA, ANA, AMA, ALKM)
iron studies
A1AT, caeruloplasmin
HAV, HEV, paracetamol

Question 4

What change to ALTs is observed in hepatitis?

Answer 4

elevated ALT (>55)

Question 5

What are the ALT findings in Autoimmune Hepatitis?

Answer 5

ALT elevation: 100-800
Immunology: ASMA++
elevated IgG
Biopsy: portal/interface hepatitis; excess plasma cells

Question 6

How would you treat Autoimmune Hepatitis?

Answer 6

Prednisolone (Steroid) - for acute disease

Question 7

What is NAFLD (non-alcoholic fatty liver disease)?

Answer 7

Asymptomatic elevations of ALT, associated with obesity.

Question 8

What are the LFT results in cholestatic disease?

Answer 8

ALP (>120), bilirubin (>22) and Gamma-GT elevation

Question 9

What are the causes of cholestasis?

Answer 9

• gallstones
• obstructing tumours (pancreas, cholangiocarcinoma)
• primary biliary cirrhosis (PBC)
• primary sclerosing cholangitis (PSC)

Question 10

What is the CPx of PBC (primary biliary cirrhosis)?

Answer 10

extreme fatigue
female 
itch
jaundice
high cholesterol

Question 11

What tests will be positive on the liver panel in PBC?

Answer 11

elevated ALP
AMA +ve
M2 antigen
mild Bilirubin and ALT elevation

Question 12

How is PBC treated?

Answer 12

Microscopic bile duct are obstructed.

-Ursodeoxycholic acid: promotes bile flow