LFTs Flashcards
What are the 3 different types of LFTs?
Hepatic, cholestatic or mixed
What are LFTs a measure of?
Protein synthesis and clotting cascade
What are LFTs?
Albumin and prothrombin time
What are liver enzymes?
ALT, AST, ALP, gamma GT, bilirubin
What should you always specifically ask for in liver disease histories?
Alcohol, tattoos, blood transfusions, medications, drug use, travel, sexual history
What test should be done after a history and LFTs?
Liver screen
What is included in a liver screen?
Immunology, virology, iron studies, A1AT, caeruloplasmin, history specific tests e.g. paracetamol
What is included in virology screening?
Hepatitis B and C virus, cytomegalovirus, ebstein-barr virus
What is included in immunology screening?
Anti smooth muscle antibodies, anti mitochondrial antibodies, anti nuclear antibodies
What is included in iron studies screening?
Transferrin saturations and ferritin
What causes a predominant rise in transaminases (AST, ALT)?
Hepatitis
What does an elevated ALT generally describe?
Injury to hepatocytes
What are common conditions presenting with increased ALT?
Autoimmune hepatitis, hepatitis B and C, other viral conditions and NAFLD
Who is autoimmune hepatitis more common in?
Females
What are symptoms of autoimmune hepatitis (if any are present at all)?
Tiredness, weight loss, RUQ discomfort
What would be findings of note in autoimmune hepatitis?
Increased ALT, anti-smooth muscle antibodies and increased IgG
What would a biopsy of autoimmune hepatitis show?
Inflammation with excess plasma cells
What do you prescribe short term and long term for autoimmune hepatitis?
Short term- steroids
Long term- azathioprine
What is the most common hepatitis in the UK (not world)?
C
Who are at risk groups for hepatitis C?
PWID, blood to blood contact, needles, tattoos, sexual history, Pakistan/Indian ethnicity
In terms of liver enzymes, what will hepatitis C show?
Increased ALT
What is a definitive determinant of hepatitis C?
Hepatitis C positive antibodies
What should you do after a diagnosis of hepatitis C is made?
Find out the genotype and refer to hepatology for treatment
What causes an asymptomatic rise in ALT?
Non-alcoholic fatty liver disease
What is NAFLD an umbrella term for?
Steatosis- fat deposits in liver
Steatohepatitis- inflammation
Fibrosis/Cirrhosis
What is NAFLD closely associated with?
Metabolic syndrome
What is usually the limit of ALT in NAFLD?
About 300- any more this diagnosis is unlikely
What is cholestasis and what causes it?
Bile not moving- caused by conditions which result in obstruction to bile flow or disease of bile ducts
What are the important cholestatic liver enzymes?
Predominantly ALP and bilirubin and some gamma GT
What usually happens to ALT in cholestatic disease?
Slight increase or normal
What determines the upper limit of normal of ALP?
Age and sex
What are some conditions causing cholestasis?
Gallstones, carcinoma of the pancreas head, cholangiocarcinoma, primary biliary cholangitis, primary sclerosing cholangitis
What type of disease is primary biliary cholangitis and who is it more common in?
Autoimmune- more in women
What age range does primary biliary cholangitis typically present?
50-65
What does primary biliary cholangitis present with?
Fatigue, itch, jaundice and increased cholesterol
What part of the body does primary biliary cholangitis affect?
Microscopic bile ducts
What will the LFT panel for primary biliary cholangitis show?
Increased ALP and slightly increased bilirubin and ALT
What will the immunology for primary biliary cholangitis be?
Anti mitochondrial antibody positive
What is treatment for primary biliary cholangitis?
Ursodeoxycholic acid and control itch
What is the most common cause of a mixed pattern of LFTs?
Alcohol
What are other causes of mixed LFTs apart from alcohol?
Obstructive tumour or drug induced liver injury
What are examples of drugs which commonly cause liver injury?
Flucloxacillin, co-amoxiclav, NSAIDs
