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GI > LFTs > Flashcards

LFTs Flashcards

1
Q

What are the 3 different types of LFTs?

A

Hepatic, cholestatic or mixed

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2
Q

What are LFTs a measure of?

A

Protein synthesis and clotting cascade

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3
Q

What are LFTs?

A

Albumin and prothrombin time

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4
Q

What are liver enzymes?

A

ALT, AST, ALP, gamma GT, bilirubin

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5
Q

What should you always specifically ask for in liver disease histories?

A

Alcohol, tattoos, blood transfusions, medications, drug use, travel, sexual history

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6
Q

What test should be done after a history and LFTs?

A

Liver screen

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7
Q

What is included in a liver screen?

A

Immunology, virology, iron studies, A1AT, caeruloplasmin, history specific tests e.g. paracetamol

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8
Q

What is included in virology screening?

A

Hepatitis B and C virus, cytomegalovirus, ebstein-barr virus

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9
Q

What is included in immunology screening?

A

Anti smooth muscle antibodies, anti mitochondrial antibodies, anti nuclear antibodies

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10
Q

What is included in iron studies screening?

A

Transferrin saturations and ferritin

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11
Q

What causes a predominant rise in transaminases (AST, ALT)?

A

Hepatitis

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12
Q

What does an elevated ALT generally describe?

A

Injury to hepatocytes

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13
Q

What are common conditions presenting with increased ALT?

A

Autoimmune hepatitis, hepatitis B and C, other viral conditions and NAFLD

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14
Q

Who is autoimmune hepatitis more common in?

A

Females

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15
Q

What are symptoms of autoimmune hepatitis (if any are present at all)?

A

Tiredness, weight loss, RUQ discomfort

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16
Q

What would be findings of note in autoimmune hepatitis?

A

Increased ALT, anti-smooth muscle antibodies and increased IgG

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17
Q

What would a biopsy of autoimmune hepatitis show?

A

Inflammation with excess plasma cells

18
Q

What do you prescribe short term and long term for autoimmune hepatitis?

A

Short term- steroids

Long term- azathioprine

19
Q

What is the most common hepatitis in the UK (not world)?

A

C

20
Q

Who are at risk groups for hepatitis C?

A

PWID, blood to blood contact, needles, tattoos, sexual history, Pakistan/Indian ethnicity

21
Q

In terms of liver enzymes, what will hepatitis C show?

A

Increased ALT

22
Q

What is a definitive determinant of hepatitis C?

A

Hepatitis C positive antibodies

23
Q

What should you do after a diagnosis of hepatitis C is made?

A

Find out the genotype and refer to hepatology for treatment

24
Q

What causes an asymptomatic rise in ALT?

A

Non-alcoholic fatty liver disease

25
Q

What is NAFLD an umbrella term for?

A

Steatosis- fat deposits in liver
Steatohepatitis- inflammation
Fibrosis/Cirrhosis

26
Q

What is NAFLD closely associated with?

A

Metabolic syndrome

27
Q

What is usually the limit of ALT in NAFLD?

A

About 300- any more this diagnosis is unlikely

28
Q

What is cholestasis and what causes it?

A

Bile not moving- caused by conditions which result in obstruction to bile flow or disease of bile ducts

29
Q

What are the important cholestatic liver enzymes?

A

Predominantly ALP and bilirubin and some gamma GT

30
Q

What usually happens to ALT in cholestatic disease?

A

Slight increase or normal

31
Q

What determines the upper limit of normal of ALP?

A

Age and sex

32
Q

What are some conditions causing cholestasis?

A

Gallstones, carcinoma of the pancreas head, cholangiocarcinoma, primary biliary cholangitis, primary sclerosing cholangitis

33
Q

What type of disease is primary biliary cholangitis and who is it more common in?

A

Autoimmune- more in women

34
Q

What age range does primary biliary cholangitis typically present?

A

50-65

35
Q

What does primary biliary cholangitis present with?

A

Fatigue, itch, jaundice and increased cholesterol

36
Q

What part of the body does primary biliary cholangitis affect?

A

Microscopic bile ducts

37
Q

What will the LFT panel for primary biliary cholangitis show?

A

Increased ALP and slightly increased bilirubin and ALT

38
Q

What will the immunology for primary biliary cholangitis be?

A

Anti mitochondrial antibody positive

39
Q

What is treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid and control itch

40
Q

What is the most common cause of a mixed pattern of LFTs?

A

Alcohol

41
Q

What are other causes of mixed LFTs apart from alcohol?

A

Obstructive tumour or drug induced liver injury

42
Q

What are examples of drugs which commonly cause liver injury?

A

Flucloxacillin, co-amoxiclav, NSAIDs

GI (17 decks)

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