LFTs Flashcards
What are the 2 true liver function tests?
Prothrombin time and albumin - measure of protein synthesis
What are they liver enzymes?
ALT, AST, ALP, Bilirubin and GGT
these are released if there is damage to the liver
What might tattoos be associated with?
Hepatitis C
What are the 3 main patterns of LFT derangement?
i) Hepatitis
ii) Cholestasis
iii) Mixed
Liver screen
> Virology (cytomegalovirus, HCV, HBV, EBV)
> Immunology
- ASMA, AMA, ANA, ALKM
> Iron studies
> A1AT
Caeruloplasmin
BMI, waist circumference
Hepatitic LFT derangement
> Predominant rise in transaminases (ALT, AST)
> ↑ALT = injury to hepatocytes
> Autoimmune hep
HBV, HCV
NAFLD
Cholestatic LFT derangement
> “Bile not moving”
Obstruction of microscopic or large bile ducts
↑ALP & ↑Bilirubin
some GGT elevation.
ALT tends to be mildly elevated or normal.
Upper limit of normal (ULN) for bilirubin
22
ALP upper limit of normal
100
Autoimmune hepatitis
What LFTs are raised?
ASMA +ve or -ve?
> More common in females
Relapsing and remitting condition
Progressive
↑ALT (100-800)
- asymptomatic
- tired, weight loss, RUQ discomfort
ASMA +ve
(anti smooth muscle antibody)
Elevated IgG (normally <12)
Portal/ interface hepatitis
excess plasma cells
Autoimmune hepatitis - treatment
Acutely//
- steroids (prednisolone)
Long term//
- steroid-sparing agent
- azathioprine
HCV
Blood to blood
Hep C antibody test +ve
↑ALT w/clinical suspicion
(not always)
NAFLD
Main cause of hepatitis in western world.
↑ALT
Obesity.
ALTs around 100-150.
(around 250/300 it is unlikely to be NAFLD)
ALP can be elevated in whom?
Teens who are growing
Breast disease
Conditions giving rise to cholestatic LFTs
> Gallstones
Obstructing tumours - pancreas, cholangiocarcinoma
> Primary biliary cirrhosis
Primary sclerosis cholangitis
