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1MB - Liver Function Tests > LFTs > Flashcards

LFTs Flashcards

1
Q

what blood tests are used to assess for liver function?

A 
Alanine transaminase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma-glutamyltransferase (GGT/Gamma-GT)
Bilirubin 
Albumin 
Prothrombin time (PT)
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2
Q

what tests are used to distinguish between hepatocellular damage and cholestasis?

A

ALT, AST, ALP and GGT

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3
Q

what tests are used to assess the liver’s synthetic function?

A

Bilirubin, albumin and PT

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4
Q

Step 1 - assesssing ALT and ALP

A

if the ALT is raised, decide if it is more than a 10-fold rise or a less than a 10-fold rise
if ALP is raised, decide if this is a more than 3-fold rise or less than a three fold rise

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5
Q

ALT

A

is found in high concentrations within hepatocytes and enters blood following hepatocellular injury - therefore is a useful marker of hepatocellular injury

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6
Q

ALP is particulary concentrated in the _, _ _ and _ tissues.

A

liver, bile ducts and bone

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7
Q

True or False? - ALP is often raised in liver pathology due to increased synthesis in response to cholestasis. As a result, ALP is a useful indirect marker of cholestasis

A

True

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8
Q

A greater than x-fold increase in ALT and a less than y-fold increase in ALP suggests a predominantly hepatocellular injury

A 
x = 10
y = 3
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9
Q

What ALT and ALP rise is suggestive of cholestasis?

A

less than 10-fold increase of ALT

more than 3-fold increase in ALP

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10
Q

Is it possible to have a mixed picture involving hepatocellular injury and cholestasis?

A

yes

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11
Q

what can a raised GGT be suggestive of?

A

biliary epithelial damage and bile flow obstruction

- it can also be raised in response to alcohol and phenytoin

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12
Q

A markedly raised ALP and with a raised GGT is highly suggestive of cholestasis - true or false?

A

true

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13
Q

what is a raised ALP in the absence of a raised GGT is indicative of?

A

raises suspicion of non-hepatobiliary pathology

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14
Q

causes of isolated rise in ALP include:

A

bony metastases/primary bone tumours (e.g. sarcomas)
vitamin D deficiency
recent bone fractures
renal osteodystrophy

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15
Q

patient is jaundiced but ALT and ALP levels are normal?

A

an isolated rise in bilirubin is suggestive of a pre-hepatic cause of jaundice

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16
Q

causes of isolated jaundice include?

A

Gilbert’s syndrome

Haemolysis

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17
Q

the liver’s main synthetic functions include?

A

conjugation and elimination of bilirubin
synthesis of albumin
synthesis of clotting factors
gluconeogenesis

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18
Q

investigations which can be used to assess synthetic liver function

A

serum bilirubin
serum albumin
prothrombin time
serum blood glucose

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19
Q

what is bilirubin

A

breakdown product of haemoglobin

20
Q

can unconjugated bilirubin affect urine colour?

A

no - unconjugated bilirubin is water-insoluble and therefore doesn’t affect colour

21
Q

what happens to unconjugated bilirubin in the liver

A

becomes conjugated

22
Q

what causes urine to become darker?

A

conjugated bilirubin can pass into the urine ar urobilinogen, causes urine to become darker

23
Q

what is steatorrhoea?

A

in cholestasis, less conjugated bilirubin enters the gut, resulting in stools becoming pale

24
Q

normal urine + normal stools

A

pre-hepatic cause

25
Q

dark urine + normal stools

A

hepatic cause

26
Q

dark urine + pale stools

A

post-hepatic cause (obstructive)

27
Q

causes of unconjugated hyperbilirubinaemia

A

haemolysis e.g. haemolytic anaemia
impaired hepatic uptake (drugs, congestive heart failure)
impaired conjugation (Gilbert’s syndrome)

28
Q

causes of conjugated hyperbilirubinaemia

A

hepatocellular injury

cholestasis

29
Q

where is albumin synthesised

A

in liver

30
Q

what does albumin bind to

A

water, cations, fatty acids and bilirubin

- also plays a key role in maintaining the oncotic pressure of blood

31
Q

albumin levels can fall due to

A

liver disease due to a decreased production of albumin (e.g. cirrhosis)
Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin
Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome

32
Q

prothrombin time?

A

measure of the blood’s coagulation tendency, specifically assessing the extrinsic pathway

33
Q

In the _ of other secondary causes such as anticoagulant drug use and vitamin _ deficiency, an increased PT can indicate liver disease and dysfunction

A

absence, K

34
Q

why would hepatic pathology result in increased PT

A

liver is responsible for the synthesis of clotting factors

35
Q

ALT>AST

A

chronic liver disease

36
Q

AST>ALT

A

cirrhosis or acute alcoholic hepatitis

37
Q

gluconeogenesis

A

generation of glucose from non-carbohydrate carbon substrates

38
Q

serum blood glucose can provide an direct assessment of the liver’s synthetic function - true or false

A

false - indirect assessment

39
Q

gluconeogenesis tends to be one of the last functions to become impaired in the context of liver failure - true or false

A

true

40
Q

cholestatsis (characteristic results)

A

ALT - normal or ^
ALP - ^^
GGT - ^^
Bilirubin - ^^

41
Q

chronic hepatocellular damage (characteristic results)

A

ALT, ALP, GGT, Bilirubin - all normal or ^

42
Q

acute hepatocellular damage (characteristic results)

A

ALT - ^^
ALP and GGT - normal or ^
Bilirubin - ^ or ^^

43
Q

common cause of acute hepatocellular injury

A

poisoning (paracetamol overdose)
infection (hep. A and B)
liver ischaemia

44
Q

common cause of chronic hepatocellular injury

A

alcoholic fatty liver disease
non-alcoholic fatty liver disease
chronic infection (hep. B and C)
primary biliary cirrhosis

45
Q

less common cause of chronic hepatocellular injury

A

alpha-1 antitrypsin deficiency
Wilson’s disease
haemochromatosis

1MB - Liver Function Tests (1 decks)

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