LFTs Flashcards
Alphafetoprotein
Tells of?
Vague Normal range?
Elevated/Low means?
Normally expressed in foetal liver.
Normal range; LOW (0-15)
Causes or rise;
Exposure of the liver to cancer-causing agents
AFP 400–500 μg/L in hepatocellular carcinoma.
Conc 400+ is associated with greater tumour size, involvement of both lobes of liver, portal vein invasion and a lower median survival rate.
Ceruloplasmin
Role?
Vague Normal range?
Elevated/Low means?
Role; carries copper in the body
range; High 200-600
Elevated; Obstructive jaundice, rheumatoid arthirits
Low; Wilsons disease - Cu accumulation
Lactate dehydrogenase
Elevated/Low means?
Found across the body
Elevated; liver damage?
Albumin
Made where?
Tells of?
Vague Normal range?
Elevated/Low means?
Synthesised in the liver.
Range; low (3-5)
Low in the ‘osis’;
Chronic liver disease i.e. cirrhosis.
Nephrosis - nephrotic syndrome - through the urine.
Increased;
burns
acute infection
surgery
Consequence of low albumin?
oedema
intravascular oncotic pressure becomes lower than the extravascular space.
GGT
Made where?
Tells of?
Vague Normal range?
Elevated/Low means?
Found in liver, intestines, renal tubules etc.
Is an enzyme
range; 9-85
Elevated;
cholestasis
viral hepatitis
alcoholism
others causes of elevation;
DM, hyperthyroid, MI, acute pancreatitis
ALP
Stands for? Made where? Tells of? Vague Normal range? Elevated/Low means?
Alkaline phosphatase
Enzyme found in BILE DUCTS, renal tubules, intestines etc. important in bone calcification
range; 40-130
Elevated; Cholestasis Acute viral hepatitis (hep a etc) Amyloidosis Abscess Bone growth - pagets
others; liver cirrhosis, cc-failure, Infiltrative liver disease
Low;
Hypothyroidism
Pernicious anaemia
Hypo-PHOSPHAT-asia
ALT
Stands for? Made where? Tells of? Vague Normal range? Elevated/Low means?
Alanine transaminase
Found in the kidneys, heart, and muscles, as well as high concs in the liver.
Range; 7-56
Elevated;
A rise of up to 300 IU/L is not specific to the liver but can be due to the damage of other organs such as the kidneys or muscles.
Rise more than 500 IU/L, causes are usually from the liver;
Hepatitis, ischeamic liver injury, and toxins that causes liver damage.
others;
Alcoholic liver disease
Non alcoholic liv disease
Compare ALT is different hepatitis;
Hep A,B,C.
Chronic hepatitis
The ALT levels in Hepatitis C rises more than in Hepatitis A and B.
Persistent ALT elevation more than 6 months is known as chronic hepatitis
Bright liver syndrome (bright liver on ultrasound suggestive of fatty liver) with raised ALT is suggestive of ?
Metabolic syndrome
AST
Stands for? Made where? Tells of? Vague Normal range? Elevated/Low means?
Aspartate transaminase
Found in wide range of organs but highest conc in liver. (means not v specific for liver)
0-35
Elevated mitochondrial AST;
tissue necrosis
MI
General elevation;
Liver cirrhosis
AST/ALT ratio
When is this elevated?
name some conditions
The AST/ALT ratio increases in liver functional impairment.
Alcoholic liver disease, the mean ratio is 1.45,
Liver cirrhosis
alcoholic hepatitis (2.0) - more raised than in non alcoholic hepatitis
What 2 possible conditions would cause ast/alt above 4.5
Wilson disease or hyperthyroidism.
Not a liver enzyme;
Amylase is made where?
Name of amylase from each?
Pancreas, salivary glands
P & S amylase respectively
What presentation would trigger an amylase test ordered?
Acute abdominal pain
Causes of raised amylase, surgical seive style?
V - Mesenteric ischaemia
Inflam - Acute pancreatitis, Hepatitis, Post ERCP, Peritonitis
Trauma - Burns, Intestinal obstruction or perforation, Duodenal ulcer
Autoimmune -
Metabolic - renal failure, renal transplant, diabetic ketoacidosis.
Infectious - Mumps
Neoplasm - Pancreatic carcinoma
D - drugs; morphine & opiates
Name 5 causes of raised amylase
which is most common of all causes?
Acute pancreatitis (4 fold increase. Most common)
Peritonitis
Hepatitis
Renal failure
Pancreatic carcinoma
Elevated ALP & GGT?
alp= alk phosphatase
since ggt elevated, alp rise unlikely due to bone.
So it HAS to be a pathology in the biliary tree - cholestasis
AST/ALT ratio is 2:1 what is the likely condition?
Alcohol
cirrhosis
alcoholic hepatitis etc
when would you see ast/alt figures in the 1000s?
budd chiari syndrome
autoimmune hepatitis
shock liver
acute viral hepatits (a,b)
you see an isolated elevation in ast. What test results would you look at? why?
ck
to ensure its not due to muscle breakdown
Test results show an elevated bilirubin, whats next?
get the direct bilirubin score (conjugated).
there is acute liver (hepatocellular) injury, which markers would you expect to be altered?
AST, ALT (raised)
there may be small rises in alp n conj.bili
there is chronic liver injury, which markers would you expect to be altered?
albumin (dropped - cirrhosis etc)
there is biliary tree/system injury (obstructive pattern), which markers would you expect to be altered?
conjugated bilirubin
ALP (alk phos - remember, found in bile ducts not liver parenchyma)
there may be small rises in ast & alt too
Case; Steep rise in ALP, smaller rises in conjugated bili.
Ultrasuond shows no obstruction, what you thinking?
Infiltrative liver disease - that causes marginally steep ALP rises
unlike cholestatic disease, these dont obstruct the biliary tree
Name some infiltrative diseases?
sarcoid, amyloid, haemochromatosis, some cancers
Case;
Elevation of total bilirubin
Conjugated bilirubin is slightly elevated
What type of jaundice?
What is the aetiology?
Pre-hepatic jaundice
because there is lots of unconjugated bilirubin but not all can be broken down by the liver, so builds up and theres lower but slightly elevated conjugated form.
aetiology; haemolysis, haemorrhage
Case;
Elevation of total bilirubin
Elevation in Conjugated bilirubin
What type of jaundice?
What is the aetiology?
Post Hepatic (obstructive) jaundice
aetiology; obstruction - stricture or stone
liver still works so can conjugate. conj bili, builds up and so overflows/spills out into blood
here the d.bili will be like 50%+ of the tbili
What would a intrahepatic jaundice picture look like?
elevated tbili
conj bili around the same/lower/not changed much
because liver funtion is damaged
with all lfts, MUST do further test i.e. imaging to aid diagnosis!!
Jaundice;
A patient presents with acute abdominal pain, jaundice. LFTs shows an obstructive picture. what is likely cause and why?
US is carried out, what is expected?
gallstone blocking biliary tree (cholelithiasis)
because, this will cause an acute obstruction hence acute pain
on US, may see small amount of liver and gallbladder inflammation - thick gallbladder wall
Jaundice;
A patient presents with unwell, NO abdominal pain, jaundice. LFTs shows an obstructive picture. what is likely cause and why?
US is carried out, what is expected?
stricture or tumour
because these take a while to obstruct, not sudden
US; very distended gallbladder and biliary ducts
*cancers include from head of pancreas, cholangiocarcinomas etc
strictures can be post ercp
Elevated ALT or ALP. what test to do next?
GGT to ascertain if elevation is from liver.
