LFTs

Question 1

Pre-hepatic jaundice

Answer 1

Raised unconjugated bilirubin
Extravascular haemolysis, Gilbert’s (partial glucoronyltransferase deficiency), Crigler-Najjar (absolute glucoronyltransferase deficiency)

Question 2

Hepatic jaundice

Answer 2

Raised unconjugated + conjugated bilirubin (loss of ability to conjugate due to hepatocyte dysfunction + compression of bile duct)
Liver causes - hepatitis, HCC, haemochromatosis, PBC / PSC

Question 3

Post-hepatic jaundice

Answer 3

Raised conjugated bilirubin (liver can conjugate the bilirubin fine, but it cannot drain into the intestine so gets pushed into the blood)
Either mural (drug induced cholestasis, cholangiocarcinoma) or extra-mural (pancreatic Ca, lymphoma)
Raised ALP

Question 4

Pale stool, dark urine

Answer 4

Can occur in hepatic + post-hepatic

• Pale stool as less stercobilinogen formed in intestine
• Dark urine as water soluble conjugated bilirubin passes into blood then > urine