LFTs

Question 1

LFTs in hepatocellular disease

Answer 1

ALT at least x2 (but can be > 10!)
ALP normal
ALT/ALP x5

(note that ALP is alk phos!)

Question 2

LFTs in cholestatic disease

Answer 2

ALT normal
ALP at least x2
ALT/ALP <2

Question 3

LFTs in mixed disease

Answer 3

ALT at least x2
ALP at least x2
ALT/ALP 2-5

Question 4

what LFTs should you compare

Answer 4

ALT vs ALP (alk phos)

Question 5

if there is a rise in ALP, what should you look at?

Answer 5

GGT

Question 6

if ALP and GGT increased, what is the likely cause?

Answer 6

cholestasis

Question 7

what drugs can raise GGT

Answer 7

alcohol

phenytoin

Question 8

raised ALP in absence of raised GGT. what is likely pathology?

Answer 8

non-hepatobiliary -> ALP is also present in bone and therefore could be disease that increases bone breakdown

Question 9

what non-hepatobiliary conditons raise alk phos?

Answer 9

bony mets/primary bone tumour e.g. sarcoma
vitamin D deficiency 
(osteopenia)
recent fracture
reanl osteodystrophy

Question 10

jaundice but ALT and ALP normal

Answer 10

prehepatic cause

• gilbert’s syndrome (most common)
• haemolysis

Question 11

why may albumin be low

Answer 11

liver disease (decreased production)
inflammation (temprarily decrease liver production)
protein losing enteropathies
nephrotic syndrome

Question 12

ALT VS AST

Answer 12

alt > ast = chronic liver disease

AST >ALT = cirrhosis, acute alc hepatitis