LFTs Chronic Liver Dz or Acute Liver Fail

Question 1

PT tests fxn of what?

Value w/ severe liver dz?

Answer 1

Factors I, II, V, VII, X (all liver produced)

↑ PT/INR

Question 2

Albumin levels w/ severe liver dz?

Answer 2

↓

Question 3

Bilirubin levels w/ severe liver dz?

Answer 3

↑ U conjugated, can be both

Question 4

Platelet Count levels w/ severe liver dz?

Why?

Answer 4

↓

Portal HTN -> Splenomagaly ->
Sequestration of platelets

Question 5

Cirrhosis presentation? (7)

Answer 5

Fatige
Abd swell
LE edema
Pruritis
Confusion
Impotence
Easy bruising

Question 6

Cirrhosis exam findings?

Answer 6

Jaundice
Telangectasias
Man boobs
Palmar erythema
Caput medusa
Asterixis (hand flapping)

Question 7

High Aminostranferases concerning when? (4)

Answer 7

1) Unexplained high liver enzymes
2) Signs/sxs of chronic liver dz or fail
3) 5 x elevation of enzymes
4) Abn levels > 6 mo

Question 8

Mild (< 5x) Aminotransferases Elevation next steps? (5)

Answer 8

1) Detailed Hx:
Hep risks
Meds incl herbals
NASH risks (fat, DM, hyperlipids)
FHx

2) r/o most C causes:
EtOH
NASH
Meds
Hep
Hemochrom

3) Stop EtOH, toxic meds
4) Assess for metabolic synd
5) Repeat LFT 2-4wks and monitor for 6 mo

Question 9

Vitamins/Herbs that ↑ AST/ALT? (4)

Answer 9

Ephedra/Ma Huang
Kava
Germander
Black Cohosh

Question 10

Meds that ↑ AST/ALT?

Answer 10

Acteaminophen
NSAIDs
Statins
Antifung
ABX
Anti-TB
Steroids

Question 11

C labs results for alcoholics? (4)

Answer 11

AST/ALT > 2
↑GGT
↑MCV
↓Folate

Question 12

If LFTs stay high for months, next steps?

Answer 12

1) Look for extrahepatic causes:
Muscle disorders or heavy exercies
Celiac
Hypothyroid
Adrenal insuff

2) Screen for rare:
Autoimm hep
Wilson’s
α-1

3) Refer