Liver Blood Test Analysis and Interpretation

Question 1

liver enzymes

Answer 1

ALT - alanine aminotransferase

AST - aspartate aminotransferase

ALP - alkaline phosphate

gGT - gamma-glutamyl transferase

bilirubin

Question 2

AST

Answer 2

TRANSAMINASES
don’t routinely test

hepatitis reaction

Question 3

ALT

Answer 3

TRANSAMINASES
hepatic pattern of injury

more sensitive than AST

PBC

increased = >55

Question 4

ALP

Answer 4

found in most organs
operates best in alkaline solutions

high = bone growth

cholestasis pattern of liver damage (bowel not moving)
gallstones, malignancy, PBE

Question 5

GGT

Answer 5

degradation of glutathione as well as drug detoxifications

marker of ongoing alcohol misuse

liver fibrosis

cholestatic liver conditions

Question 6

bilirubin

Answer 6

high = jaundice
yellow colour (also in bruises)

predominantly a breakdown product of Heme

associated with liver/bile duct

obstruction to the drainage of bile - gallstones or tumour

synthetic dysfunction of the liver - cirrhosis

acute severe inflammatory liver injury

Question 7

hepatitic pattern

Answer 7

rise in ALT (+/- AST)

NAFLD/NASH
AIH
HBV, HCV

Question 8

cholestatic pattern

Answer 8

rise in ALP (+/- ALP, +/- bilirubin)

obstructive conditions
PBC

Question 9

mixed pattern - ALT and ALP/gGT/bilirubin

Answer 9

any liver condition

alcohol
DILI
systemic causes of LFT derangement

Question 10

liver screening includes

Answer 10

history and examination
alcohol history
virology, immunology, iron studies, immunoglobulins, AIAT

serum based fibrosis markers

Question 11

fibrosis markers

Answer 11

staging of liver disease
patient triage and stratification

morbidity and mortality

convincing largely asymptomatic patients that there is a liver disease

caution in relaxing if markers are normal
caution in interpreting fibrosis markers

Question 12

fibrosis assessing tools

Answer 12

IMAGING BASED
firboscan
ARFI
MRI based

SERUM BASED MARKERS
NAFLD fibrosis scores
FIB4
APRI
BARD
BAAT
ELF
AST:ALT
Firbo test, NASH test

Question 13

serum scores

Answer 13

exclude the presence of advanced fibrosis

not good at middle ground

Question 14

FIB4

Answer 14

age, AST, ALT, Plts

four fibrosis markers

Question 15

liver function

Answer 15

jaundice, ascites, encephalopathy, easy/multiple bruises, muscle wasting/sarcopenia

Question 16

liver failure - measurements

Answer 16

Bilirubin = increase
Albumin = reduce
prothrombin = prolong
glucose = reduce (late stage)

renal function assessment - Na+ and creatintin