Liver Function Tests Flashcards

1
Q

why are LFTs checked?

A

investigate for liver disease
monitor current liver disease
monitor effects of hepatotoxic medication (methotrexate/DMARDs)

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2
Q

what LFTs test liver inflammation and damage?

A

ALT (alanine aminotransferase)
AST (apartate aminotransferase)
GGT (gamma glucuronic transferase)
Bilirubin

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3
Q

what LFTs test for impairment of liver synthesis?

A

albumin
glucose (lack of glucogenesis)
PT time/ratio

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4
Q

describe the enzymes ALT and AST as LFTs

A

raised during hepatocellular injury (hepatitis, cirrhosis, drug/toxin induced, malignancy)

AST:ALT ratio determines cause of hepatocellular injury (>2:1 suggestive of alcohol related)

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5
Q

describe ALP and GGT as LFTs

A

ALP = serum alkaline phosphatase, derived from biliary epithelial cells and bones
GGP = non-specific/highly sensetive cholestasis marker

ALP/GGT interpreted together
ALP increased, GGT normal = bone disease (pagets/vit D deficiency)
ALP and GGT increased = cholestasis

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6
Q

what is cholestasis?

A

interruption in bile flow from hepatocytes to SI

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7
Q

explain what bilirubin is

A

waste product of haemoglobin breakdown
metabolised/excreted by liver
conjugated in the biliary tract and enters SI lumen in bile

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8
Q

what are the causes of increased bilirubin?

A

excess bilirubin production (pre-hepatic jaundice)
reduction in bilirubin metabolism (hepatocellular/hepatic jaundice)
blockage in bile excretion pathway (cholestatic jaundice)

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9
Q

explain hepatocellular/hepatic jaundice

A

damaged hepatocytes, inability to metabolise unconjugated bilirubin (builds up in blood)
high ALT/AST levels marking hepatocyte damage

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10
Q

what are the causes of unconjugated hyperbilirubinaemia?

A

pre-hepatic jaunduce (haemolysis)
gilbert syndrome (genetic)

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11
Q

what are the causes of conjugated hyperbilirubinaemia?

A

cholestasis
hepatocellular jaundice

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12
Q

explain cholestatic jaundice

A

interruption in bile flow
conjugated bilirubin builds up in blood
ALP/GGT high (biliary system issue)
causes dark urine and pale stools

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13
Q

what are the 2 types of cholestasis?

A

intrahepatic (obstruction of hepatic bile canaliculi)
extrahepatic (obstruction of hepatic ducts/distal biliary tree)

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14
Q

what are the causes of intrahepatic cholestasis?

A

hepatitis (viral A-E/autoimmune)
cirrhosis
malignancy
drugs (antibiotics/steroids/anabolic steroids/contraception)
pregnancy

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15
Q

what are the causes of extrahepatic cholestasis?

A

gallstones
primary sclerosing cholangitis
intraluminal malignancy (cholangiocarcinoma)
extraluminal malignancy causing duct compression (pancreas head tumours)

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16
Q

describe albumin and its LFT function

A

synthesises in liver, controls oncotic blood pressure
used as non-specific marker of livers synthetic function

decreased: malnutrition, liver disease, inflammation
increased: nephrotic syndrome, protein losing enteropathies

17
Q

describe how hepatic synthetic function is assessed

A

low albumin - oedema, ascites, increased infection risk
coagulation - bleeding, bruising
low blood glucose - sweats, impaired motor/cognitive function

18
Q

name the viral/antibody related liver screening tests

A

hepatitis serology
anti-mitochondrial antibody (AMA)
anti-smooth-muscle antibody (ASMA)
anti liver/kidney microsomal antibodies (LKM)
anti-nuclear antibody (ANA)
p-ANCA
immunoglobulins (IgM, IgG)

19
Q

name the liver screening tests used to rule out specific diseases

A

a1 antitrypsin (rule out deficiency)
serum copper/ceruloplasmin (wilson’s disease)
ferritin (haemochromatosis)

20
Q

what further investigations can be used to assess liver function?

A

ultrasound (cholestatis obstruction/hepatocellular lesions)

CT/MRI (MRCP - cholangio pancreatogram) for stones/blockages

endoscopy - ultrasound, retrograde cholangiopancreatography (ERCP)

21
Q

describe liver biopsies and fibroscans

A

biopsy (invasive), histological analysis

fibroscan (non-invasive), measures elasticity of liver
stiffness/fattiness = less elasticity
(doesn’t identify cause)