Liver function tests Flashcards

1
Q

LFTs can be split into markers of liver cell damage and markers of synthetic function

Give examples of both

A

Liver cell damage:
- ALT, AST, ALK phosp, GGT, Bilirubin

Synthetic function:
- Clotting INR, Albumin, Glucose

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2
Q

What is the best marker of liver function in acute liver injury?

A

Prothrombin time

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3
Q

What LFTs are seen in **acute **viral hepatitis or paracetamol overdose or ischaemic hit?

Anything very acute

A

Transaminitis in the 1000s

(AST and ALT)

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4
Q

What does this ratio indicate:
ALT>AST?

A

Chronic liver disease e.g. NASH, chronic hep C, advanced cirrhosis

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5
Q

What is AST:ALT ratio of 2:1 indicating?

A

Alcoholic liver disease

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6
Q

Why is AST higher than ALT in alcoholic liver disease?

A

Alcohol metabolism affects the mitochondria of hepatocytes, this is where AST is more concentrated

GGT is also quite elevated in alcholic liver disease

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7
Q

What does a ratio of AST:ALT 1:1 indicative of?

A

Viral hepatitis

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8
Q

What does raised GGT and ALP indicate?

A

Cholestatic / obstructive picture

Also chronic alcoholic disease

ALP found in in bile duct epithelium

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9
Q

Raised ALP + Raised Bilirubin → ?

Raised ALP + Normal Bilirubin → ?

A

Raised ALP + Raised Bilirubin → Suggests obstructive jaundice.

Raised ALP + Normal Bilirubin → Consider early cholestasis, bone disease, or pregnancy.

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10
Q

Raised ALP + Raised GGT → ?

Raised ALP + Normal GGT → ?

A

Raised ALP + Raised GGT → Cholestasis (biliary obstruction, PBC, PSC, drug-induced).

Raised ALP + Normal GGT → Consider bone pathology.

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11
Q

ALP isolated rise which is >5x the normal upper limit

A

Bone = pagets disease
osteomalacia
Liver = cirrhosis

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12
Q

ALP isolated rise which is <5x the normal upper limit

A

Bone = primary tumour e.g. sarcoma, fracture

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13
Q

Why is ALP normal in myeloma?

A

Plasma cells suppress osteoblasts, alp is hence normal

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14
Q

Why may albumin be low?

A

Chronic liver disease
Malnutrition
protein losing enteropathy
sepsis - 3rd spacing
nephrotic syndrome

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15
Q

Why may urea be low?

A

Severe liver disease, malnutrition, pregnancy

because urea is made in liver

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16
Q

Raised urea x10 of upper limit?

A

Upper GI bleed (or large protein meal)

Dehydration / aki (as urea is excreted renally)

17
Q

How much albumin is normally synthesised?

A

200mg/g

hypoalbuminaemia is common in acute/systemically ill patients in hispital. Poor prognostic factor

18
Q

INR vs PT time?

A

INR is the PT time standardised for age and population

19
Q

What is bilirubin?

A

Breakdown product of heme, elevated levels manifest as yellowing (jaundice)

20
Q

What is the normal metabolism of bilirubin?

A

Conjugation in hepatocytes and subsequent secretion into bile duct -> GI tract -> metabilised in GI into urobillinogen

Urobilinogen excreted by kidneys as urobilin, rest is converted to stercobilin in faeces

21
Q

What are prehepatic causes of jaundice?

A

Haemolytic anaemia

Ineffective erythropoiesis e.g. thalassemia

Congestive cardiac failure

22
Q

What are hepatic causes of jaundice?

A

Hepatocellular dysfunction

Impaired conjugation / Bilirubin update

Gilbert syndrome / crigler najjar syndrome

23
Q

What are post hepatic causes of jaundice?

A

Intraluminal obstruction e.g. stones / strictures

Luminal obstruction e.g. mass / neoplasms / inflammation

Dextra-luminal e.g. pancreas / cholangio carcinoma

24
Q

Prehaptic causes of jaundice

  • Conjugated/Un
  • urobilinogen
  • Urine bilirubin
  • urine colour
  • stool colour
  • AST/ALT
  • ALP
  • Splenomegaly
A
  • Unconjugated
  • urobilinogen increased
  • Urine bilirubin absent
  • urine colour normal
  • stool colour normal
  • AST/ALT normal
  • ALP normal
  • Splenomegaly present
25
Hepatic causes of jaundice - Conjugated/Un - urobilinogen - Urine bilirubin - urine colour - stool colour - AST/ALT - ALP - Splenomegaly
- Conjugated increased - Unconjugated increased - urobilinogen increased - Urine bilirubin present - urine colour dark - stool colour pale - AST/ALT increased - ALP increased - Splenomegaly present
26
Post Hepatic causes of jaundice - Conjugated/Un - urobilinogen - Urine bilirubin - urine colour - stool colour - AST/ALT - ALP - Splenomegaly
- Conjugated increased - urobilinogen decreased - Urine bilirubin present - urine colour dark - stool colour pale - AST/ALT increased - ALP increased! - Splenomegaly absent
27
Why is there no bilirubin in urine for prehepatic jaundice causes?
There is unconjugated bilirubin tightly bound to albumin - cannot get through glomerulus
28
Why is post hepatic jaundice present with dark urine and pale faeces?
increase in conjugated bilirubin ends up in blood rather than going through GI. Excreted by kidneys but no stercobilinogen so pale faeces
29
Hepatomegaly with smooth margin may be seen in?
Viral hepatitis Biliary tree obstruction hepatic congestion 2 to HF
30
Hepatomegaly with craggy border seen in?
Hepatic metastatic disease Polycystic disease Cirrhosis
31
What would be see in wilson's disease?
Isolated increase in unconjugated bilirubin
32
What would be seen in Obstetric cholestasis?
Bilirubin 100+ Raised ALT, AST, GGT Bile salts 10+