TOP OF GI TABLE / Interprtation LFT Flashcards
When do you do endoscopy
ALARMS - Anorexia - Loss of weight unintentionally - Anaemia - Recent onset / refractory dyspepsia - Melena / haematemesis / persistent vomit - Swallowing difficulty (dysphagia) = urgent >55
Other reasons
Mass Nocturnal >55 + new onset dyspepsia >55 + weight loss + raised platelet +- - Abdo pain - Refux / Dyspepsia
What are indications for colonoscopy
Rectal bleeding Iron deficiency anaemia Persistent diarrhoea / change in bowel habit >6 weeks Positive qFIT IBD suspicion COlon caner surveillance >50 + IBS symptoms as rare
Who gets 2 week cancer referral + qFIT
GUIDANCE
> 40 + unexplained abdominal pain + weight loss
50 + unexplained rectal bleed
60 + change in bowel or iron deficiency / any anaemia
qFIT shows blood
Consider if rectal / abdominal mass
Consider if <50 with rectal bleed
- abdo pain
- change in bowel
- weight loss
- iron anaemia
Offer qFIT if no rectal bleed / do not meet criteria and <50
When are aminotransferases raised
Tissue injury
ALT more specific
AST more specific to alcohol
Will be normal in obstruction
When is alk phosphatase raised
Obstruction of liver / cholestatic picture
When can it be raised physiologically
Growing child
Pregnancy
Healing fracture
When can it be raised pathologically
Paget's Osteomalacia Boen mets Hyperparathyroid Renal failure Lymphoma Infiltratin - sarcoid
When is GGT raised
Alcohol If ALP also raised suggest cholestatic But also raised NSAID Malignancy / tumour Rifampicin Carbmazepine COPD / renal / post MI
How do all interact
Tissue can affect pipes so can all be raised
What are tests for hepatic function
Serum albumin - produced in liver Serum bilirubin - high in cholestasis PT / INR - as liver producing clotting Platelet count Lactate Glucose as gluconeogensis in liver Ammonia
Why is platelets affected
Cirrhosis leads to splenomegaly which decreases platelet
What should you consider if predominate hepatocellular injury
Medication?
Alcohol history
USS for fatty liver / mets
Viral serology - A, B, C, D, EBV, CMV
What is typical of alcoholic picture
Raised GGT Macrocytosis Raised ALP AST > ALT Low platelet
What do you do if tissue injury suggestive on LFT but asymptomatic and tests -ve
Lifestyle - weight / alcohol / DM / lipids Stop hepatotoxic drug Repeat test after 1-2 months Do USS +- abdo CT Consider biopsy
Raised ALP but normal LFT
Suspect bone mets
Albumin and relation to malnutrition
Albumin = test of liver function as producer there
Low albumin likely due to acute illness
If CRP is high / no illness then consider malnutrition
Lactate and liver
Liver metabolises lactate into glucose so high in liver failure
Glucose and liver
Glucose low and high lactate suggests acute liver failure as responsible of gluconeogenesis
Ammonia and liver
Marker of hepatic encephalopathy
GI Question
Appetite Dysphagia Dyspepsia N+V - blood / bile Abdo pain Bowels PR bleed Jaundice
What systemic screen
Weight loss Energy Eye problem Skin rash Joint
What does bilious vomit suggest
Obstruction in Lowe GI
What is included in LFT
ALP ALT TOtal protein Albumin Total bilirubin
What do you. add on
AST / GGT - alcohol
PT - different tube
If abnormal LFT what next
History - Any regular meds or acute Rx e.. Ax - Illicit drug use / herbal - Viral risk - FH autoimmune - Comorbid e.g. CCF or DM Examination Non-invasive screen
Non invasive screen
LFT inc creatinine / platelet / INR Virology - Hep B,C,E - E only if acute - EBV, CMV, HIV, Yellow fever if indicated Biochemistry - TSH - Lipids + glucose - Serum copper - for Wilson disease if young - Ferritin and transferrin -Haemochromatosis - A1-anti-trypsin Immunology - AMA, SMA, Anti-TTG
What else is standard imaging
USS
Further
Fibroscan
- DM / NAFLD / hepatitis / alcohol / CLD
Biopsy
What typically causes an isolated ALT rise
Ischaemic hepatitis e.g. after hypobolaemia
Paracetamol / toxins
Viral hepatitis
