wk 7 5 LFTs Flashcards
other than ALT/AST what other enzymes studied in LFTs
GGT
Alkaline phosphatase
where else is alkaline phosphatase found
placenta
GGT indicates
alcholic liver disease
when are the transaminases released
in response to hepatocellular injury
where is ALT found in liver cells
near cytosol
biliary obstruction will coincid to how much ALT
> 1/2000 U/L (should revert back)
obstructive jaundice is seen as
less than 500 U/L (ALT)
half lives of ALT, AST and ALkaline phosphatase
…(27hr~)
…(17hr~)
1 week (slow rise)
what is bilirubin bound to
albumin
bilirubin is the breakdown of
Hb
liver is important for many clotting factors, which ones are fibrinogen/prothrombin
Factor I
Factor II
other than I and II, what other clotting factors produced
v viii ix x xii xiii
what does PT measure
conversion of PT - thrombin, relfect clotting time
elevated may reflect of reduced synthetic functionality
other causes of prolongation of PTb
drugs
bile malabsorption (causes relative vit K deficiency)
consumptive /congenital coagulopathy
areas needed in history to cover for liver
drugs (OTC, herbal, controlled, prescription)
pruritus, jaundice, arthralgi weight loss, xanthema fever, anorexia
parenteral exposures (IV) blood transfusions, intranasal, drugs, tattoos sexual history
travel history - timings, zoos, unusual hobbies
alcohol exposure - specific
occupation
temporal variation - itchy at night, fatigue in morning (cholestatic jaundice)
questions for medications
timing? changed?
antibiotics/depressants, HMG Co-A nhibitors (statins), NSAIDS, anti-epiletics, anti-tuberculous, sulphonamides/sulphonylureas
PT/INR increase alone indicates
prolonged jaundice/ vit k malabsorption
hepatocellular dysfunctiosn
hepatocellular injury wiill see
AST/ALT > ALP
Bili N incr
cholestasis will be indicated by
ALP > ALT/AST
Bili incr
ratio of what in AST:ALT ratio is suggestive of Alcohol
normal < 1
>2 indicates alcohol
other than ratio, what screens should be considered in acute hepatocellular injury
Hep A/HepB/HepC/HepE/HIV
Cytomegalovirus/ Epstein-barr Virus
Herpes Simplex Virus (pregnant/ immunocompromised)
what conditions need to excluded for acute liver disease
coeliac - tTG (IgA), genotyping
muscle disorders (CK)
Adrenal insufficiency
Anorexia Nervosa (mixed form of LFT)
rare causes of liver disease
autoimmune hepatitis (ASM antibody) (biopsy gold standard)
wilsons disease - caeruloplasmin
Hemochromatosis (ferritin > 500 - gene testing)
alpha 1 anti-trypsin (PiZZ - worse)
hyperbilirubinaemia - unconjugated
incr bilirubin production
- extra/intravascular haemolysis
- extravasation of blood into tissues
impairec hepatic bilirubin uptake
- heart failure
- portosystemic shunts (TIPS)
- drugs - rifampicin, probenecid
impaired bilirubin conjugation
- GIlberts - low hyperbilirubinaemia, high LFT - send for genetics
- CN Type II - same gene
- Hyperthyroidism
- Advanced liver disease
hyperbilirubinaemia - conjugated
extrahepatic cholestasis (biliary obstruction)
- cholelithiasis
- PSC
- cholangiocarcinoma
- Head of Pancreas mass
- acute/chronic pancreatitis
intrahepatic cholestasis
- sepsis/hypoperfusion states
- cirrhosis
- TOtal perental nutriton (pronounced, may lead to liver failure, refeeding)
- Infiltrative diseaases
- acute hepatitis
- drug - alkylated steroids, rifampicin, chlorpromerazine
cholesterol high and LDL >5 indicates
might be genetic
CMV /EBV is mostly supportive care, however the patient must be told to
avoid contact sports - may rupture spleen/liver
