LFTs part II

Question 1

what other bloods should be investigated when presented with deranged LFTs?

Answer 1

• virology
• immunology
• iron
• caeruloplasmin
• alpha-1 antitrypsin
• any history specific tests ie paracetamol, HEV, HAV

Question 2

what is the upper normal limit for ALT?

Answer 2

55

*elevated ALT suggests hepatocyte injury

Question 3

what common conditions present with hepatitis?

Answer 3

NAFLD, AIH, HCV

Question 4

LFTs for autoimmune hepatitis (AIH)?

Answer 4

elevated ALTs ie 100-800+

• when ALTs are severely elevated then this indicates that the AIH is of acute onset
• AIH is usually asymptomatic or presents very generally ie malaise, fatigue
• immunology will also show ASMA+ and elevated IgG

Question 5

LFTs for Hepatitis C virus?

Answer 5

elevated ALTs also with clinical suspicion

Question 6

LFTs for NAFLD?

Answer 6

asymptomatic with moderately elevated ALTs with features of Metabolic Syndrome

*ALTs of more than 250 is unlikely to show NAFLD

Question 7

LFTs for cholestasis?

Answer 7

elevated ALP, elevated Bilirubin

moderately elevated GGT and ALT

Question 8

what is the normal upper limit for bilirubin?

Answer 8

22

Question 9

LFTs for PBC?

Answer 9

cholestatic LFTs

elevated Bilirubin and ALP, and moderately elevated GGT and ALT