Chemical Pathology 18 - LFT cases

Question 1

What 2 LFT results are very suggestive of alcoholic liver disease?

Answer 1

AST: ALT > 2.0

High GGT

Question 2

When is ALP most markedly elevated?

Answer 2

Bile duct damage/ obstructive jaundice

Question 3

What is the half life of albumin?

Answer 3

20 days

Question 4

Systematically recall some reasons why albumin may be low

Answer 4

1. Low production (chronic liver disease/ malnutrition)
2. Loss (gut/ kidney (nephrotic))
3. Sepsis, “3rd sponge” - due to endothelial leaking

Question 5

What is the best measure of acute liver function?

Answer 5

Prothrombin time

Question 6

Recall 4 scenarios in which AFP is raised

Answer 6

1. Pregnancy (physiolgically)
2. Hepatocellular carcinoma
3. Testicular cancer
4. Hepatic damage/ regeneration

Question 7

What are the 2 possible causes of jaundice when LFTs are normal?

Answer 7

Gilbert’s

Haemolysis

Question 8

In a jaundiced patient with a raised ALP, what should your diagnostic approach be?

Answer 8

Do a USS
If dilated ducts: gallstones/ cancer
If undilated ducts: drugs/ PSC/PBC/ pregnancy

Question 9

What in the LFTs would indicate that jaundice had a hepatocellular origin?

Answer 9

Raised ALT/AST as opposed to ALP

Question 10

How can you identify obstructive jaundice clinically without measuring bilirubin?

Answer 10

Pale stool and dark urine

Question 11

What is the ELF score, and how is it calculated?

Answer 11

Enhanced liver fibrosis score

Combines TMIP-1, P11 NP and HA in a clever algorithm

Question 12

Which common drug is often implicated in cholestasis?

Answer 12

Augmentin (co-amoxiclav)

Question 13

Which type of hepatitis is most common cause of acute viral illness in returning travellers?

Answer 13

Hepatitis A (water-borne)

Question 14

What USS finding is very suggestive of liver cirrhosis?

Answer 14

Coarse liver

Question 15

Which type of hepatitis is most likely to be transmitted by IV drug use?

Answer 15

Hep C