Hepatology: LFTs Flashcards
The following LFT results indicate a problem in which area of the body?
High AST
High ALT
Very high ALP
Very high GGT
Normal PT
Blood
Hepatocytes
Bones
Intestines
Biliary tree
Biliary tree
The correct answer here would be the biliary tree. High ALP and GGT, out of proportion with AST/ALT, suggests a cholestatic cause such as bile duct obstruction. ALP can also be high in bone disease and GGT can also be high with alcohol or phenytoin use, but together with other results, biliary tree obstruction is more likely.
The following LFT results would most likely indicate a problem in which area of the body?
Very raised ALT
Raised AST
Slightly raised ALP
Slightly raised bilirubin
Slightly raised GGT
Prolonged PT
Intestines
Hepatocytes
Bones
Blood
Biliary tree
Hepatocytes
A raised ALT/AST, out of proportion with ALP and bilirubin, suggests a hepatocellular origin. This is further reinforced by the prolonged PT which can occur when a damaged liver can no longer make plentiful clotting factors.
When ALT>AST, what are two most likely causes? [2]
acute viral hepatitis or acute drug toxicity
When AST>ALT, what is the more likely pathology? [1]
When AST>ALT, cirrhosis is more likely.
Paul is a 47-year-old with a long history of alcohol abuse.
Which of the following LFT results would be most likely?
Very high AST, high ALT, high GGT
Very high AST, high ALT, low GGT
High AST, very high ALT, high GGT
Low AST, high ALT, high GGT
High AST, very high ALT, low GGT
Paul is a 47-year-old with a long history of alcohol abuse.
Which of the following LFT results would be most likely?
Very high AST, high ALT, high GGT
Very high AST, high ALT, low GGT
High AST, very high ALT, high GGT
Low AST, high ALT, high GGT
High AST, very high ALT, low GGT
In alcohol abuse, the AST is typically much higher than the ALT.
How does pancreatic cancer present in LFTs? [3]
Raised cholestatic LFTS:
- Raised ALP, GGT & bilirubin
Which liver enzyme is liver specific? [1]
ALT
AST is found in the liver and which other tissue? [3]
Heart, muscle & kidney
ALP is released from which tissues? [3]
Bile cannalicluar
Bone
Placenta
Which liver enzyme is particularly raised in patients with alcohol excess? [1]
GGT
The AST:ALT ratio of WHAT indicates alcoholic liver disease? [1]
AST:ALT > 2:1
ALP and GGT are interpreted together to localise the source of raised ALP in the blood:
An ALP rise with normal GGT suggests []
An ALP rise with associated GGT rise is more suggestive of []
An ALP rise with normal GGT suggests bone disease (e.g. Paget’s disease, vitamin D deficiency, bony metastases)
An ALP rise with associated GGT rise is more suggestive of cholestasis
An isolated GGT rise is classically associated with []
An isolated GGT rise is classically associated with alcohol excess.
Severe liver disease leads to decreased production of clotting factors and an [increased or decreased] prothrombin time (PT) / INR in the absence of other causes of coagulopathy?
Severe liver disease leads to decreased production of clotting factors and an increased prothrombin time (PT) / INR in the absence of other causes of coagulopathy.
Combination of which blood function liver tests would suggest severe liver disease?
Elevated bilirubin & liver enzyme
Describe what is an ECRP procedure? [3]
Endoscopic Retrograde Cholangio Pancreaticography:
- Endoscopy under fluroscopic guidance of biliary tree and pancreatic tree (dye of each structure)
- Diagnose to ID block of each tree
- Therapy: stent / tube to open blockage
USED AFTER MRCP as more invasive
Describe the process of TIPS [2]
- shunt inserted into portal vein & into hepatic circulation
- reduces portal pressure
