Liver investigaitons - yr 4

Question 1

What biochemical tests are indications of liver function

Answer 1

PT, bilirubin, albumin

Question 2

Differntials for ALT >1000

Answer 2

Drugs, ischaemia, viruses

Question 3

What LFT is isolated raised physiologiically in 3rd trimester preg

Answer 3

ALP

Question 4

Standard liver function test includes

Answer 4

Bilirubin
Albumin
Transferases - ALT, AST
ALP
GGT
serum coag/INR

Question 5

Which diabetes is C peptide raised in

Answer 5

T2DM

Question 6

INvestigation for haemolysis if raised unconjugted bilirubin

Answer 6

• Reticulocyte count
• LDH
• Blood film
• Haptoglobin
• Direct coombs test

Question 7

What drug can cause raised unconjugated bilirubin

Answer 7

Rifampacin

Question 8

Cholestatic drugs -> conjugated bilirubin rise

Answer 8

Nitrofurantoin, penicillin

Question 9

Causes of raised conjugated bilirubin

Answer 9

Biliary obstruction at any level of bile ducts - malignancy - cholagniocarcninoma, pancreatic
Gallstones in CBD
AI cholestatic - PSC, PBC
Hepatitis
Criihpsis

Question 10

Mild raised AST, ALT causes

Answer 10

Cirrhosis, chronic hepatitis

Question 11

Moderate raised ALT, AST causes

Answer 11

Alchoolic liver disease, AI hep

Question 12

Marked raised AST/ALT

Answer 12

Acute viral heapatitis, ischaemic or toxic liver injury

Question 13

Causes of acute and chronic hepatitis

Answer 13

• Alcohol - chronic abuse and hepatitis
• NAFLD
• Viral hepatitis (acute or chronci)
• AI hepatitis
• Drug toxicity
• Ischaemia - sudden drop in BP/shock
• Metabolic liver disease (Wilsons, haemochromatosis)

Question 14

When are ALT/AST released

Answer 14

Hepatocellular damage - AST more diffuse also cardiac, muscle, renal RBC
ALT more liver specific

Question 15

What ALP i snormla

Answer 15

<130

Question 16

Physiologicak rises in ALP

Answer 16

• 3rd trimester pregnancy
• Increased bone turnover - adolescents during periods of growth

Question 17

Hepatic cause raised ALP

Answer 17

Bile dut obstruction
PSC
PBC
Drug induced cholestasis, antibiotics, anabolic steroids

Question 18

Extra hepatic casues of raised ALP

Answer 18

Bone disease - fractures, pagets, bone mets, isolated ALP in PSC, PBC and bone mets

Question 19

Isolated raised GGT vs raised GGT and ALP

Answer 19

GGT alone = alcohol abuse, COPD, renal failure
GGT+ALP = hepatobiliary source

Question 20

Where is the cause when AST/ALT»>ALP/GGT

Answer 20

Hepatic cause

Question 21

Where is the cause when ALP/GGT»>AST/ALT

Answer 21

Biliary/obstructive cause

Question 22

Causes of PT prolongation

Answer 22

Chronic liver disease where loss of symthetic function
Deficiency of ft soluble vit K
Obstructive jaundice - lack bile cant absorb fat soluble vits

Question 23

Cuases of low albumin

Answer 23

Liver function
Nutiritonal
Loss: renal - nephrotic syndrome
SIRS - sepsis extravasation, burns
Physiological stress eg IBD dont produce