3: LFTs

Question 1

Which levels give an indication of the liver’s function?

Answer 1

Albumin

Prothrombin time

Question 2

The albumin level gives an indication of the liver’s ability to synthesise ___.

Answer 2

protein

Question 3

The INR gives an indication of the liver’s ability to produce ___ ___.

Answer 3

clotting factors

Question 4

What are the enzymes included in a liver function (damage?) test?

Answer 4

ALP (alkaline phosphatase)

ALT/AST

GGT

Bilirubin (not an enzyme…)

Question 5

What are key things to ask about in the history of someone with liver disease?

Answer 5

Alcohol?

Drugs?

Medication?

Travel history?

Sexual history?

Any tattoos? Blood transfusions?

Question 6

Recent tattoos from a foreign country indicate what cause of liver disease?

Answer 6

Hepatitis C

Question 7

Recent dodgy blood transfusion indicates what cause of liver disease?

Answer 7

Hepatitis C

Question 8

Which medications can induce liver disease?

Answer 8

Antibiotics

NSAIDs

Methotrexate

Question 9

Which particular antibiotics can trigger liver disease?

Answer 9

Flucloxacillin

Co-amoxiclav

Question 10

Broadly, which viruses can cause liver disease?

Answer 10

Hepatitis viruses (A, B, C, D, E)

Cytomegalovirus (CMV)

Epstein-Barr virus (EBV)

Question 11

The presence of particular antibodies can indicate the cause of liver disease. Which diseases are diagnosed based on the presence of…

Anti smooth muscle antibody (ASMA)

Anti mitochondrial antibody (AMA)

Answer 11

ASMA ⇒ autoimmune hepatitis, primary sclerosing cholangitis

AMA ⇒ primary biliary cholangitis

Question 12

LFT derangements indicate three broad categories of disease. What are they?

Answer 12

Hepatitic disease

Cholestatic disease

Mixed disease

Question 13

What is hepatitis?

What happens to hepatocytes?

Answer 13

Inflammation of the liver

Hepatocytes are damaged

Question 14

Which liver enzymes are elevated in hepatitic disease?

Answer 14

ALT

AST

Question 15

Which three diseases cause hepatitic LFT changes?

Answer 15

Non-alcoholic fatty liver disease

Viral hepatitis

Autoimmune hepatitis

Question 16

How do bilirubin, ALP and GGT appear in hepatitic disease?

Answer 16

Normal

Because there’s no bile duct obstruction

Question 17

Autoimmune hepatitis is common in (males / females) aged 20-40 and 55-65.

Answer 17

females

Question 18

Autoimmune hepatitis comes in waves. What terms are used to describe this?

Answer 18

Relapsing and remitting

Question 19

Which:

liver enzyme

specific antibody

broad class of antibody

are raised in autoimmune hepatitis?

Answer 19

ALT

Anti smooth muscle antibody (ASMA)

IgG

Question 20

Which immune cells are found on biopsy of someone with autoimmune hepatitis?

Answer 20

Plasma cells

(produce antibodies)

Question 21

What are some symptoms of autoimmune hepatitis?

Answer 21

Fatigue

Weight loss

RUQ pain

Question 22

How is autoimmune hepatitis treated?

Answer 22

Prednisolone (steroid)

Azathioprine / Mercaptopurine (steroid-sparing immunosuppressants)

Question 23

Who is at risk of catching Hepatitis C?

Answer 23

PWID

People who get tattoos and blood transfusions

Pakistani / Indian people

Question 24

Which:

liver enzyme

antibody

is raised in Hepatitis C infection?

Answer 24

ALT

HCV antibody

Question 25

How is **Hepatitis C** treated?

Answer 25

Refer to a hepatologist

Question 26

What is the most common hepatitis seen in the West? What is the cause?

Answer 26

**Non-alcoholic fatty liver diseae (NAFLD)** **Obesity**

Question 27

**NAFLD** exists on a spectrum. What is: **simple steatosis** **steatohepatitis** **cirrhosis**?

Answer 27

**Simple steatosis** - fat in the liver **Steatohepatitis** - fat and inflammation in the liver **Cirrhosis** - irreversible fibrosis of the liver due to chronic inflammation

Question 28

**NAFLD** is usually **(symptomatic / asymptomatic)**.

Answer 28

**asymptomatic** goes undetected for ages

Question 29

Which liver enzyme is raised in **NAFLD**?

Answer 29

**ALT** modestly

Question 30

What is **cholestatic** disease?

Answer 30

Disease in which **bile is stationary**, so **obstruction / disease** **of the bile ducts**

Question 31

Which components of an LFT are raised in **cholestatic disease**?

Answer 31

**ALP** **GGT** **Bilirubin** ALT is mildly elevated too.

Question 32

When is **ALP** elevated?

Answer 32

**Bile duct obstruction** **Bone growth** (normal and abnormal) **Breast disease** so you need to be careful diagnosing something based off ALP alone

Question 33

Which liver enzyme is used to confirm **cholestatic** disease indicated by an elevated ALP?

Answer 33

**GGT**

Question 34

Why may the bile ducts be obstructed?

Answer 34

**Gallstones** **Obstructing tumours** (pancreatic tumours, cholangiocarcinomas) **Primary biliary cholangitis** **Primary sclerosing cholangitis**

Question 35

**Primary biliary cholangitis** is an autoimmune disease caused by the body's production of which antibody?

Answer 35

**Anti mitochondrial antibody** (AMA)

Question 36

Who tends to develop **primary biliary cholangitis**?

Answer 36

**Older women**

Question 37

Which bile ducts are inflamed in **primary biliary cholangitis**?

Answer 37

**Microscopic ones within the liver**

Question 38

What are the symptoms of **PBC**?

Answer 38

**Fatigue** **Itch** **Jaundice** **Hyperlipidaemia**

Question 39

What is the classic presentation of **PBC**?

Answer 39

**Old lady who is itchy, jaundiced, tired** and has **high cholesterol** on investigation

Question 40

Which components of an LFT are raised in **PBC**?

Answer 40

**ALP** **Bilirubin** ALT modestly raised too.

Question 41

Patients with **primary biliary cholangitis** will be positive for which antibody?

Answer 41

**Anti mitochondrial antibody** (AMA)

Question 42

How is **primary biliary cholangitis** treated?

Answer 42

**Ursodeoxycholic acid** (to help bile flow by making it less sticky) **Itching relief** (baths, lotions etc.)

Question 43

What causes **mixed** **cholestatic and hepatitic disease**?

Answer 43

**Alcohol** **Obstructive tumours** **Drugs** diagnosed by taking a good history.