Interpretation Of LFT's

Question 1

Acute hepatitis

Answer 1

ALT/AST in 1000 (massive increase), ALP mildly raised

Question 2

Chronic hepatitis

Answer 2

ALT/AST in 100’s (milder increase)

Question 3

Cholestatic/ obstructive picture

Answer 3

ALP markedly raised, ALT/AST mildly raised, increased bilirubin

Question 4

Alcoholic picture

Answer 4

Increased gamma GT, increased MCV, AST/ALT mildly elevated, increased bilirubin in acute alcoholic hepatitis

Question 5

Cirrhosis/ chronic liver disease (not chronic hepatitis)

Answer 5

Liver enzymes may be normal, decreased albumin, abnormal coagulation profile

Question 6

Marked increases ALP (>4x normal)

Answer 6

Cholestasis (gallstones, PBC, PSC, pancreatic cancer)

Question 7

Moderate increase ALP (<3x normal)

Answer 7

Hepatitis, infiltration, cirrhosis

Question 8

Gamma GT

Answer 8

Mirrors ALP so can be used to confirm if a raised ALP is hepatic in origin

Also raised with alcohol abus

Question 9

Unconjugated hyperbilirubinaemia

Answer 9

Pre hepatic jaundice

Increased RBC breakdown eg. Sickle cell or thalassaemia
Impaired hepatic uptake eg. Heart failure
Impaired conjugation eg. Physiological neonatal jaundice

Question 10

Conjugated hyperbilirubinaemia

Answer 10

Hepatocellular dysfunction (liver disease)- hepatic jaundice
Impaired hepatic secretion (cholestasis)- post hepatic jaundice

Question 11

Decreased albumin decreased protein

Answer 11

Advanced cirrhosis, alcoholism, protein malnutrition, chronic inflammation, gut/ renal loss

Question 12

Decreased albumin and normal protein

Answer 12

Infection (albumin is a negative acute phase protein)

Question 13

Decreased albumin and increased protein

Answer 13

Myeloma, chronic inflammation (autoimmune condition), acute infection

Question 14

Drugs that cause hepatitis

Answer 14

TB antibiotics, sodium valproate, methotrexate, amiodarone, statins, paracetamol, nitrofurantoin, sulfonylureas

Question 15

Cholestasis drugs

Answer 15

Co amoxiclav, clarithromycin, carbamazepine, sulfonylureas, COCP

Question 16

Red urine

Answer 16

Haematuria, haemoglobinuria, porphyria, beetroot, rifampicin

Question 17

Brown urine

Answer 17

Bile pigments, myoglobin, metronidazole, nitrofurantoin

Question 18

Green/ blue urine

Answer 18

Pseudomonas UTI, biliverdin, amitryptilline

Question 19

Orange urine

Answer 19

Bile pigments

Question 20

Aminotransferases

Answer 20

ALT- liver specific
AST- liver, heart, skeleton, kidney,pancreas

Marked increase (>1000): drug induced hepatitis, acute viral hepatitis, liver ischaemia 
Modest increase (300-500): chronic viral, alcoholic, autoimmune, biliary obstruction 
Mild increase (<300): cirrhosis, NA steatohepatitis, HCC, haemachromatosis, Wilson’s 

ALT>AST: chronic liver disease
AST>ALT: greater in established cirrhosis and much greater in alcoholic liver disease

Question 21

Alkaline Phosphatase (ALP)

Answer 21

Main source is biliary ducts and bone (Pagets, bony metastasis, fracture, osteomalacia, renal bone disease)

Lesser source- placenta (pregnancy), small intestine (fatty meals) and kidneys (CKD)

NB- if ALP is hepatic in origin yGT will also rise (isosnzyme analysis)

Question 22

Viral tests to find liver abnormality cause

Answer 22

Viral hepatitides
CMV serology
EBV serology

Question 23

Autoimmune liver screen to identify liver abnormality

Answer 23

Anti smooth muscle (autoimmune hepatitis type 1)
Anti mitochondrial (PBC)
Anti liver kidney microsomal (autoimmune hepatitis type 2, hepatitis CD, drug induced hepatitis) 
Anti nuclear (autoimmune hepatitis type 1, SLE)

Question 24

Tumour markers to identify liver abnormality

Answer 24

Alpha fetoprotein (HCC)

Question 25

Tests to discover infiltrative cause in liver abnormality

Answer 25

Ferritin and transferrin saturation (haemachromatosis)- careful as ferritin is an acute phase protein Fasting glucose and lipids- fatty liver disease

Question 26

Metabolic investigations for liver abnormality

Answer 26

Alpha 1 antitrypsin TTG antibody- coealic disease Immunoglobulins- PBC, alcoholic liver disease, autoimmune hepatitis

Question 27

Liver biopsy

Answer 27

CT guided, but done transjugularly if there is ascites or coagulopathy

Question 28

Non hepatic causes of deranged LFT

Answer 28

Hepatitis- TB antibiotics, valproate, methotrexate, methyldopa, amiodarone, statin, paracetamol, nitrofurantoin, sulfonylurea Cholestasis- coamoxiclav, flucloxacillin, sulfonylurea, clarithromycin, contraceptives ``` RHS heart failure Sepsis Coeliac disease Haemolysis Hyperthyroidism Right lower lobe pneumonia ```

Question 29

Pre hepatic jaundice (non-liver aetiology)/

Answer 29

High unconjugated bilirubin Normal conjugated billirubin Normal liver enzymes

Question 30

Hepatic jaundice (liver aetiology)

Answer 30

Normal unconjugated bilirubin High conjugated billirubin High ALT/AST Mild ALP increase

Question 31

Post hepatic jaundice (Obstructive cause)

Answer 31

Normal unconjugated bilirubin Mildly increased conjugated bilirubin Mildly increased ALT AST High ALP

Question 32

Stool/urine in types of jaundice

Answer 32

?