L1: LFTs

Question 1

Tests of liver cell integrity (Injury)

Answer 1

• ALT
• AST

Question 2

Tests of biliary tract Integrity (Cholestasis)

Answer 2

• ALP
• GGT
• 5’-nucleotidase

Question 3

Tests of Liver cell Function

Answer 3

• Albumin
• Bili
• INR

Question 4

Liver Biochemestries

Answer 4

Question 5

Aminotransferases

Answer 5

Question 6

ALT

Answer 6

Question 7

AST

Answer 7

Question 8

Degree of elevation of → AST and ALT are useful in distinguishing ….

Answer 8

acute and chronic liver diseases.

Question 9

ALT and AST → are the most widely ordered liver chemistries that reflect injury to the liver.

Answer 9

….

Question 10

aminotransferase levels < 300 iu ml

Answer 10

• alcoholic hepatitis
• non-alcoholic fatty liver disease
• Chronic viral hepatitis (hepatitis B and C).

Question 11

patients with levels between 500 iu ml and 5,000 iu ml

Answer 11

• acute viral hepatitis
• autoimmune hepatitis
• drug reaction Viral
• drug induced hepatitis will raise aminotransferase levels steadily and peak in the low thousands within 7-14 days, return to normal over weeks

Question 12

high levels (greater than 5,000 iu ml)

Answer 12

• acetaminophen related liver failure
• ischemia
• herpes simplex hepatitis

Question 13

what to suspect when ALT > AST?

Answer 13

Typical for most liver conditions, including chronic viral hepatitis and NAFLD

Question 14

what to suspect when ALT < AST?

Answer 14

Question 15

AST > ALT Ratio results from ……

Answer 15

Question 16

Def of Cholestasis

Answer 16

• impairment in bile flow.
• Cholestasis liver profile characterized by -an elevation in alkaline phosphatase with or without an elevation in bilirubin.

Question 17

Normal alk phosphate level

Answer 17

125 IU/ml

Question 18

When SAP elevation is detected, …..

Answer 18

• Repeat the test.
• Confirm the hepatic origin: Serum GGT - 5’Nucleotidase.

Question 19

causes of elevated Serum alkaline phosphate

Question 20

Albumin

Answer 20

Question 21

PT

Answer 21

Question 22

Bilirubin

Answer 22

Question 23

Child-Turcotte-Pugh Classification for Severity of Cirrhosis

Answer 23

Question 24

Isolated elevated indirect (unconjugated) bilirubin

Answer 24

• Hemolysis
• Drugs
• Gilbert’s Disease
• Crigler-Najjar type Il

Question 25

Drugs **Isolated elevated indirect (unconjugated) bilirubin**

Answer 25

Probenecid, Rifampicin

Question 26

Gilbert's Syndrome **Isolated elevated indirect (unconjugated) bilirubin**

Answer 26

Question 27

CNJ Type II **Isolated elevated indirect (unconjugated) bilirubin**

Answer 27

A. Caused by gene mutation B. Reduced activity of Bilirubin UDP glucuronosyl

Question 28

Causes of Intrahepatic Cholestasis

Answer 28

Question 29

Causes of Extrahepatic Cholestasis

Answer 29

Question 30

Causes of hepatocellular injury

Answer 30

Question 31

Etiology of **PBC**

Answer 31

Unknown

Question 32

pathology of **PBC**

Answer 32

Injury of the interlobular or septal bile ducts.

Question 33

CP of **PBC**

Answer 33

Question 34

Investigations for **PBC**

Answer 34

1. LFTS: Raised serum ALP 2. Serology positive AMA in 95% of patient, high serum IgM. 3. Liver biopsy: Injury of the interlobular or septal bile ducts.

Question 35

TTT of **PBC**

Answer 35

Question 36

Symptomatic TTT of **PBC**

Answer 36

Question 37

Causes of Pruritis

Answer 37

- Obstructive jaundice - Cholestasis of pregnancy - Renal failure - Lymphoma - PBC - DM - Leukemia - Polycythemia Rubra Vera

Question 38

Def of **PSC**

Answer 38

- chronic progressive disorder of unknown etiology that is characterized by inflammation, fibrosis, and structuring of medium size and large ducts in the intrahepatic and extrahepatic biliary tree

Question 39

Incidence of **PSC**

Answer 39

90% have inflammatory bowel disease, especially ulcerative colitis

Question 40

Symptoms of **PSC**

Answer 40

Pruritus, fatigue, RUQ pain

Question 41

Dx of **PSC**

Answer 41

* Ultrasound * Cholangiogram: multifocal stricturing and dilation of intrahepatic

Question 42

Prognosis of **PSC**

Answer 42

* Poor; average life expectancy after diagnosis is -12 years * 10-15% risk of developing cholangiocarcinoma

Question 43

what is the ultimate TTT of **PSC**?

Answer 43

Transplant