Lecture: LFT and EUC

Question 1

Intracellular potassium concentration

Answer 1

high

Question 2

Intracellular sodium concentration

Answer 2

low

Question 3

Extracellular potassium concentration

Answer 3

low

Question 4

Extracellular sodium concentration

Answer 4

high

Question 5

Intracellular potassium concentration

Answer 5

high

Question 6

Extracellular potassium concentration

Answer 6

low

Question 7

Intracellular chloride concentration

Answer 7

low

Question 8

Extracellular chloride concentration

Answer 8

high

Question 9

What drives the majority of changes in concentration of sodium?

Answer 9

disturbances in water homeostasis

Question 10

What does hypernatraemia usually indicate?

Answer 10

Dehydration

Question 11

Cholestasis LFT?

Answer 11

ALP significantly elevated

ALT normal/mildly elevated

Question 12

What are the four hepatic enzymes commonly measured?

Answer 12

AST
ALT
GGT 
Alk. phos.
liver transaminases:
aspartate transaminase (AST or SGOT)
alanine transaminase (ALT or SGPT) 
are useful biomarkers of liver injury in a patient with some degree of intact liver function
Some tests are associated with functionality (e.g., albumin), some with cellular integrity (e.g., transaminase), and some with conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase).

Question 13

Name two liver synthetic function tests.

Answer 13

INR and albumin

Question 14

Where can AST be found in the body?

Answer 14

liver, heart, muscles, kidney, RBC

Question 15

Where can ALT be found in the body?

Answer 15

Predominantly the liver

Question 16

When is ALT>AST and what condition does this indicate?

Answer 16

Most chronic liver disease not caused by alcohol

Question 17

When is AST>ALT?

Answer 17

Cirrhosis of the liver. AST:ALT > 2 strongly suggests alcohol as the cause of cirrhosis.

Question 18

AST:ALT > 5 strongly suggests what?

Answer 18

An extrahepatic cause of elevated AST such as rhabdomyolysis or MI

Question 19

What is ALP (alkaline phosphatase) and where is it found?

Answer 19

Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. It can also be found on the mucosal epithelium of the small intestine, proximal convoluted tubule of the kidneys, bone, liver, and placenta.

Question 20

What is GGT?

Answer 20

GGT is a microsomal enzyme found in hepatocytes, biliary epithelial cells, renal tubules, pancreas, and intestines. It helps in glutathione metabolism by transporting peptides across the cell membrane.

Question 21

Diagnostic consideration:
Mild/Moderate Elevated ALP
Elevated GGT

Answer 21

Hepatic or biliary disease

Question 22

Diagnostic consideration:
Severely Elevated ALP
Elevated GGT

Answer 22

Biliary disease only

Question 23

Diagnostic consideration:
Elevated ALP
Normal GGT

Answer 23

Bone disease

Question 24

Diagnostic consideration:
Normal ALP
Elevated GGT

Answer 24

Alcohol abuse

Question 25

What does the INR measure?

Answer 25

The prothrombin time. Measures the extrinsic pathway of clotting. This is dependent on clotting factors produced by the liver.

Question 26

Probable etiology of: Elevated unconjugated bilirubin Elevated conjugated bilirubin

Answer 26

Diffuse hepatocellular or biliary system process

Question 27

Probable etiology of: | Isolated Elevated unconjugated bilirubin

Answer 27

Haemolysis | Genetic conditions: Gilbert's or GN syndromes

Question 28

Probable etiology of: | Isolated Elevated conjugated bilirubin

Answer 28

Early biliary disease | Genetic conditions

Question 29

Common pattern of LFT abnormalities on hepatocellular injury?

Answer 29

*AST and ALT mild/severe elevated *ALP and GGT normal/moderate elevated Bilirubin normal/moderate elevated Albumin normal/moderate decreased INR normal/moderate increase

Question 30

Common pattern of LFT abnormalities on cholestatic injury?

Answer 30

``` AST and ALT normal/mild elevated *ALP and GGT mild/severe elevated *Bilirubin mild/severe elevated Albumin normal unless severe INR normal unless severe ```

Question 31

Common pattern of LFT abnormalities on isolated hyperbilirubinaemia injury?

Answer 31

``` AST and ALT normal ALP and GGT normal *Bilirubin mild/severe elevated Albumin normal INR normal ```

Question 32

Common pattern of LFT abnormalities on isolated synthetic dysfunction injury?

Answer 32

``` AST and ALT normal ALP and GGT normal Bilirubin normal *Albumin mild/severe decrease *INR mild/severe elevation ```

Question 33

Common pattern of LFT abnormalities on cirrhosis injury?

Answer 33

``` *AST and ALT mild/severe elevated ALP and GGT normal *Bilirubin mild/severe elevated *Albumin mild/severe decreased *INR mild/severe increase ```

Question 34

Causes of ALT 500 IU/L

Answer 34

When ALT rises to more than 500 IU/L, causes are usually from the liver. It can be due to hepatitis, ischemic liver injury, and toxins that causes liver damage. Poisoning causes levels in the 1000s