LFTs

Question 1

What are the 3 different types of LFTs?

Answer 1

Hepatic, cholestatic or mixed

Question 2

What are LFTs a measure of?

Answer 2

Protein synthesis and clotting cascade

Question 3

What are LFTs?

Answer 3

Albumin and prothrombin time

Question 4

What are liver enzymes?

Answer 4

ALT, AST, ALP, gamma GT, bilirubin

Question 5

What should you always specifically ask for in liver disease histories?

Answer 5

Alcohol, tattoos, blood transfusions, medications, drug use, travel, sexual history

Question 6

What test should be done after a history and LFTs?

Answer 6

Liver screen

Question 7

What is included in a liver screen?

Answer 7

Immunology, virology, iron studies, A1AT, caeruloplasmin, history specific tests e.g. paracetamol

Question 8

What is included in virology screening?

Answer 8

Hepatitis B and C virus, cytomegalovirus, ebstein-barr virus

Question 9

What is included in immunology screening?

Answer 9

Anti smooth muscle antibodies, anti mitochondrial antibodies, anti nuclear antibodies

Question 10

What is included in iron studies screening?

Answer 10

Transferrin saturations and ferritin

Question 11

What causes a predominant rise in transaminases (AST, ALT)?

Answer 11

Hepatitis

Question 12

What does an elevated ALT generally describe?

Answer 12

Injury to hepatocytes

Question 13

What are common conditions presenting with increased ALT?

Answer 13

Autoimmune hepatitis, hepatitis B and C, other viral conditions and NAFLD

Question 14

Who is autoimmune hepatitis more common in?

Answer 14

Females

Question 15

What are symptoms of autoimmune hepatitis (if any are present at all)?

Answer 15

Tiredness, weight loss, RUQ discomfort

Question 16

What would be findings of note in autoimmune hepatitis?

Answer 16

Increased ALT, anti-smooth muscle antibodies and increased IgG

Question 17

What would a biopsy of autoimmune hepatitis show?

Answer 17

Inflammation with excess plasma cells

Question 18

What do you prescribe short term and long term for autoimmune hepatitis?

Answer 18

Short term- steroids

Long term- azathioprine

Question 19

What is the most common hepatitis in the UK (not world)?

Answer 19

C

Question 20

Who are at risk groups for hepatitis C?

Answer 20

PWID, blood to blood contact, needles, tattoos, sexual history, Pakistan/Indian ethnicity

Question 21

In terms of liver enzymes, what will hepatitis C show?

Answer 21

Increased ALT

Question 22

What is a definitive determinant of hepatitis C?

Answer 22

Hepatitis C positive antibodies

Question 23

What should you do after a diagnosis of hepatitis C is made?

Answer 23

Find out the genotype and refer to hepatology for treatment

Question 24

What causes an asymptomatic rise in ALT?

Answer 24

Non-alcoholic fatty liver disease

Question 25

What is NAFLD an umbrella term for?

Answer 25

Steatosis- fat deposits in liver Steatohepatitis- inflammation Fibrosis/Cirrhosis

Question 26

What is NAFLD closely associated with?

Answer 26

Metabolic syndrome

Question 27

What is usually the limit of ALT in NAFLD?

Answer 27

About 300- any more this diagnosis is unlikely

Question 28

What is cholestasis and what causes it?

Answer 28

Bile not moving- caused by conditions which result in obstruction to bile flow or disease of bile ducts

Question 29

What are the important cholestatic liver enzymes?

Answer 29

Predominantly ALP and bilirubin and some gamma GT

Question 30

What usually happens to ALT in cholestatic disease?

Answer 30

Slight increase or normal

Question 31

What determines the upper limit of normal of ALP?

Answer 31

Age and sex

Question 32

What are some conditions causing cholestasis?

Answer 32

Gallstones, carcinoma of the pancreas head, cholangiocarcinoma, primary biliary cholangitis, primary sclerosing cholangitis

Question 33

What type of disease is primary biliary cholangitis and who is it more common in?

Answer 33

Autoimmune- more in women

Question 34

What age range does primary biliary cholangitis typically present?

Answer 34

50-65

Question 35

What does primary biliary cholangitis present with?

Answer 35

Fatigue, itch, jaundice and increased cholesterol

Question 36

What part of the body does primary biliary cholangitis affect?

Answer 36

Microscopic bile ducts

Question 37

What will the LFT panel for primary biliary cholangitis show?

Answer 37

Increased ALP and slightly increased bilirubin and ALT

Question 38

What will the immunology for primary biliary cholangitis be?

Answer 38

Anti mitochondrial antibody positive

Question 39

What is treatment for primary biliary cholangitis?

Answer 39

Ursodeoxycholic acid and control itch

Question 40

What is the most common cause of a mixed pattern of LFTs?

Answer 40

Alcohol

Question 41

What are other causes of mixed LFTs apart from alcohol?

Answer 41

Obstructive tumour or drug induced liver injury

Question 42

What are examples of drugs which commonly cause liver injury?

Answer 42

Flucloxacillin, co-amoxiclav, NSAIDs