LFTs

Question 1

what is jaundice

Answer 1

a clinical sign- first seen in sclera of

Question 2

what is bilirubin a marker of

Answer 2

liver synthesis function

Question 3

what are the liver function tests

Answer 3

bilirubin, albumin, prothrombin time, serum blood glucose

Question 4

are ALT, ALP, GGT, AST liver function tests

Answer 4

no

Question 5

what do ALP, ALT, AST and GGT show

Answer 5

liver damage

Question 6

when is a rise in ALT significant

Answer 6

more than a 10 fold rise

Question 7

when is a rise in ALP significant

Answer 7

more than a 3 fold rise

Question 8

when is ALT raised

Answer 8

with hepatocellular injury

Question 9

where is ALP and when is it raised

Answer 9

concentrated in the liver, bile ducts and bone. often raised in cholestasis

Question 10

what test results show hepatocellular damage

Answer 10

more than 10x increase in ALT and less than 3x increase in ALP

raised AST

Question 11

what test results show cholestasis

Answer 11

less than 10x increase in ALT and more than 3x increase in ALP

raised GGT

Question 12

what is seen in a mixed pattern

Answer 12

all raised

Question 13

what can a raised GGT mean

Answer 13

biliary epithelial damage and bile flow obstruction

can also be raised in response to alcohol and drugs

Question 14

what does a raised ALP and GGT mean

Answer 14

cholestasis

Question 15

what does a raised ALP and normal GGT

Answer 15

non hepatobiliary (e.g bone problem)

Question 16

what is an isolated rise in bilirubin with no ALT or ALP increase suggestive

Answer 16

pre hepatic jaundice

Question 17

what can cause isolated jaundice

Answer 17

gilberts syndrome, haemolysis

Question 18

what are the livers main synthesis functions

Answer 18

conjugation and elimination of bilirubin,
synthesis of albumin,
synthesis of clotting factors, gluconeogenesis

Question 19

what what type of jaundice is there normal coloured urine and normal stools

Answer 19

pre-hepatic (unconjugated bilirubin)

Question 20

what what type of jaundice is there dark urine and normal stools

Answer 20

hepatic

Question 21

what what type of jaundice is there dark urine and pale stools

Answer 21

obsructive

Question 22

what is albumin

Answer 22

synthesised in the liver, helps to bind water, cations, fatty acids and bilirubin- maintains oncotic pressure

Question 23

low albumin can mean

Answer 23

liver disease (cirrhosis), acute phase response to inflammation which lowers liver production, excessive loss of protein e.g nephrotic syndrome

Question 24

what is pro thrombin time

Answer 24

measure of bloods coagulation tendency, specifically extrinsic pathway

Question 25

what can an increase PT mean

Answer 25

indicate liver disease in the absence of anticoagulants or vit K deficiency

Question 26

what test results are seen in acute hepatocellular damage

Answer 26

very increased ALT, normal/ raised ALP, normal/raised GGT, raised/very raised bilirubin

Question 27

what test results are seen in chronic hepatocellular damage

Answer 27

normal/ raised ALP, ALT, GGT, bilirubin

Question 28

what test results are seen in cholestasis

Answer 28

normal/ raised ALT, very raised ALP, GGT, bilirubin

Question 29

what are common causes of acute heatocellular damage

Answer 29

poisoning (paracetamol overdose). infection (hep A and B), liver ischaemia

Question 30

what are the common causes of chronic hepatocellular damage

Answer 30

alcoholic fatty liver disease, NAFLD, chronic infection (hep B or C), primary biliary cirrhosis

Question 31

what are the less common chronic hepatocellular injury

Answer 31

wilsons disease, alpha -1 - antitrysin deficiency, haemochromatosis (iron overload)

Question 32

what are the components of a lover screen

Answer 32

LFTs, coagulation screen, hepatitis serology (A/B/C), Epstein barr virus, cytomegalovirus, AMA, ASMA, ANA, p-ANCA, immunoglobulin, serum copper, ceruloplasmin, ferritin

Question 33

what is AMA

Answer 33

anti- mitochondrial antibody= seen in PBC (95%), autoimmunehepatitis (30%)

Question 34

what is ASMA

Answer 34

anti smooth muscle antigen= autoimmune hepaitits (70%) and PBC (50%)

Question 35

what is ANA

Answer 35

anti nuclear antibody= seen in SLE

Question 36

what is p-ANCA seen in

Answer 36

churg-struass syndrome, good pastures, UC, crohns, sclerosing cholangitis, autoimmune hep

Question 37

what is cholestasis

Answer 37

a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts. Blockage of biliary system causing jaundice and increase in ALP and GGT

Question 38

what should you do in autoimmune hep

Answer 38

liver biopsy and ultrasound

Question 39

what is the treatment for autoimmune hep

Answer 39

prednisolone and azathioprine

Question 40

when is a mixed picture LFT seen

Answer 40

in ischaemia

Question 41

what drugs raised CCT

Answer 41

alcohol, rifampicin

Question 42

what do ALP, ALT and GGT not tell you about

Answer 42

the function of the liver- shows damage to the liver

Question 43

what are the serum transaminases

Answer 43

AST/ALT, alanine, asparate

Question 44

what is bilirubin transported bound to

Answer 44

albumin

Question 45

what happens to bilirubin in hepatocytes

Answer 45

undergoes conjugation

Question 46

what clotting factors does the liver synthesise

Answer 46

I, II, V, VII, IX, XII, XIII

Question 47

what is fibrinogen

Answer 47

clotting factor I

Question 48

what is prothrombin

Answer 48

II

Question 49

what does prothrombin time measure

Answer 49

time for conversion of prothrombin to thrombin- relfects synthetic function of the liver

Question 50

how does the liver affect vit k

Answer 50

decreased bile salts leads to impaired vit k absorption and deficiency

Question 51

what antibiotics can cause hepatitis

Answer 51

penicillins, beta lactams

Question 52

what can cause a increased PT time

Answer 52

prolonged jaundice, vit k malabsorption, hepatocellular dysfunction

Question 53

what tests are done for coealiac

Answer 53

tTG-IgA, HLA typing, biopsies gold standard, NAFLD +/- IDA

Question 54

what immune components indicate autoimmune hep

Answer 54

ASMA/ immunoglublins

Question 55

what suggests wilsons

Answer 55

caerulosplasmin

Question 56

what suggests haemochromatosis

Answer 56

ferritin/ staturation

Question 57

what is causes of unconjugated hyperbilirubinaemia and what are the underlying aetiologies

Answer 57

= increased production, extra/intravascular haemolysis, impaired uptake (heart failure, portosystemic shunts, drugs; rifampicin, probenecid), impaired conjugation (congenital- gilberts/ CN type II)(hyperthyroidism)(advanced liver disease)

Question 58

what does an conjugated hyperbilirubinaemia mean and what are the causes

Answer 58

extrahepatic cholestasis (biliary obstruction; cholelithiasis, PSC, cholangiocarcinoma, HoP mass, acute/ chronic pancreasitis), intrahepatic cholestasis (sepsis, hypoperfusion states, cirrhosis, infiltrative diseases, TPN (total parentral nutrition), acute hepatitis, drugs (steroids, herbs, rifampicin))

Question 59

what are the features of acute liver failure

Answer 59

encephalopathy, jaundice, reduced coagulability