LFTs

Question 1

Alphafetoprotein

Tells of?
Vague Normal range?
Elevated/Low means?

Answer 1

Normally expressed in foetal liver.

Normal range; LOW (0-15)

Causes or rise;
Exposure of the liver to cancer-causing agents
AFP 400–500 μg/L in hepatocellular carcinoma.

Conc 400+ is associated with greater tumour size, involvement of both lobes of liver, portal vein invasion and a lower median survival rate.

Question 2

Ceruloplasmin

Role?
Vague Normal range?
Elevated/Low means?

Answer 2

Role; carries copper in the body

range; High 200-600

Elevated; Obstructive jaundice, rheumatoid arthirits

Low; Wilsons disease - Cu accumulation

Question 3

Lactate dehydrogenase

Elevated/Low means?

Answer 3

Found across the body

Elevated; liver damage?

Question 4

Albumin

Made where?
Tells of?
Vague Normal range?
Elevated/Low means?

Answer 4

Synthesised in the liver.

Range; low (3-5)

Low in the ‘osis’;
Chronic liver disease i.e. cirrhosis.
Nephrosis - nephrotic syndrome - through the urine.

Increased;
burns
acute infection
surgery

Question 5

Consequence of low albumin?

Answer 5

oedema

intravascular oncotic pressure becomes lower than the extravascular space.

Question 6

GGT

Made where?
Tells of?
Vague Normal range?
Elevated/Low means?

Answer 6

Found in liver, intestines, renal tubules etc.

Is an enzyme

range; 9-85

Elevated;
cholestasis
viral hepatitis
alcoholism

others causes of elevation;
DM, hyperthyroid, MI, acute pancreatitis

Question 7

ALP

Stands for?
Made where?
Tells of?
Vague Normal range?
Elevated/Low means?

Answer 7

Alkaline phosphatase

Enzyme found in BILE DUCTS, renal tubules, intestines etc. important in bone calcification

range; 40-130

Elevated;
Cholestasis
Acute viral hepatitis (hep a etc)
Amyloidosis
Abscess
Bone growth - pagets

others; liver cirrhosis, cc-failure, Infiltrative liver disease

Low;
Hypothyroidism
Pernicious anaemia
Hypo-PHOSPHAT-asia

Question 8

ALT

Stands for?
Made where?
Tells of?
Vague Normal range?
Elevated/Low means?

Answer 8

Alanine transaminase

Found in the kidneys, heart, and muscles, as well as high concs in the liver.

Range; 7-56

Elevated;
A rise of up to 300 IU/L is not specific to the liver but can be due to the damage of other organs such as the kidneys or muscles.
Rise more than 500 IU/L, causes are usually from the liver;
Hepatitis, ischeamic liver injury, and toxins that causes liver damage.

others;
Alcoholic liver disease
Non alcoholic liv disease

Question 9

Compare ALT is different hepatitis;

Hep A,B,C.
Chronic hepatitis

Answer 9

The ALT levels in Hepatitis C rises more than in Hepatitis A and B.

Persistent ALT elevation more than 6 months is known as chronic hepatitis

Question 10

Bright liver syndrome (bright liver on ultrasound suggestive of fatty liver) with raised ALT is suggestive of ?

Answer 10

Metabolic syndrome

Question 11

AST

Stands for?
Made where?
Tells of?
Vague Normal range?
Elevated/Low means?

Answer 11

Aspartate transaminase
Found in wide range of organs but highest conc in liver. (means not v specific for liver)

0-35

Elevated mitochondrial AST;
tissue necrosis
MI

General elevation;
Liver cirrhosis

Question 12

AST/ALT ratio

When is this elevated?
name some conditions

Answer 12

The AST/ALT ratio increases in liver functional impairment.

Alcoholic liver disease, the mean ratio is 1.45,
Liver cirrhosis
alcoholic hepatitis (2.0) - more raised than in non alcoholic hepatitis

Question 13

What 2 possible conditions would cause ast/alt above 4.5

Answer 13

Wilson disease or hyperthyroidism.

Question 14

Not a liver enzyme;

Amylase is made where?
Name of amylase from each?

Answer 14

Pancreas, salivary glands

P & S amylase respectively

Question 15

What presentation would trigger an amylase test ordered?

Answer 15

Acute abdominal pain

Question 16

Causes of raised amylase, surgical seive style?

Answer 16

V - Mesenteric ischaemia

Inflam - Acute pancreatitis, Hepatitis, Post ERCP, Peritonitis

Trauma - Burns, Intestinal obstruction or perforation, Duodenal ulcer

Autoimmune -

Metabolic - renal failure, renal transplant, diabetic ketoacidosis.

Infectious - Mumps

Neoplasm - Pancreatic carcinoma

D - drugs; morphine & opiates

Question 17

Name 5 causes of raised amylase

which is most common of all causes?

Answer 17

Acute pancreatitis (4 fold increase. Most common)
Peritonitis
Hepatitis

Renal failure
Pancreatic carcinoma

Question 18

Elevated ALP & GGT?

Answer 18

alp= alk phosphatase

since ggt elevated, alp rise unlikely due to bone.

So it HAS to be a pathology in the biliary tree - cholestasis

Question 19

AST/ALT ratio is 2:1 what is the likely condition?

Answer 19

Alcohol
cirrhosis
alcoholic hepatitis etc

Question 20

when would you see ast/alt figures in the 1000s?

Answer 20

budd chiari syndrome

autoimmune hepatitis

shock liver

acute viral hepatits (a,b)

Question 21

you see an isolated elevation in ast. What test results would you look at? why?

Answer 21

ck

to ensure its not due to muscle breakdown

Question 22

Test results show an elevated bilirubin, whats next?

Answer 22

get the direct bilirubin score (conjugated).

Question 23

there is acute liver (hepatocellular) injury, which markers would you expect to be altered?

Answer 23

AST, ALT (raised)

there may be small rises in alp n conj.bili

Question 24

there is chronic liver injury, which markers would you expect to be altered?

Answer 24

albumin (dropped - cirrhosis etc)

Question 25

there is biliary tree/system injury (obstructive pattern), which markers would you expect to be altered?

Answer 25

conjugated bilirubin
ALP (alk phos - remember, found in bile ducts not liver parenchyma)

there may be small rises in ast & alt too

Question 26

Case; Steep rise in ALP, smaller rises in conjugated bili.

Ultrasuond shows no obstruction, what you thinking?

Answer 26

Infiltrative liver disease - that causes marginally steep ALP rises

unlike cholestatic disease, these dont obstruct the biliary tree

Question 27

Name some infiltrative diseases?

Answer 27

sarcoid, amyloid, haemochromatosis, some cancers

Question 28

Case;
Elevation of total bilirubin
Conjugated bilirubin is slightly elevated

What type of jaundice?
What is the aetiology?

Answer 28

Pre-hepatic jaundice

because there is lots of unconjugated bilirubin but not all can be broken down by the liver, so builds up and theres lower but slightly elevated conjugated form.

aetiology; haemolysis, haemorrhage

Question 29

Case;
Elevation of total bilirubin
Elevation in Conjugated bilirubin

What type of jaundice?
What is the aetiology?

Answer 29

Post Hepatic (obstructive) jaundice

aetiology; obstruction - stricture or stone

liver still works so can conjugate. conj bili, builds up and so overflows/spills out into blood
here the d.bili will be like 50%+ of the tbili

Question 30

What would a intrahepatic jaundice picture look like?

Answer 30

elevated tbili
conj bili around the same/lower/not changed much

because liver funtion is damaged

with all lfts, MUST do further test i.e. imaging to aid diagnosis!!

Question 31

Jaundice;

A patient presents with acute abdominal pain, jaundice. LFTs shows an obstructive picture. what is likely cause and why?

US is carried out, what is expected?

Answer 31

gallstone blocking biliary tree (cholelithiasis)

because, this will cause an acute obstruction hence acute pain
on US, may see small amount of liver and gallbladder inflammation - thick gallbladder wall

Question 32

Jaundice;

A patient presents with unwell, NO abdominal pain, jaundice. LFTs shows an obstructive picture. what is likely cause and why?

US is carried out, what is expected?

Answer 32

stricture or tumour

because these take a while to obstruct, not sudden

US; very distended gallbladder and biliary ducts

*cancers include from head of pancreas, cholangiocarcinomas etc
strictures can be post ercp

Question 33

Elevated ALT or ALP. what test to do next?

Answer 33

GGT to ascertain if elevation is from liver.