Liver Function Tests (LFTs)

Question 1

What processes is the liver responsible for?

Answer 1

Gluconeogenesis
Glycogenolysis
Glycogenesis
Detoxification
Synthesising amino acids/fats/proteins

Question 2

What is bile responsible for?

Answer 2

Breaking down fat during digestion

Question 3

What is bilirubin, and where is it found?

Answer 3

It is found in the bile, and is a waste product of haemoglobin

Question 4

What drugs should you be careful with if a patient has low albumin levels (hypoalbuminaemia)?

Answer 4

Phenytoin
Warfarin
Calcium

This is because they are all protein (albumin)-binding drugs

Question 5

What can high bilirubin levels indicate?

Answer 5

Obstruction in system
Cholestasis - stoppage/blockage of bile flow
Gallstones

Question 6

What are the symptoms of high bilirubin levels (Gilberts syndrome)?

Answer 6

Itchiness
Jaundice
N+V
Abdominal pain

Question 7

What can high AST/ALT levels indicate?

Answer 7

Acute liver damage, e.g. hepatitis, or injury

Question 8

What should the ratio of AST/ALT always be?

Answer 8

<1

Question 9

What can high ALP levels indicate?

Answer 9

Cholestasis
Tumour
Cirrhosis

Question 10

Is ALP specific to the liver?

Answer 10

No

Question 11

What can high GGT levels indicate?

Answer 11

Alcohol
Enzyme inducing drugs - phenytoin, carbamazepine, rifampicin, st johns wort

Question 12

What 2 indicators which when high, can indicate cholestasis in the body?

Answer 12

GGT + ALP

Question 13

What is a patient at risk of if their PT level is high?

Answer 13

Risk of bleeding, because the liver cannot produce clotting proteins

Question 14

What condition can contribute to a high PT level?

Answer 14

Vitamin K deficiency, as it is needed to produce clotting factors

Question 15

How is a high PT level reversed?

Answer 15

By giving IV vitamin K

Question 16

What is ascites?

Answer 16

A condition associated with hypoalbuminaemia/low oncotic pressure.

This causes an increase in sodium/water retention, and portal hypertension

Question 17

What specific drugs should you avoid in people with ascites, and why?

Answer 17

NSAIDs and steroids, because they increase sodium/water retention

Question 18

What are some treatment options for ascites?

Answer 18

Bed rest
Lower salt intake/fluid restriction
Spironolactone +/- furosemide
K+ sparing diuretics
B-blockers for portal hypertension

Question 19

What antibiotic is given to reduce the risk of infection associated with ascites?

Answer 19

Floxacillin

Question 20

What are oesophageal varices?

Answer 20

Enlarged veins in the oesophagus due to portal hypertension

Question 21

What is the treatment for oesophageal varices?

Answer 21

B-blocker to reduce portal hypertension
Elastic bands to tie off bleeding veins
Terlipressin (vasoconstrictor on V1 receptors)

Question 22

What is spider naevus?

Answer 22

Enlarged blood vessels due to absent oestrogen metabolism

Question 23

Which indicator is mostly present in foetal liver?

Answer 23

AFP

Question 24

What can high levels of AFP indicate?

Answer 24

Cancer
Neural tube defects
Tumour

Question 25

What is hepatic encephalopathy?

Answer 25

Reversible altered mental function due to high levels of ammonia from liver impairment

Question 26

What is the treatment for hepatic encephalopathy?

Answer 26

Lactulose + neomycin

Question 27

What specific drugs should a patient with hepatic encephalopathy avoid?

Answer 27

Constipating drugs, e.g. Opioids Diuretics Antidepressants Sedative drugs

Question 28

What is Wernickes encephalopathy?

Answer 28

Neurological symptoms caused by thiamine depletion (e.g. alcohol, prolonged vomiting)

Question 29

How is wernickes encephalopathy treated?

Answer 29

Pabrinex (vit. B/C)