[W8] Clinical Biochemistry of Liver Disease

Question 1

What are the liver’s blood supplies?

Answer 1

Hepatic artery (oxygen), portal vein (nutrients), hepatic vein (drains).

Question 2

Name four main liver functions.

Answer 2

Nutrient storage/release, detoxification, protein production, red cell breakdown.

Question 3

Where does bilirubin come from?

Answer 3

Haemoglobin breakdown.

Question 4

What causes dark urine and pale stools in liver disease?

Answer 4

↑ conjugated bilirubin excreted in urine, not in stool.

Question 5

What does raised ALT suggest?

Answer 5

Hepatocellular injury.

Question 6

What does a large ALP rise indicate?

Answer 6

Cholestasis or bile duct obstruction.

Question 7

What test reflects liver synthetic function?

Answer 7

Prothrombin time (PT/INR).

Question 8

What liver marker is induced by alcohol?

Answer 8

γGT (GGT).

Question 9

What is cirrhosis?

Answer 9

Irreversible liver scarring causing functional decline.

Question 10

What is a typical lab pattern in viral hepatitis?

Answer 10

↑↑ ALT/AST, mild ↑ ALP/bilirubin.

Question 11

What antibody confirms primary biliary cirrhosis?

Answer 11

Anti-mitochondrial antibody (AMA).

Question 12

What does very high ALT + paracetamol = ?

Answer 12

Acute hepatocellular injury (toxic hepatitis).

Question 13

Raised ALP + GGT + low albumin = ?

Answer 13

Suggests cholestasis or liver metastases.

Question 14

What does low albumin + raised total protein suggest?

Answer 14

Raised immunoglobulins – often autoimmune liver disease.

Question 16

What is the likely diagnosis in a patient with ALT ~20,000 and normal ALP?

Answer 16

Paracetamol overdose (acute hepatocellular injury).

Question 17

What lab pattern is typical of paracetamol-induced liver damage?

Answer 17

Massive ALT rise, minimal or no ALP/GGT change.

Question 18

What does a disproportionate ALT elevation suggest in liver biochemistry?

Answer 18

Acute hepatocellular necrosis, often due to toxins or viruses.

Question 19

What is the expected progression of LFTs in acute viral hepatitis?

Answer 19

Initial ALT rise, followed by bilirubin, ALP, GGT increase.

Question 20

What symptoms and urine/stool changes are associated with viral hepatitis?

Answer 20

Jaundice, dark urine, pale stools, and systemic symptoms.

Question 21

What does bilirubin in the urine indicate?

Answer 21

The presence of conjugated bilirubin, which is water-soluble.

Question 22

What is the typical biochemical pattern in alcoholic cirrhosis?

Answer 22

↑ Bilirubin, ALP, ALT, GGT; ↓ albumin, ↑ INR.

Question 23

What explains a previously raised GGT in alcohol misuse?

Answer 23

Enzyme induction by ethanol.

Question 24

What is the significance of INR = 3.3 in liver disease?

Answer 24

Indicates severely impaired liver synthetic function.

Question 25

What LFT pattern is classic for Primary Biliary Cirrhosis (PBC)?

Answer 25

Cholestatic: ↑ ALP, GGT, bilirubin, ↓ albumin.

Question 26

What additional test supports a PBC diagnosis?

Answer 26

Positive anti-mitochondrial antibodies (AMA).

Question 27

What does a high total protein + low albumin suggest?

Answer 27

Raised immunoglobulins, typical in autoimmune liver disease.

Question 28

What LFT pattern is suggestive of liver metastases?

Answer 28

↑ ALP, GGT, normal bilirubin and ALT, ↓ albumin, ± anaemia.

Question 29

What imaging finding confirms the diagnosis in liver metastases?

Answer 29

A liver mass on ultrasound or CT.

Question 30

Why is ALT often normal in metastatic liver disease?

Answer 30

Because hepatocyte function may be relatively preserved until late.