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Flashcards in Liver Function tests Deck (23)
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1

What are the 7 markers used to test liver function?

- alanine transaminase (ALT)
- aspartate aminotransferase (AST)
- alkaline phosphatase (ALP)
- Gamma-glutamyltransferase (GGT)
- Bilrubin
- Albumin
- Prothrombin time (PT)

2

Which 4 markers are used to distinguish between hepatocellular damage and cholestasis?

- ALT, AST, ALP and GGT

3

Which 3 markers are used to assess livers synthetic function?

- Bilirubin, albumin, Prothrombin time

4

What is ALT a good marker of?

hepatocellular injury

5

What is ALP a good marker of?

a good indirect marker of cholestasis

6

How many times the normal value of ALT is pathological?

x10

7

How many times the normal value of ALP is pathological?

x3

8

What does a raised ALP and GGT suggest?

Cholestasis (reduction or stoppage of bile flow)
Biliary epithelial damage and bile flow obstruction
Could also be raised due to alcohol and drugs (phenytoin)

9

What does a raised ALP and normal GGT suggest?

non-hepatobiliary pathology
- could be anything that leads to bone break down as bone contains ALP (bony metastases, Vit D deficiency, bone fracture)

10

What does it suggest if ALT is raised much more than ALP and vice versa?

ALT > ALP - hepatocellular pattern
ALP > ALT - cholestatic pattern

11

The common causes of isolated jaundice (LFT normal)?

- Gilberts syndrome
- Haemolysis

12

Jaundice + normal urine + normal stools - where is the problem?

Pre-hepatic cause

13

Jaundice + dark urine + normal stools - where is the problem?

Hepatic cause

14

Jaundice + dark urine + pale stools - where is the problem?

Post-hepatic cause (obstructive)

15

Name the 3 causes of unconjugated hyperbilirubinaemia?

Haemolysis (anaemia)
Impaired hepatic uptake (drugs, congestive HF)
Impaired conjugation (gilberts)

16

Name the 2 causes of conjugated hyperbilirubinaemia?

Hepatocellular injury
Cholestasis

17

What are the 3 main causes of a fall in albumin?

- liver disease resulting in a decreased production of albumin (cirrhosis)
- inflammation triggers an acute phase response, which temporarily decreases the production of albumin
- Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome

18

what does the ratio between ALT/AST show?

ALT > AST chronic liver disease
AST> ALT liver cirrhosis and acute alcoholic hepatitis

19

Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis

ALT - Very raised
ALP - Normal or S.raised
GGT - Normal or S. raised
Bilirubin - Very raised

Actute hepatocellualr damage

20

Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis

ALT - Normal or S.raised
ALP - Normal or S.raised
GGT - Normal or S. raised
Bilirubin - Normal or S.raised

Chronic hepatocellular damage

21

Look at the following presentation and choose between acute hepatocellular damage, chronic hepatocellular damage and cholestasis

ALT - Normal or S.raised
ALP - V.raised
GGT - V. raised
Bilirubin - V.raised

Cholestatsis

22

What are the 3 causes of acute hepatocellular injury?

Poisoning
Infection (hep A or B)
Liver ischaemia

23

What are the 4 causes of chronic hepatocellular injury?

Alcoholic fatty liver disease
Non-alcoholic fatty liver disease
Chronic infection (Hep B or C)
Primary biliary cirrhosis

Less common:
- Alpha 1 antitrypsin deficiency
- Wilsons disease
- Haemochromatosis