Liver Function Tests: Routine pre-surgical measurement Majority of patients with abnormal results have underlying liver pathology
logy Common liver diseases Alcoholic liver disease Non alcoholic liver disease Normal LFT does not necessarily rule out possibility of chronic liver disease
Transaminases ALT & AST -- Together indicates level of inflammation in the liver ALP biliary obstruction & hepatic mets
Try to remember the A** tests that end in T are the transaminase ones. ALT is more specific for the Liver. ALT (alanine transaminase aminotransferase) 5-45U/L When high, suggests viral/drug induced hepatitis or extensive hepatitis with necrosis of another source Found mainly in the liver (small amounts found in kidneys, cardiac and skeletal muscle) During liver damage, ALT is released into the serum raised levels Will be raised before jaundice 2x raised ALT & AST than normal level= significant AST (aspartate transaminase) 5-45U/L Normally indicates: Viral hepatitis Severe skeletal muscle trauma Extensive surgery Drug induced hepatic trauma Found in liver, cardiac, RBC, and skeletal muscle (damage to any of these may elevate levels)
ALP (alkaline phosphatase) 25-110 U/L Found in large quantities in bile duct and bone Raised plasma level usually means damage to bile duct/bone Largely elevated in bile duct blockage Slightly elevated in liver disease (e.g. hepatits/ca hepatocellular) Gamma-GT <65 U/L Common in biliary duct obstruction Often used to confirm AST readings are due to liver damage Often used to monitor alcoholic cirrhosis
Bilirubin 1-20 mol/l Levels raised in liver damage and in cases of severe RBC damage Also raised in obstructive jaundice Urobillinogen test can be used to determine raised levels are due to RBC or problems within liver/bile system Albumin 33-49 g/l Major protein constituent in plasma May be reduced as a result of: Diarrhoea Liver disease Poor diet Iron deficiency Infection Interpretation: ALP; slightly ALT Problems in the bile duct ALT; slightly d ALP likely to be a problem in the liver V ALT; slightly AST Viral/drug induced/severe hepatic necrosis ASP; slightly ALT alcoholic/drug induced cirrhosis Patterns of LFT results 2 main patterns to identify cause of abnormal results: Obstructive bile duct obstruction bilirubin ALP Normal ALT Hepatic this is a sign of acute liver inflammation. The pattern will give: VeryALT between 200- 2000 U/L Varying bilirubin the higher the level, the greater the degree of damage SlightlyALP should be no higher than 2x normal. prothrombin time slightly; cases of severe liver failure may exceed 25s
Test Result Bilirubin only
Initial Action The proportion of conjugated bilirubin with respect to the total raised bilirubin can give a clue as to cause of jaundice. 20-40% of total: more suggestive of hepatic than posthepatic jaundice 40-60% of total: occurs in either hepatic or posthepatic causes > 50% of total: more suggestive of posthepatic than hepatic jaundice Note that if conjugated bilirubin is less than 20% of total then the cause of hyperbilirubinaemia is secondary to haemolysis or constitutional e.g. Gilbert's disease From history: Alcohol? Enzyme inducing drugs? Obese? -----------------------------------------------
Management Plan Reassure likely to be Gilberts Syndrome
gamma-GT only ALP / ALT <2x normal ALP / ALT >2x normal (or <2x normal, but persistently high) -
Further Tests: Hepatitis virus Autoimmune tests Ferritin USS liver
Reduce alcohol intake No action Lose weight Reduce alcohol intake Stop hepatotoxic drugs Lose Weight (BMI>25) Recheck LFTs in 3-6 months Dilated bile ducts: Cholangiography, ERCP Normal bile ducts: Treat specific disorder
