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Abnormal LFTs Liver disease is often asymptomatic Deranged LFTs may be the only sign of a serious underlying liver disease Or they may be nothing wrong!

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Presentation on theme: "Abnormal LFTs Liver disease is often asymptomatic Deranged LFTs may be the only sign of a serious underlying liver disease Or they may be nothing wrong!"— Presentation transcript:

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2 Abnormal LFTs Liver disease is often asymptomatic Deranged LFTs may be the only sign of a serious underlying liver disease Or they may be nothing wrong!

3 Hyperbilirubinaemia Slight increases in bilirubin (17-30 µmol/L) common & usually not clinically significant. Checking conj/unconj (direct/indirect) bilirubin is seldom required in adults, unless isolated raised bilirubin (i.e. normal liver enzymes) Causes of isolated hyperbilirubinaemia UnconjugatedConjugated Gilbert’s syndrome (usually < 70 µmol/L) Drugs e.g. phenothiazines, sulfonamides and carbimazole Stress/fastingDubin-Johnson syndrome Drugs e.g. rifampicin, sulfonamidesRotor syndrome Haemolytic disease

4 Hyperbilirubinaemia

5 Transaminases (ALT, AST) ALT: mostly liver specific AST: expressed in liver cells, skeletal muscle, kidneys, brain, RBCs ALT 120iu/L: severe AST:ALT ratio > 2.1 may be suggestive alcohol related liver disease AST:ALT ratio < 2.1 may suggest hepatic steatosis or chronic viral hepatitis Causes of raised transaminases: CommonRarerNon-hepatic AlcoholAutoimmune hepatitisCoeliac disease SteatosisHaemachromatosisStrenuous exercise Viral HepatitisAlpha-1-antitrypsin deficMuscle disease Medications/toxinsWilson’s diseaseEndocrine (e.g. hypo/hyperthyroid

6 Raised ALT

7 Alkaline Phosphatase The two main sources of ALP are liver and bone, although there are also intestinal and placental isoforms. Causes of raised ALP: PhysiologicalPathological Third trimester of pregnancyBile duct obstruction Adolescents, due to bone growthPrimary biliary cirrhosis Benign, familialPrimary sclerosing cholangitis Drug induced cholestasis, e.g. anabolic steroids, COCP Metastatic liver disease Bone disease, e.g. Pagets Heart failure

8 Gamma Glutamyl Transferase (gGT) γGT : v sensitive marker for hepatobiliary disease, but its use is limited by poor specificity. (Causes include hepatobiliary disease (often with other liver enzyme abnormalities), pancreatic disease, alcohol, COPD, Renal failure, Diabetes, IHD, Drugs, e.g. carbamazepine, phenytoin and barbiturates and oral contraceptive pill) Main role of gGT is to support a hepatobiliary source for other liver enzymes If isolated raised γGT: rpt bloods after 3m if 5x ULN;

9 Raised ALP

10 Deranged LFTs - history PMH: diabetes, hyperlipidaemia, obesity, autoimmune conditions Medications Alcohol Consumption Occupational exposure to toxins Family history of liver disease, autoimmune conditions Risk factors for viral hepatitis: intravenous drug use travel history non-sterile ear or body piercing tattoos health care intervention in developing nations country of birth

11 Liver screen Liver Ultrasound AST γGT Immunoglobulins CK Ferritin TFTs Fasting Lipids Glucose / HbA1c Coeliac Serology Hepatitis serology (HBsAg, anti-HCV Abs) Liver Autoantibodies Alpha-1-antitrypsin Caeruloplasmin (if < 50y)


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