Page 2 of 2: OSCE-Buster: Abnormal Liver Function Tests - Counseling

babo7511 · Credits: 200 My Scrapbook

nice job ..very good

babo7511 · Credits: 200 My Scrapbook

very good info

babo7511 · Credits: 200 My Scrapbook

very good info

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buble · Credits: 1325 My Scrapbook

abnornal LFT -- Full history - Include:

Recent travel
Transfusions
Drugs including paracetamol overdose and herbal remedies
Tattoos
Unprotected sexual intercourse
Drug history (including herbal remedies)
Alcohol
Occupation
Diabetes Mellitus, obesity, hyperlipidaemia (all associated with fatty liver disease)
Family history

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INTERPRETATIONS:

Transferases - usually either Alanine aminotransferase (ALT) or Aspartate aminotransferase (AST), rarely does a laboratory routinely provide both:
These enzymes normally reside inside cells (in cytoplasm) so raised levels usually represent hepatocellular damage. ALT is more specific to the liver, as AST is also found in cardiac and skeletal muscle and red blood cells.
Very high levels (>1000 IU/l) suggest drug induced hepatitis (e.g. paracetamol), acute viral hepatitis (A or B) , ischaemic or rarely autoimmune hepatitis.
The ratio of AST to ALT can give some extra clues as to the cause:
In chronic liver disease ALT > AST, once cirrhosis established AST > ALT. The extremes of the ratio of AST:ALT can also be helpful: >2 suggests alcoholic liver disease, and a ratio of <1.0 suggests non-alcoholic liver disease.2,4
Gamma-glutamyl transferase (GGT) - also related to the bile ducts. Typically elevated in cholestasis (with elevated ALP), but if ALP normal suggests induction of hepatic metabolic enzymes (e.g alcohol or enzyme inducing drugs).
Alkaline phosphatase (ALP) - comes mainly from the cells lining bile ducts but also in bone. Marked elevation is typical of cholestasis (often with elevated GGT) or bone disorders (usually normal GGT). Isoenzymes analysis may help identify source. It is physiologically increased when there is increased bone turnover (e.g. adolescence) and is elevated in the third trimester (produced by the placenta).

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