Page 1 of 1: OSCE-Buster: Abnormal Liver Function Tests - Counseling

akanksha · Credits: 41385 My Scrapbook

Abnormal Liver Function Tests - Counselling

Hello Mr.X, I am Dr.A , a Senior House Officer in the department. I gathered that you are being asked to go through liver function tests, so that we can find out the real cause of the illness you are going thru now.

is ther anything u wud like to know abt the tests? feel free to ask any questions u hav in mind.

Wat exactly are liver function tests? wat does it signify?

Liver function tests measure various chemicals in the blood made by the liver.

An abnormal result signifies that there might be some problem with your liver and the type of abnormality in the tests may also help to identify the cause.

However, in some cases, we might need to do further tests to identify the real cause of the liver problem.

Wat all various chemicals u need to measure for this?

The liver function tests is commonly intended to measure the following:

1)Alanine transaminase (ALT)
2)Alkaline phoshpatase (ALP)
3)Albumin
4)Total Protein
5)Bilirubin

Wat does an abnormal test signify?

1)ALT : This enzyme is normally present inside the liver cells; any cause which can damage the integrity of the liver cells leads to release of large amount of ALT in your blood stream. Hence, a raised ALT usually signify damage to liver cells. Most commonly this occurs when you have hepatitis.

2) ALP: This is a similar enzyme like ALT, however, liver is not the only organ to produce ALP; thus a raised ALP can be due to liver injury or bile duct injury or even diseases of the bones.

3)Albumin: This is the major protein produced by the liver. As the liver gets diseased, its ability to produce albumin is also depressed; hence, a low level of albumin signifies depressed liver function. It is seen in chronic liver disease.

4)Total albumin: This test is similiar to that of measuring albumin, only dat it measures other proteins as well (along wid albumin).

5) Bilirubin: This is the chemical actually derived from your old red blood cells. This is secreted by liver into the bile.

If something gets wrong with the secretion or if the flow of bile is blocked, bilirubin levels in your blood can rise and give your skin a 'yellow' clor, which u might appreciate as 'jaundice'. This can occur with hepatitis, liver injury, or long-term alcohol abuse.

Also, when there is rapid formation of bilirubin, the liver may not be able to excrete it all out of the body- this happens in some special type of anemias where red cells die out faster than usual.

Why am I asked to go for liver function tests?

Liver function tests are usually suggested if you have some symptoms suggestive of liver disease (say, jaundice).

or, if you have had a long standing liver condition (say alcoholic liver disease), we might ask u to go for LFT, to monitor ur progress.

Sometimes we may ask u to go for this test, as a routine precuation after starting certian medications, jus to make sure that its not causing any liver damage as a side-effect.

Are ther more tests I might need to undergo to be sure if my liver is ok?

Well Mr. X the LFT is described jus now usually give the required hints to know wat exactly is goin wrong wid the liver. However, in certain situations u might be required to undergo few more tests depending on wat sort of abnormality we are suspecting. These tests can be:

1) Blood clotting tests: Like albumin, liver also synthesises many other proeyins which are required to make blood clot.In certain liver disorders the liver cannot make enough of these proteins and so blood does not clot so well. So, blood clotting tests may be used as a 'marker' of the severity of certain liver disorders.

2) Gamma-glutamyl transferase (GGT or 'Gamma GT'): This is another enzyme which occurs in liver cells. A high level of this enzyme is particularly associated with heavy alcohol drinking.

3) Immunology: Blood tests may be done to detect viruses and antibodies to viruses. Various virus infections can cause hepatitis (inflammation of the liver). For example, hepatitis A virus, hepatitis B virus, etc.
auto-antibodies.

Then there can be antibodies which attack a part of your own body and occur in autoimmune disorders.
The most common autoimmune disorders of the liver are:
-Primary biliary cirrhosis (associated with anti-mitochondrial antibodies).
-Autoimmune hepatitis (associated with smooth muscle antibodies).
-Primary sclerosing cholangitis (associated with antinuclear cytoplasmic antibodies).

Then there are certain other proteins in the blood can point to specific liver diseases. For example:
-Ceruloplasmin is reduced in Wilson's disease.
-Lack of 1-antitrypsin can be a cause of cirrhosis.
-A high level of ferritin is a marker of haemochromatosis.

Then you might also be required to undergo certain tests like liver biopsy, ultrasound scan, other types of scan, etc.

However, I assure u that all of these may not be essential but may be needed to clarify the cause of your liver disorder, and/or to monitor its progress.

are ther more questions u want me to clarify?

akanksha · Credits: 41385 My Scrapbook

Abnormal liver Function Tests - History

Hello Mr.X, I am Dr.A , a Senior House Officer in the department. I gathered that you are being asked to go through liver function tests, so that we can find out the real cause of the illness you are going thru now.

Will it be alright to you, if i ask you some few questions regarding ur illness?

Wat exactly is bothering you right now?

-Jaundice (yellowing of skin)

-when did you (or ur GP) observe it first?

(long duration- chronic liver disease;
short duration- Hepatitis
Since birth- metabolic disorders, Gilbertz)

-History of recent foreign travel/ sexual exposure?
(viral hepatitis, malaria)

- did u have had any fever before this yellowing appeared? (viral hepatitis)

-Drug intake (chlorpromazine, isoniazid)

-Do u drink? wat do u drink? how frequently? how much daily? since how many years? (alcoholic liver disease)

-Family history of similar illness - Sickle cell disease, WIlson's Disease, Thalssemia.

-hav u had similar illness before?

-Do feel easily tired and breathlessness (anemia- hemolytic anemia, Sickle cell, Thalssemia).

-Any associated pain in ur tummy?
(Colicky RUQ - gallstones)
(Also PAINLESS progressive jaundice- Ca Pancreas)

-U think ur tummy is looking more full these days or any mass u have observed lately?
(RUQ mass- Hepatocellular carcinoma/ hepatomegaly/ metastasis
Epigastric mass- carcinoma pancreas)

-Wat about the color of ur urine & stools?
(pale stools/ dark urine - Ca Pancreas, hepatitis, gallstones)

-u think u hav lost appreciable weight lately?
(rapid weight loss- Ca Pancreas, HCC, metastasis)

Is there anything else u wud like to tell me?

If restless, poor concentration and drowsy - suggest fulminant hepatic failure.

[P.S.: Correct me and add any more points u think appropriate].

akanksha · Credits: 41385 My Scrapbook

When are these tests requested?

These tests are used when symptoms suspicious of a liver condition are noticed.

These include: jaundice, dark urine and light-coloured bowel movements; nausea, vomiting and diarrhoea; loss of appetite; vomiting of blood; bloody or black bowel movements; swelling or pain in the belly; unusual weight change; or fatigue or loss of stamina.

One or more of these tests may be requested when a person has been or may have been exposed to a hepatitis virus; has a family history of liver disease; has excessive alcohol intake; or is taking a drug that can cause liver damage.

sajida · Wednesday 7th of September 2005 07:10:27 PM (4 years ago) #4

A 50 year old lady with abnormal LFT¡¦s. Take a history and explain the abnormal findings
Establish if the tests suggests cholestatic pattern or hepatocellular pattern.

Ask for history of pruritus, abdominal pain, altered sleep wake pattern, altered colour of urine or stool.

History of abdominal distension (ascites), haematemesis, coffee ground vomiting, per-rectal bleeding could suggest decompensated liver disease)

Details of the amount of alcohol consumed in a week on an average

Detailed history of medications (both prescribed and over-the-counter medications)

Assess risk factor for viral hepatitis (History of travel to hepatitis A/B endemic countries, history of blood transfusions in the past, sexually transmitted diseases or multiple sexual partners, history of needle stick injuries, Intravenous drug use)

Family history: family history of liver diseases could suggest wilson¡¦s disease, haemachromatosis, primary biliary cirrhosis)

Other disease conditions:
The presence of diabetes, hyperlipidemia and obesity may suggest fatty liver disease especially if the patient is asymptomatic and has no jaundice.
The presence of symptoms suggestive of ulcerative colitis could indicate primary sclerosing cholangitis as the underlying disease.

The above station requires you to then discuss the differential diagnosis with the patient depending on the type of liver injury. Make sure you allow time for this .

kami0011 · Credits: 881 Preparing for: PLAB Part 2 My Scrapbook

hi lets make things easy
pre hepatic jaundice:
most common cause hemolysis so ask about
common symptoms of anemia
fatigue
exertional dyspnea
palpitations
chest pain
then specifically about sickle cell anemia
joint pains
leg ulcers
then about malaria
fever
chills
travel to tropics
so this in short covers prehepatic cause most commonly anemia,this is enough to ask in 1 min
now lets come to hepatic causes
most common causes viral,infectious
hepatitis A virus
young patient
ask about eating out,contaminated food etc
nausea
malaise
anorexia
fever
jaundice
dislike for ciggs
dislike for coffee
dislike of fatty meals
pale stools
dark urine
HEPATITIS B:
ask about travel
ask about sexual relations
ask about blood transfusions
ask about needle sharing
ask about needle prics
HEPATITIS C:
fever
chronic liver disease symptoms
joint pains
POST HEPATIC:
GALL STONES
CARCINOMA PANCREAS
CHOLANGITIS
THESE R DISCUSSED BELOW
INFECTIVE:
LIVER ABCESS
fever
abdominal pain
cough
chestpain
ALSO GATHER INFO ABOUT THE CONGENITAL CAUSES GILBERTS (SINCE CHILDHOOD,IN WINTERS,YELLOW SKIN ON STARVATION)
MALIGNANCY
SECONDARIES FROM BOWEL SO ASK BOWEL SYMPTOMS
WT LOSS
HCC
PANCREATIC CA PAINLESS PROGRESSIVE JAUNDICE
GALL STONES
METABOLIC DISEASES
ASK REGARDING
DRUGS:ISONIAZID,RIFAMPICIN,CHLORPROMAZINE
FOODS:BEET ROOT
DEHYDRATION DARK URINE
AND FIALLY REMEMBER ONCE U GET THE LEAD GO DIRECTLY TO THE CONDITION AND EXPLORE IT COMPLETELY TIME IS SHORT ALLOW THE PATIENT TO TALK AS WELL.TAKE THE LEAD FROM THE AGE AND SEX OF THE PERSON
YOUNG=HEPATITIS A ,SO THINK ALONG THESE LINES
FEMALES
PBC=ASK PRURITES
CHOLECYSTITIS
OLD
TUMORS

THNX N GOOD LUCK

sam7881 · Credits: 6332 Preparing for: MRCS Part 3 My Scrapbook

great job people

nintendo · Credits: 361 Preparing for: MRCP Part 1 My Scrapbook

Good
explained in detail

d_razaq · Credits: 709 Preparing for: Canada My Scrapbook

CORRECTION

Alanine Aminotransferase (ALT),more specific for liver

Aspartate Aminotransferase (AST)

Alkaline phoshpatase (I don't think there is any abreviation used for it)

LK007 · Credits: 1184 Preparing for: PLAB Jobs My Scrapbook

great....thanks for the thorough explanations

adsad21 · Credits: 220 My Scrapbook

thanks for the liver function test 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

surfy · Credits: 1164 Preparing for: MRCS Part 1 My Scrapbook

nice work ,really appreciate that........

buble · Credits: 1325 Preparing for: PLAB Part 2 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

buble · Credits: 1325 Preparing for: PLAB Part 2 My Scrapbook

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).

chocolate0711 · Credits: 287 Preparing for: IELTS My Scrapbook

thanls u all.great joB DEAR!!!!!!!!!!!!

shambhavi · Credits: 381 My Scrapbook

plenty of informations..thanks to all...got an idea how to start this station.

anilkumarjagani · Credits: 230 Preparing for: MRCPsych Paper 2 My Scrapbook

thanks for very nice points

theguru417 · Credits: 181 My Scrapbook

thank u ..it's helpful

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