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    Interpretation of Abnormal Lfts

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    Isaac Mwangi
    This document provides guidance on interpreting abnormal liver function tests (LFTs). It notes that 2.5% of the population has raised LFTs and normal tests do not rule out liver disease. A careful history should be taken regarding risk factors like drugs, alcohol, medical history. Physical exam can reveal signs of liver disease. The likely diagnosis should be pursued rather than following an algorithm. Mild abnormalities with no risk factors may warrant repeating tests after lifestyle changes. Key LFTs markers and indications are described for hepatocellular damage, cholestasis and liver synthetic function. Acute hepatitis causes are outlined. Investigation approach is provided depending on severity of ALT/AST elevations. Liver biopsy can accurately grade disease severity

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    Interpretation of Abnormal Lfts

    Uploaded by

    Isaac Mwangi
    17 views22 pages
    This document provides guidance on interpreting abnormal liver function tests (LFTs). It notes that 2.5% of the population has raised LFTs and normal tests do not rule out liver disease. A careful history should be taken regarding risk factors like drugs, alcohol, medical history. Physical exam can reveal signs of liver disease. The likely diagnosis should be pursued rather than following an algorithm. Mild abnormalities with no risk factors may warrant repeating tests after lifestyle changes. Key LFTs markers and indications are described for hepatocellular damage, cholestasis and liver synthetic function. Acute hepatitis causes are outlined. Investigation approach is provided depending on severity of ALT/AST elevations. Liver biopsy can accurately grade disease severity

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    This document provides guidance on interpreting abnormal liver function tests (LFTs). It notes that 2.5% of the population has raised LFTs and normal tests do not rule out liver disease. A careful history should be taken regarding risk factors like drugs, alcohol, medical history. Physical exam can reveal signs of liver disease. The likely diagnosis should be pursued rather than following an algorithm. Mild abnormalities with no risk factors may warrant repeating tests after lifestyle changes. Key LFTs markers and indications are described for hepatocellular damage, cholestasis and liver synthetic function. Acute hepatitis causes are outlined. Investigation approach is provided depending on severity of ALT/AST elevations. Liver biopsy can accurately grade disease severity

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    17 views22 pages

    Interpretation of Abnormal Lfts

    Uploaded by

    Isaac Mwangi
    This document provides guidance on interpreting abnormal liver function tests (LFTs). It notes that 2.5% of the population has raised LFTs and normal tests do not rule out liver disease. A careful history should be taken regarding risk factors like drugs, alcohol, medical history. Physical exam can reveal signs of liver disease. The likely diagnosis should be pursued rather than following an algorithm. Mild abnormalities with no risk factors may warrant repeating tests after lifestyle changes. Key LFTs markers and indications are described for hepatocellular damage, cholestasis and liver synthetic function. Acute hepatitis causes are outlined. Investigation approach is provided depending on severity of ALT/AST elevations. Liver biopsy can accurately grade disease severity

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    INTERPRETATION

    OF ABNORMAL
    LFTS
    DR ALEX MOGERE
    CONSULTANT PHYSICIAN
    Principles of invx of abn LFTs

    • 2.5 of population have raised LFTs


    • Normal LFTs do not exclude liver disease
    • Interpret LFTs in clinical context
    • Take a careful history for risk factors, drugs
    (inc OTCs), alcohol, comorbidity, autoimmunity
    • Physical examination for liver disease
    • Chase likely diagnosis rather than follow
    algorithm unless there are no clues
    • If mild abnormalities and no risk factors or
    suggestion of serious liver disease , repeat LFTs
    after an interval (with lifestyle modification)
    LFTS
    • LFTsMarkers of hepatocellular damage
    • Cholestasis
    • Liver synthetic function
    Markers of hepatocellular damage
    • AST- liver, heart skeletal muscle, kidneys,
    brain, RBCs
    • In liver 20 %activity is cytosolic and 80 %
    mitochondrial
    • Clearance performed by sinusoidal cells,
    half-life 17hrs
    • ALT more specific to liver, v.low
    concentrations in kidney and skeletal muscles.
    • Half-life 47hrs
    GGT
    • Gamma-GT hepatocytes and biliary epithelial
    cells, pancreas, renal tubules and intestine
    • Very sensitive but Non-specific
    • Raised in ANY liver disease hepatocellular or
    cholestatic
    • Usefulness limited
    • Confirm hepatic source for a raised ALP
    • Alcohol
    • Isolated increase does not require any further
    evaluation, suggest watch and rpt 3/12 only if
    other LFTs become abnormal then investigate
    CHOLESTASIS
    • ALP liver and bone (placenta, kidneys,
    intestines or WCC)
    • Hepatic ALP present on surface of bile duct
    epithelia and accumulating bile salts increase
    its release from cell surface. Takes time for
    induction of enzyme levels so may not be first
    enzyme to rise and half-life is 1 week.
    • ALP isoenzymes, 5-NT or gamma GT may be necessary
    to evaluate the origin of ALP
    Cont. cholestasis
    •Isolated ALP 3rd trimester, adolescents
    •Bone exclude by raised GGT, 5-NT or isoenzymes
    •May suggest biliary obstruction, chronic liver
    disease or hepatic mass/tumour
    •Liver USS/CT most important investigation-dilated
    ducts
    •Ca pancreas, CBD stones, cholangioca or liver
    mets
    Cont . Cholestasis(non-dilated ducts)
    • Cholestatic jaundice Drugs- Antibiotics,
    Nsaids, Hormones, ACEI
    • PBC anti- mitochondrial Ab, M2 fraction, IgM
    • PSC associated with IBD 70, p-ANCA, MRCP and
    liver biopsy
    • Chronic liver disease
    • Cholangiocarcinoma beware fluctuating levels
    • Primary or Metastatic cancer, lymphoma
    • Infiltrative sarcoid, inflammatory-PMR, IBD
    • Liver biopsy often required
    Bilirubin, albumin and PTI(INR)
    • Useful indicators of liver synthetic function
    • In primary care when associated with liver
    disease abnormalities should raise concern
    • Thrombocytopenia is a sensitive indicator of
    liver fibrosis
    • Unconjugated bilirubin is raised in Haemolysis,Gilbert’s syndrome, a
    benign, inherited disease
    Acute hepatitis
    • Viral Hep A, B, C, E, CMV, EBV
    • ALT levels usually peak before jaundice appears.
    • Jaundice occurs in 70% Hep A, 35% acute Hep B,
    25% Hep C
    • Check for exposure
    • Check Hep A IgM, Hep B core IgM and HepBsAg, Hep
    C IgG or Hep C RNA
    Investigation of Abnormal LFTs - ALT/AST 2-5x
    normal (100-200)

    • History and Examination


    • Discontinue hepatotoxic drugs
    • Continue statins but monitor LFTs monthly
    • Lifestyle modification (lose wt, reduce alcohol,
    diabetic control)
    • Repeat LFTs at 1 month and 6 months
    Cont.Investigation of Abnormal LFTs - ALT/AST 2-5x
    normal (100-200)

    • If still abnormal at 6 months


    • Consider referral to secondary care
    • Hepatitis serology (B, C)
    • Iron studies: transferrin saturation .ferritin
    • Autoantibodies immunoglobulins
    • Consider caeruloplasmin
    • Alpha-1- antitrypsin
    • Coeliac serology
    • TFTs, lipids/glucose
    • Consider liver biopsy esp if ALT gt 100)
    Value of liver biopsy in deranged LFT
    • The most accurate way to grade the severity of
    liver disease
    • Aminotransferase levels correlate poorly with
    histological activity
    • Narrows the diagnostic options, if not diagnostic
    THANK YOU!

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