1 / 12

Liver “ Function ” Test

Liver “ Function ” Test. 2013 Mini-Lecture. Objectives. Understand the significance of Liver Function Tests Identify the patterns that indicate specific disease categories Identify the appropriate further work up of abnormalities. Case.

leigh-cote
Download Presentation

Liver “ Function ” Test

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Liver “Function” Test 2013 Mini-Lecture

  2. Objectives • Understand the significance of Liver Function Tests • Identify the patterns that indicate specific disease categories • Identify the appropriate further work up of abnormalities

  3. Case • 49 year old Female presents with chest pain and negative troponins admitted for monitoring, LFT in ED show AST: 57, ALT: 62, Alk Phos: wnl, T. Bili: wnl. What is the next step in management? • A: RUQ Ultrasound • B: Hepatitis Panel • C: Screen for Alcohol Use • D: CT Scan Abdomen

  4. Etiology • Synthetic Function: Total protein, serum albumin, total bilirubin, prothrombin time • ALT: found primarily in Hepatocytes • AST: found in many sources- Liver, heart, intestine, pancrease • Alkaline phosphatase: found in liver, bones, intestines, and placenta • Bilirubin: Two sources- indirect (old red cells), Direct (conjugated in liver)

  5. Patterns • Elevation in ALT & AST: primarily cellular injury • Etiology: Acute Viral Hepatitis, Acetaminophen toxicity, shock liver • Elevation in AlkPhos and Bilirubin: cholestasis or obstruction • Etiology: choledocholithiasis, biliary stricture, malignancy • Mixed: Serum Bilirubin can be elevated in both conditions

  6. Pearls for further evaluation • Albumin • Low Albumin- suggests chronic process (cirrhosis/cancer) • Normal- suggests acute process • Prothrombin • Prolonged • suggests vitamin K deficiency 2/2 prolonged jaundice or malabsorption • Significant hepatocellular dysfunction (failure to correct w/ vit K administration indicates severe injury) • Bilirubin in Urine • Indicates hepatobiliary disease (indirect not excreted by kidney)

  7. Mild Aminotransferase Elevation Workup • Primary Causes • Screen for alcohol abuse (AST/ALT > 2:1) • Review medications • If Negative: then serology for hepatitis B/C, screen for hemochromatosis, then evaluate for fatty liver w/ RUQ US • Secondary • Exclude muscle disorders • Thyroid function tests • Celiac disease • Adrenal insufficiency • IF All negative: Autoimmune, Wilson’s dx, alpha 1 antitrypsin, consider biopsy or observe (pt w/ ALT/AST less that 2x ULN)

  8. Hyperbilirubinemia • Unconjugated • Over production: hemolysis, extravasation of blood into tissue, ineffective erythropoiesis • Impaired Uptake: Heart failure, portosystemic shunts, Gilberts, Drugs (Rifampicin and probenecid) • Impaired conjugation: Gilberts, hyperthyroidism, Liver Dx, Crigler-Najjar • Conjugated • Extrahepatic: choledocholithiasis, tumors, PSC, AIDS, pancreatitis, strictures, parasitic infxn • Intrahepatic: hepatitis, PBC, Drugs, Sepsis/hypoperfusion, infiltrative disease, TPN, Sickle cell, pregnancy, Dubin Johnson and Rotor Syndrome

  9. Alkaline Phosphatase • Source includes: bone, liver, placenta, varies w/ age • Serum GGT: elevated in Liver Disease not Bone disease • Most common cause: chronic cholestasis or infiltrative disease • Primary biliary cirrhosis, primary sclerosis cholangitis • Sarcoidosis, amyloidosis, liver metastasis • Initial Workup: • RUQ Ultrasound • Anti-mitochondrial Antibody • Consider- MRCP or ERCP • Observe: if Alk phos <50% above normal

  10. Elevation of Several LFT’s • Hepatocellular pattern • ALT/AST > 25 ULN only seen in hepatocullular dx • With Jaundice • Alcholic • AST:ALT.2 • AST rarely > 300 units/L • Viral • Aminotransferase> 500 u/L w/ ALT >AST • Toxic: i.e. Acetaminophen • Shock liver • Autoimmune and Wilson’s Dx

  11. Elevation of Several LFT’s • Predominantly Cholestatic Pattern • Determine Intra vs Extra hepatic • RUQ U/S: assess for Biliary dilation • Extrahepatic: consider CT or MRCP or ERCP • Common Causes: choledocholithiasis, malignancy, PSC, Pancreatitis • Intrahepatic: broad differential • Work-up determined by clinic situation

  12. Summary • Described significance of each Liver function test • Identified common LFT abnormalities • Familiarized with basic initial work up of elevated Liver function Tests

More Related