Transcript Abnormal LFTs in Adults

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!
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
Unconjugated
Conjugated
Gilbert’s syndrome (usually < 70
µmol/L)
Drugs e.g. phenothiazines,
sulfonamides and carbimazole
Stress/fasting
Dubin-Johnson syndrome
Drugs e.g. rifampicin, sulfonamides Rotor syndrome
Haemolytic disease
Hyperbilirubinaemia
Transaminases (ALT, AST)
 ALT: mostly liver specific
 AST: expressed in liver cells, skeletal muscle, kidneys, brain, RBCs
 ALT <120iu/L: generally considered mild; >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:
Common
Rarer
Non-hepatic
Alcohol
Autoimmune hepatitis
Coeliac disease
Steatosis
Haemachromatosis
Strenuous exercise
Viral Hepatitis
Alpha-1-antitrypsin defic
Muscle disease
Medications/toxins
Wilson’s disease
Endocrine (e.g.
hypo/hyperthyroid
Raised
ALT
Alkaline Phosphatase
 The two main sources of ALP are liver and bone, although there are
also intestinal and placental isoforms.
 Causes of raised ALP:
Physiological
Pathological
Third trimester of pregnancy
Bile duct obstruction
Adolescents, due to bone growth
Primary biliary cirrhosis
Benign, familial
Primary sclerosing cholangitis
Drug induced cholestasis, e.g.
anabolic steroids, COCP
Metastatic liver disease
Bone disease, e.g. Pagets
Heart failure
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;
consider USS if >5x ULN;
Raised
ALP
Deranged LFTs - history
 PMH: diabetes, hyperlipidaemia, obesity, autoimmune
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Medications
Alcohol Consumption
Occupational exposure to toxins
Family history of liver disease, autoimmune conditions
Risk factors for viral hepatitis:
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intravenous drug use
travel history
non-sterile ear or body piercing
tattoos
health care intervention in developing nations
country of birth
Liver screen
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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)