brightcitylights
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Ok so I came across a q recently with various liver function test results and the following options: cholecystitis, cholelithiasis, cholangitis, primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), viral cholangitis, hepatic cancer and pancreatic cancer. Could someone tell me any patterns I should be looking for in the above pathologies? The reason I don't remember the q in detail is because I am pretty bad at intepreting LFTs! And help would be really appreciated.
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brightcitylights
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Oh gosh!! I copied and pasted the above from word and this has happened! I'm trying to edit it but tsr won't unbolden it and reduce the size! So sorry!
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Beska
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The liver function tests are:

ALP - Increases with biliary tree problems (P looks like a 'tube')
ALT - Increases with hepatocyte damage, and is quite liver-specific (L = liver)
AST - Increases with hepatocyte damage, but is not liver-specific; also found in muscle, etc.
g-GT - Used to confirm the other tests, quite sensitive, also an acute marker of alcohol use in absence of other markers

There's also things like albumin, prothrombin time (PT)/INR & bilirubin.

Albumin - synthetic function of the liver
PT/INR - synthetic function of the liver, or cholestasis as fat soluble vitamins (K) can't be absorbed in absence of bile
Bilirubin - marker of lots of problems, pre hepatic, hepatic and post hepatic.

For the causes, just think about what tests would be elevated in light of the pathology and what I've said before.

Cholecystitis: A problem with the biliary tree, so you'd get an elevated ALP and g-GT. You might also get a small raise in AST/ALT, but ALP will predominate. There might be elevated serum bilirubin as well. Outside of LFTs themselves, you'd get an elevated CRP and white blood cells.

Cholelithiasis: This is just gallstones in the gallbladder, so is likely to be asymptomatic in most people and LFTs are probably not going to be deranged too much. http://www.ncbi.nlm.nih.gov/pubmed/20524486

Cholangitis: Again, a biliary problem so you'd get an obstructive picture with raised ALP/g-GT and elevated bilirubin. Since it's infective, you'd get a raised WCC and CRP.

PSC: Again, biliary problem, so you'd get ALP/g-GT and bilirubin.

PBC: Elevated ALP/g-GT, maybe some rises in ALT/AST.

Hepatic cancer: Elevated ALT, AST since it's hepatocyte injury. alpha-fetoprotein for cancer. Might get low synthetic function, so low albumin and a high INR, and if you're not conjugating well you might get a raised bilirubin. g-GT might also be raised in hepatic cancer.

Pancreatic cancer: Head cancer classically presents with painless jaundice, so an obstructive picture with raised ALP, g-GT and bilirubin. Tail usually presents with pain. Jaundice and a palpable gall bladder is unlikely to be caused by gallstone problems.

All needs to be seen with the clinical picture. Lab tests on their own are worthless and something like 20% of people have deranged LFTs but have completely normal livers/biliary trees with no symptoms.
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brightcitylights
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(Original post by Beska)
The liver function tests are:

ALP - Increases with biliary tree problems (P looks like a 'tube')
ALT - Increases with hepatocyte damage, and is quite liver-specific (L = liver)
AST - Increases with hepatocyte damage, but is not liver-specific; also found in muscle, etc.
g-GT - Used to confirm the other tests, quite sensitive, also an acute marker of alcohol use in absence of other markers

There's also things like albumin, prothrombin time (PT)/INR & bilirubin.

Albumin - synthetic function of the liver
PT/INR - synthetic function of the liver, or cholestasis as fat soluble vitamins (K) can't be absorbed in absence of bile
Bilirubin - marker of lots of problems, pre hepatic, hepatic and post hepatic.

For the causes, just think about what tests would be elevated in light of the pathology and what I've said before.

Cholecystitis: A problem with the biliary tree, so you'd get an elevated ALP and g-GT. You might also get a small raise in AST/ALT, but ALP will predominate. There might be elevated serum bilirubin as well. Outside of LFTs themselves, you'd get an elevated CRP and white blood cells.

Cholelithiasis: This is just gallstones in the gallbladder, so is likely to be asymptomatic in most people and LFTs are probably not going to be deranged too much. http://www.ncbi.nlm.nih.gov/pubmed/20524486

Cholangitis: Again, a biliary problem so you'd get an obstructive picture with raised ALP/g-GT and elevated bilirubin. Since it's infective, you'd get a raised WCC and CRP.

PSC: Again, biliary problem, so you'd get ALP/g-GT and bilirubin.

PBC: Elevated ALP/g-GT, maybe some rises in ALT/AST.

Hepatic cancer: Elevated ALT, AST since it's hepatocyte injury. alpha-fetoprotein for cancer. Might get low synthetic function, so low albumin and a high INR, and if you're not conjugating well you might get a raised bilirubin. g-GT might also be raised in hepatic cancer.

Pancreatic cancer: Head cancer classically presents with painless jaundice, so an obstructive picture with raised ALP, g-GT and bilirubin. Tail usually presents with pain. Jaundice and a palpable gall bladder is unlikely to be caused by gallstone problems.

All needs to be seen with the clinical picture. Lab tests on their own are worthless and something like 20% of people have deranged LFTs but have completely normal livers/biliary trees with no symptoms.
WOW! This is such a useful post! Thanks so much. It's finally starting to make sense! Thanks so much!!
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brightcitylights
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(Original post by brightcitylights)
Ok so I came across a q recently with various liver function test results and the following options: cholecystitis, cholelithiasis, cholangitis, primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), viral cholangitis, hepatic cancer and pancreatic cancer. Could someone tell me any patterns I should be looking for in the above pathologies? The reason I don't remember the q in detail is because I am pretty bad at intepreting LFTs! And help would be really appreciated.
Yeah I'm sorry - it was driving me mad too!
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