LFT example cases

Question 1

• 21 year old man with jaundice and malaise
• Normal albumin
• Slightly raised ALP and bilirubin
• Markedly raised ALT

What is going on?

Answer 1

Intrahepatic cause

Eg hep, ALD, overdose

Question 2

• Asymptomatic jaundice in a man with the flu and
• Normal albumin ALP and ALT
• Raised bili, pariticularly unconjugated

What is going on and what other test may you do?

Answer 2

• He is having trouble conjugating the bilirubin
• Reticulocyte test to see if there is more immature RBC
• If he has no haemolytic disease then it may be Gilberts - problem conjugating bilirubin in times of stress

Question 3

• Splenomegaly due to heamolytic disease
• Raised unconjugated bilirubin only
• Why is there no bilirubin in the urine?

Answer 3

• Because unconjuated is not water soluble

Question 4

What is painless jaundice a sign of and what blood results/symptoms may you see?

Answer 4

Pancreatic cancer

Increase in ALP, conjugated bilirubin

Weight loss

Question 5

Raised ALT (Liver disease)

Arthritis

Hyperpigmentation

DM

What can be expected and what blood test could you do to confirm this?

Answer 5

• Heamochoromotosis
• Ferritin