LFTs

Question 1

ddx for cholestasis picture on LFT
(ALP>200, ALP> 3xALT)

small biliary ducts (2)
larger ducts (6)
wildcard (1)

Answer 1

small biliary ducts

• primary biliary cirrhosis
• drug induced cholestasis ( flucloxacillin, oestrogen, erythromycin )

larger ducts

• gallstones
• hepatocellular carcinoma
• liver metastases
• pancreatic cancer
• cholangocarcinoma
• primary sclerosing cholangitis

pregnancy

Question 2

key features in history for deranged LFTs
personal (4)
symptoms (6)
tox (2)

Answer 2

personal
- family hx liver disease
- IVDU
- tattooing
- overseas blood transfusion or transfusion < 1990
 (risk factors for viral hepatitis )

symptoms

• change in stool or urine appearance
• abdominal pain
• N+V
• weight loss
• night sweats
• fevers

tox

• etoh use
• methotrexate or other medication history causing LFT deranging medications

Question 3

Gastric disorders red flags that would prompt further Ix
GI sx. (5)
personal (2)
systemic sx. (1)
sx evolution (2)

Answer 3

GI sx.

• persistent/freq vomiting
• early satiety
• dysphagia
• malaena
• haematemesis

personal

• Age > 50yrs
• FHx gastric cancer

systemic
- wt loss
sx evolution
- progressively worsening symptoms
- persistent and unremitting symptoms

Question 4

Red flags GORD
personal (1)
upper GI (2)
lower GI (3)
systemic sx (2)
sx. duration (2)
rx . response (1)

Answer 4

Age > 50yrs

dysphagia
epigastric mass

evidence of GI bleed - haematemesis, malaena, fe def anaemia

nocturnal pain
wt loss

onset symptoms <6/12
duration symptoms > 5yrs
symptoms not improved with trial of PPI

Question 5

Hereditary haemochromatosis - key features in history (6)

Answer 5

skin bronzing
arthralgia
upper abdo discomfort
impotence
loss of libido
fhx haemochromatosis

Question 6

Hereditary haemochromatosis - key features in examination (3)

Answer 6

hepatomegaly
arthritis - mcp, wrists knees, feet
cardiomyopathy

Question 7

Hereditary haemochromatosis - key investigations

Answer 7

LFTs - hepatocellular picture
Iron studies - TS elevated, ferritin normal or elevated
TS % >45 male; >55% female; ferritin >300 male; >200 female
HFE gene testing - C282Y and H63D
C282Y homo - develop fe overload
C282Y or H63D heterozygote = carrier, not a/w disease