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LFTs

 

  • Background

    Overview

    • Abnormal in 1/20 people.
    • In many diseases, all or several LFTs may be raised. The question is, which are the most raised? To determine which measure is highest, calculate how many times its respective upper limit it is.

    Patterns of chronic LFT changes

    • Cirrhosis: ↑all enzymes.
    • ALD: ↑↑AST (on the Sauce. Also raised in MI), ↑ALT (liver specific), ↑↑MCV.
    • NAFLD: ↑↑ALT (Lipid), ↑AST, ↑MCV (uncommon).

    Patterns of acute LFT changes

    • Drug, viral, or auto-immune hepatitis: ↑↑ALT, ↑↑AST.
    • Cholestatic disease: ↑GGT, ↑alk phos. DDx of ↑alk phos, ABCD: Autoimmune (ankylosing spondylitis, temporal arteritis), Bone disease (Paget's, osteomalacia and Rickets, cancer mets or osteosarcoma), Cholestasis (gallstones, PBC/PSC, gestational), Drugs.
    • Alcohol intoxication: ↑GGT.

  • Drug-induced LFT changes

    Hepatocellular (↑ALT, ↑AST):

    • Anti-epileptics: phenytoin, valproate.
    • Anti-TB: isoniazid, rifampicin.
    • CV: statins, amiodarone.
    • Anti-inflammatory: methotrexate, aspirin (Reye's syndrome), diclofenac.

    Cholestatic (↑GGT, ↑alk phos):

    • Antibiotics: macrolides (especially erythromycin), flucloxacillin, co-amoxiclav, ciprofloxacin.
    • CNS: carbamazepine, tricyclic anti-depressants, phenothiazines.
    • Carbimazole
    • Hormonal: OCP, anabolic steroids.
    • Allopurinol
    • Parenteral nutrition.

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