Clinical Case

 A 65 year-old man came to his GP with visible jaundice which he had noticed to be deepening in colour.
He had no pain but had noticed some weight loss and that his stools were pale. He was a moderate
drinker and was not on any drug therapy.

 Table Of LFT
Parameter Test Value Normal range
Bilirubin 250 3-22
(μmol\L)
AST 87 12-48
(IU\L)
ALT 92 3-55
(IU\L)
ALKP 855 80-280
(IU\L)

 What is the differential diagnosis?

 Comment on any useful investigations
 Liver Function Tests
Objectives:
Bilirubin metabolism
Liver Function tests
Clinical case
Liver Function Tests
True LFT
Parameter
Investigate the metabolic function
PT •Cholestasis of the liver.
(due to Vit.
K def.)
•Warfarin
therapy
Bilirubin •Hepatitis - Albumin
•Cholestasis
•Malaria
•Liver cancer
Ammonia
PT Bile salts
Bile salts
Albumin •Renal True
disease
•Hepatocell-
ular damage
LFT

Bilirubin Ammonia
Ammonia
 Routine LFT
Parameter
ALKP •Cholestasis Indicative of liver damage or
•Cirrhosis biliary tract disease.
•Cholangitis
•Hepatitis
ALT •Liver cancer
•Cirrhosis ALT
ALT
•Hepatitis
AST •Hepatitis
•Cirrhosis ALKP AST
•Cholestasis
Albumin
γGT •Alcohol toxicity Routine
•Cholestatic LFT
damage
Bilirubin •Hemolytic anemia
•Cirrhosis Bilirubin
Bilirubin Albumin
Albumin
•Hepatitis

γGT
γGT
 Clinical Case
 A 65 year-old man came to his GP’s with visible jaundice which he had noticed to be deepening in colour.
He had no pain but had noticed some weight loss and that his stools were pale. He was a moderate
drinker and was not on any drug therapy.

 Table Of LFT
Parameter Test Value Normal range
Bilirubin 250 3-22
(μmol\L)
AST 87 12-48
(IU\L)
ALT 92 3-55
(IU\L)
ALKP 855 80-280
(IU\L)

 What is the differential diagnosis?

 Comment on any useful investigations
Differential Diagnosis of Obstructive Liver disease:

Obstructive Liver
disease

Intrahepatic Extrahepatic
Extrahepatic

Drug
Drug toxicity
toxicity
Alcoholic (e.g.
(e.g. Pancreatic
Pancreatic Gall
Gall bladder
bladder
liver Acetaminophen
Acetaminophen Liver
Liver Cancer
Cancer Gallstones
Gallstones carcinoma
cancer
cancer carcinoma
disease phenytoin
phenytoin
Allopurinol
Allopurinol
Diagnosis of Obstructive Liver Disease
Arteriography
Nuclear Liver
Scans
Liver Ultrasound