- Gastroenterology Education and CPD for trainees and specialists - https://www.gastrotraining.com -
Abnormal Liver Function Test (LFT)
Discuss abnormal LFT’s?
Discuss the evaluation of abnormal LFTs?
In those with persistently (>6 months) abnormal LFTs, screening with ultrasound scan, hepatitis B and C serology, Ferritin, TIBC, autoantibodies, immunoglobulin’s and coeliac serology plus screening for alpha-1-antitrypsin deficiency and Wilson’s disease in selected patients will often yield a diagnosis.
Blood glucose, thyroid function tests and lipid profile is also checked.
Discuss the management of persistently abnormal LFTs and negative results of the tests above?
If LFTs are markedly abnormal (transaminases > 5 times abnormal), or if significant symptoms or evidence of chronic or decompensated liver disease are present, then a liver biopsy is usually indicated.
In the absence of above, check for risk factors for NAFLD (BMI, diabetes). If risk factors present are present, they should be addressed and LFTs reassessed at 6 months. If ALT is improving, life style measures should be continued. If ALT fails to improve or if risk factors for NAFLD are absent, a liver biopsy should be considered.
Discuss the aetiology of abnormal LFTs in the presence of negative serological investigations?
In the setting of abnormal liver enzymes in the absence of diagnostic serology, a liver biopsy in a large study (1) of 354 patients showed the following:
NAFLD (including NASH) – 66%
Normal- 06%
Cryptogenic hepatitis-9%
Drug reaction-8%,
Alcohol- 3%,
Others- 7%.
26% of the patients had fibrotic liver disease and 6% cirrhosis. Further, management was altered directly by the liver histology findings in 18%.
Discuss the role of liver biopsy in the setting of abnormal LFTs and negative serology?
Liver biopsy is often recommended in patients with ‘unexplained’ abnormal LFTs in order to determine the cause, to stage hepatic fibrosis and to grade hepatic inflammation. While the information derived from a liver biopsy is useful, performing a liver biopsy on all persons with unexplained abnormal LFTs may not be feasible since this laboratory abnormality is so common. Non invasive methods need to be developed that can evaluate disease severity and likelihood of disease progression in persons with raised aminotransferase activity.
Serum markers, and serum panel markers for the assessment of chronic liver disease, such as Enhanced (European) Liver Fibrosis (ELFTM) test and FibroTest, have been proposed. Liver stiffness measurement using transient elastography (TE) (FibroScan®) is another recently developed technique designed for the assessment of liver fibrosis. These non invasive methods may help us in better defining the extent of the problem in future, however they are not ready for prime time use yet
Thus, the need for liver biopsy should be individualised.
Ref
Article printed from Gastroenterology Education and CPD for trainees and specialists: https://www.gastrotraining.com