LFTs and Bloods Laz

SBA 1 A 43-year-old woman is admitted to A&E with severe right upper quadrant pain. It came on last night and has not subsided. She has experienced similar pain in the past after eating fast food, however, this pain is usually less intense. On examination she is jaundiced. LFTs reveal: Bilirubin : 59 micromol/L (3-17) AST : 47 iU/L (5-35)
 ALT : 49 iU/L (5-35)
 ALP : 430 iU/L (30-150) A  Gallstones 
 B  Alcoholic hepatitis 
 C  Viral hepatitis 
 D  Hepatocellular carcinoma 
 E  Gilbert’s syndrome

SBA 1 A 43-year-old woman is admitted to A&E with severe right upper quadrant pain. It came on last night and has not subsided. She has experienced similar pain in the past after eating fast food, however, this pain is usually less intense. On examination she is jaundiced. LFTs reveal: Bilirubin : 59 micromol/L (3-17) AST : 47 iU/L (5-35)
 ALT : 49 iU/L (5-35)
 ALP : 430 iU/L (30-150) A  Gallstones 
 B  Alcoholic hepatitis 
 C  Viral hepatitis 
 D  Hepatocellular carcinoma 
 E  Gilbert’s syndrome

Liver AST + ALT Biliary GGT + ALP LFTs Made Easy Viral Hepatitis Hepatotoxic Drugs Alcoholic Hepatitis Liver AST + ALT Biliary GGT + ALP Gallstones Cholecystitis Cholangitis PSC/PBC

LFTs Made Slight More Complicated Most Liver Diseases (e.g. viral hepatitis) Increase in ALT > Increase in AST Alcoholic Hepatitis AST:ALT > 2:1 Acute Alcohol Intake GGT Needs to be elevated with GGT to be suggestive of biliary disease ALP can come from BONE!!

LIVER BILIARY Gilbert’s BONE Quickfire LFTs ALCOHOLIC LIVER NORMAL RANGES Bilirubin : 3-17 U/L AST : 5-35
U/L ALT : 5-35
U/L ALP : 30-150 U/L GGT: 9-48 U/L Patient 1 AST : 88
 ALT : 140 ALP : 70 GGT: 45 LIVER Patient 2 AST : 44
 ALT : 42 ALP : 237 GGT: 195 Patient 3 AST : 180
 ALT : 86 ALP : 82 GGT: 56 ALCOHOLIC LIVER BILIARY Patient 5 Bilirubin: 42 AST : 30
 ALT : 29 ALP : 114 GGT: 37 Patient 4 AST : 28
 ALT : 32 ALP : 425 GGT: 40 BONE Gilbert’s

SBA 2 A 65-year-old man, with a 40-pack-year smoking history, is brought to A&E by his daughter. He appears confused. His daughter adds that he has lost about 4 kg in weight over the past 5 months, and he has been coughing up a small amount of blood over the past month. A blood test shows the following results: Na+ : 121 mmol/L (135 - 145)
 K+ : 4.1 mmol/L (3.5 - 5)
 Ca2+ : 2.3 mmol/L (2.2-2.6)
 What is the most likely diagnosis? A  Addison’s disease 
 B  Hypothyroidism 
 C  Heart failure 
 D  SIADH 
 E  Cirrhosis

Everything is linked to ADH Hyponatraemia Everything is linked to ADH Rx: FLUID RESTRICT Can use saline BEWARE: do NOT correct Na+ too quickly or it could cause central pontine myelinolysis

SBA 2 A 65-year-old man, with a 40-pack-year smoking history, is brought to A&E by his daughter. He appears confused. His daughter adds that he has lost about 4 kg in weight over the past 5 months, and he has been coughing up a small amount of blood over the past month. A blood test shows the following results: Na+ : 121 mmol/L (135 - 145)
 K+ : 4.1 mmol/L (3.5 - 5)
 Ca2+ : 2.3 mmol/L (2.2-2.6)
 What is the most likely diagnosis? A  Addison’s disease 
 B  Hypothyroidism 
 C  Heart failure 
 D  SIADH 
 E  Cirrhosis

SBA 3 A 49-year-old man attends A&E complaining of palpitations. An ECG shows tented T waves and flattened P waves. He is currently on ramipril and spironolactone for his hypertension. A blood test reveals: Na+ : 137 mmol/L (135-145) K+ : 6.8 mmol/L (3.5-5) Ca2+ : 2.3 mmol/L (2.2-2.6) pH : 7.35 (7.35-7.45) What is the first step in the management of this patient?
 A  IV salbutamol 
 B  50 ml 50% dextrose with 10U insulin 
 C  50 ml 5% dextrose with 10U insulin 
 D  10 ml 10% calcium gluconate 
 E  IV sodium bicarbonate

SBA 4 A 62-year-old diabetic on metformin sees his GP for a routine blood test. He claims that he has been compliant with his treatment and has not experienced any symptoms recently. His blood test reveals: Na+ : 116 mmol/L (135-145)
 K+ : 3.7 mmol/L (3.5-5)
 Ca2+ : 2.4 mmol/L (2.2-2.6)
 Total Cholesterol : 9.2 mmol/L (< 5) Serum Albumin : 48 g/L (35 -50) TFT - Normal What is the most likely cause of his hyponatraemia? A  Addison's disease 
 B  Hypothyroidism 
 C  Erroneous result 
 D  Drug side-effect 
 E  Nephrotic syndrome

Hyperkalaemia Causes Acute kidney failure Chronic kidney disease Medications (e.g. potassium-sparing diuretics, ACE inhibitors/ARBs) Addison’s disease Treatment 10 mL 10% Calcium Gluconate 50 mL 50% dextrose + 10U insulin Other options: IV salbutamol, IV sodium bicarbonate ECG Features Tented T waves Flattened P waves Broad QRS Bradycardia BEWARE: haemolysis during venipuncture can lead to artefactual hyperkalaemia

SBA 3 A 49-year-old man attends A&E complaining of palpitations. An ECG shows tented T waves and flattened P waves. He is currently on ramipril and spironolactone for his hypertension. A blood test reveals: Na+ : 137 mmol/L (135-145) K+ : 6.8 mmol/L (3.5-5) Ca2+ : 2.3 mmol/L (2.2-2.6) pH : 7.35 (7.35-7.45) What is the first step in the management of this patient?
 A  IV salbutamol 
 B  50 ml 50% dextrose with 10U insulin 
 C  50 ml 5% dextrose with 10U insulin 
 D  10 ml 10% calcium gluconate 
 E  IV sodium bicarbonate

SBA 4 A 62-year-old diabetic on metformin sees his GP for a routine blood test. He claims that he has been compliant with his treatment and has not experienced any symptoms recently. His blood test reveals: Na+ : 116 mmol/L (135-145)
 K+ : 3.7 mmol/L (3.5-5)
 Ca2+ : 2.4 mmol/L (2.2-2.6)
 Total Cholesterol : 9.2 mmol/L (< 5) Serum Albumin : 48 g/L (35 -50) TFT - Normal What is the most likely cause of his hyponatraemia? A  Addison's disease 
 B  Hypothyroidism 
 C  Erroneous result 
 D  Drug side-effect 
 E  Nephrotic syndrome