1. LFTs and Bloods
Laz

2. 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

3. 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

4. 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

5. 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!!

6. 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 : 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

7. 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 ( )

K+ : 4.1 mmol/L ( )

Ca2+ : 2.3 mmol/L ( )

What is the most likely diagnosis?
A  Addison’s disease 

B  Hypothyroidism 

C  Heart failure 

D  SIADH 

E  Cirrhosis

8. 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

9. 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 ( )

K+ : 4.1 mmol/L ( )

Ca2+ : 2.3 mmol/L ( )

What is the most likely diagnosis?
A  Addison’s disease 

B  Hypothyroidism 

C  Heart failure 

D  SIADH 

E  Cirrhosis

10. 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 ( )
K+ : 6.8 mmol/L (3.5-5)
Ca2+ : 2.3 mmol/L ( )
pH : 7.35 ( )
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

11. 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 ( )

K+ : 3.7 mmol/L (3.5-5)

Ca2+ : 2.4 mmol/L ( )

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

12. 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

13. 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 ( )
K+ : 6.8 mmol/L (3.5-5)
Ca2+ : 2.3 mmol/L ( )
pH : 7.35 ( )
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

14. 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 ( )

K+ : 3.7 mmol/L (3.5-5)

Ca2+ : 2.4 mmol/L ( )

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