Liver Disease
Non-alcoholic Fatty Liver Disease
Neonatal jaundice
Neonatal Cholestasis
Intestinal failure related liver disease
Paracetamol overdose
Alcohol overdose
Hepatoblastoma (secrete BhCG > LH receptor agonist > virilisation)
Viral Hepatitis A-E
Autoimmune hepatitis (ANA, SMA-smooth muscle antibody, liver-kidney microsomal antibody) Rx steroids
Coeliac: TTG
Haemolysis: LDH, haptoglobin, retics
Thyroid: TSH
Haemochromatosis: Fe, Ferritin, TIBC
Chronic Liver Disease
Cystic Fibrosis
Inflammatory
- autoimmune hepatitis
- sclerosing cholangitis
- Wilson Disease: Ceruloplasmin
- A1AT deficiency: A1AT
Hepatocytes
Kupffer cells (macrophages lining the sinusoids (part of mononuclear phagocyte system)
LFTs
Hepatocellular injury
ALT
AST
ALP
GGT
Elevated ALP (GGT suggests whether liver or bone)
- ALP-liver isoenzyme/high GGT/LFTs/Hx/Ex suggest liver disease > refer to gastroenterology
- ALP-bone isoenzyme/normal GGT/Hx/Ex suggest bone disease > CMP/PTH/VitD
- Both isoenzyme up/normal GGT/transaminases/HxEx NAD/ <5yo > likely transient hyperphosphatemia > repeat in 4m
Bilirubin
- conjugated
synthetic function
- PT/INR (post parenteral vit K as cholestasis causes nutritional deficiency)
- Albumin
Other function
BSL
Ammonia