what must i do about abnormal lft?
DESCRIPTION
What must I do about abnormal LFT?. KEVIN ROSENFELD Consultant Radiologist West Hertfordshire Hospitals Spire Hospital Harpenden Spire Hospital Bushey. Abnormal LFT. Symptomatic or incidental finding Symptoms Pain,nausea,LOW,known malignancy Ultrasound Pathology Gallstones neoplasm. - PowerPoint PPT PresentationTRANSCRIPT
What must I do about abnormal LFT?KEVIN ROSENFELD
Consultant Radiologist
West Hertfordshire Hospitals
Spire Hospital Harpenden
Spire Hospital Bushey
Abnormal LFT
Symptomatic or incidental finding Symptoms
– Pain,nausea,LOW,known malignancy Ultrasound Pathology
– Gallstones– neoplasm
Asymptomatic abnormal LFT
Incidental finding
CASE 1
40 M Insurance medical Bloods:GGT 240 rest bloods normal What do next?
• Ultrasound• GI referral• Counsel patient• nothing
CASE 2
55F Pneumonia Treated A/B Still unwell Bloods : AST 95 alk phos normal GGT 150 What next
• GI referral• Ultrasound• Stop AB and recheck bloods in 4 weeks
Management of asymptomatic abnormal LFT
Draft guidelines BSG Not universally accepted West Herts adopted for primary care
F i g u r e 1 . S u g g e s t e d M a n a g e m e n t o f A b n o r m a l L F T s
C L I N I C A L S I T U A T I O N
A C T I O N S U G G E S T E D
M A N A G E M E N T S U G G E S T E D
A b n o r m a l a l k a l i n e p h o s p h a t a s e o r s e r u m t r a n s a m i n a s e s < 2 x u p p e r l i m i t o f n o r m a l
L I V E R S C R E E N i . e F u l l h i s t o r y , H B S A g , H C V A b ,
1 A T A u t o i m m u n e P r o f i l e , F e r r i t i n , C a e r u l o p l a s m i n , I m m u n o g l o b u l i n s U l t r a s o u n d a b d o m e n
D i l a t e d b i l e d u c t s
2 . S t o p h e p a t o t o x i c d r u g s
3 . A d v i s e w e i g h t l o s s i f B M I > 2 5
5 . R e c h e c k L F T i n 3 - 6 m o n t h s
P E R S I S T E N T L Y A B N O R M A L L F T
I n c r e a s e d G T o n l y A l c o h o l a b s t i n e n c e
I n c r e a s e d B i l i r u b i n o n l y
R e c h e c k w i t h c o n j u g a t e d b i l i r u b i n , e x c l u d e h a e m o l y s i s E
R e a s s u r e a s l i k e l y G i l b e r t s S y n d r o m e
4 . C h e c k G T i f R a i s e d A L P
1 . A l c o h o l a b s t i n e n c e
A l c o h o l a d v i c e
C h o l a n g i o g r a p h y M R C P o r E R C P
N o n - d i l a t e d b i l e d u c t s
C o n s i d e r t r e a t i n g u n d e r l y i n g d i s o r d e r e g P B C , h a e m o c h r o m a t o s i s o r a L i v e r B i o p s y
A b n o r m a l a l k a l i n e p h o s p h a t a s e o r s e r u m t r a n s a m i n a s e s > 2 x u p p e r l i m i t o f n o r m a l
Liver Metastases U/S
Liver Metastases CT
Fatty Liver
Common ultrasound finding
F i g u r e 1 . S u g g e s t e d M a n a g e m e n t o f A b n o r m a l L F T s
C L I N I C A L S I T U A T I O N
A C T I O N S U G G E S T E D
M A N A G E M E N T S U G G E S T E D
A b n o r m a l a l k a l i n e p h o s p h a t a s e o r s e r u m t r a n s a m i n a s e s < 2 x u p p e r l i m i t o f n o r m a l
L I V E R S C R E E N i . e F u l l h i s t o r y , H B S A g , H C V A b ,
1 A T A u t o i m m u n e P r o f i l e , F e r r i t i n , C a e r u l o p l a s m i n , I m m u n o g l o b u l i n s U l t r a s o u n d a b d o m e n
D i l a t e d b i l e d u c t s
2 . S t o p h e p a t o t o x i c d r u g s
3 . A d v i s e w e i g h t l o s s i f B M I > 2 5
5 . R e c h e c k L F T i n 3 - 6 m o n t h s
P E R S I S T E N T L Y A B N O R M A L L F T
I n c r e a s e d G T o n l y A l c o h o l a b s t i n e n c e
I n c r e a s e d B i l i r u b i n o n l y
R e c h e c k w i t h c o n j u g a t e d b i l i r u b i n , e x c l u d e h a e m o l y s i s E
R e a s s u r e a s l i k e l y G i l b e r t s S y n d r o m e
4 . C h e c k G T i f R a i s e d A L P
1 . A l c o h o l a b s t i n e n c e
A l c o h o l a d v i c e
C h o l a n g i o g r a p h y M R C P o r E R C P
N o n - d i l a t e d b i l e d u c t s
C o n s i d e r t r e a t i n g u n d e r l y i n g d i s o r d e r e g P B C , h a e m o c h r o m a t o s i s o r a L i v e r B i o p s y
A b n o r m a l a l k a l i n e p h o s p h a t a s e o r s e r u m t r a n s a m i n a s e s > 2 x u p p e r l i m i t o f n o r m a l