Assessment of Liver Function
A 50-year-old man has been referred to the Liver Clinic by his GP following the discovery of a mildly elevated ALT on a routine blood test. He has a past medical history of type 2 diabetes and hypertension. There is no history of ischaemic heart disease,
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Key Learning Points
• The liver is the largest solid organ in the human body. • The liver performs key roles in glucose metabolism, lipid metabolism, synthesis of proteins and clotting factors, storage of vitamins and immune regulation. • In contrast to other organs, the blood supply to the liver is predominantly venous (70–75 %). • Liver function tests can help to elicit the cause of liver disease, i.e. pre-hepatic, hepatic or post-hepatic. • The degree of liver scarring (fibrosis) historically was determined by liver biopsy, but non-invasive tests are now available for routine clinical use. • The most common causes of abnormal LFTs are related to medications, alcohol and fatty liver disease. • History and clinical examination is vital to investigating abnormal liver function.
L.E.J. Loo • S. Singh, MB BS, MRCP C. Sieberhagen, M.B.Ch.B, MRCP () Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK e-mail: [email protected] T. Cross (ed.), Liver Disease in Clinical Practice, In Clinical Practice, DOI 10.1007/978-3-319-43126-0_1, © Springer International Publishing Switzerland 2017
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Case Study A 50-year-old man has been referred to the Liver Clinic by his GP following the discovery of a mildly elevated ALT on a routine blood test. He has a past medical history of type 2 diabetes and hypertension. There is no history of ischaemic heart disease, neuropathy or retinopathy, and his regular medication includes metformin and amlodipine. He drinks less than 10 units of alcohol per week and denies any heavy alcohol consumption in the past. Physical examination reveals a pulse of 70 bpm and blood pressure of 145/80 mmHg, and he is afebrile. His BMI is elevated at 31 kg/m2. There are no stigmata of chronic liver disease, and there is no evidence of hepatomegaly, splenomegaly or clinical evidence of ascites. The blood tests done by his GP reveal: Normal full blood count and renal function Random blood glucose 8.5 mmol/L LFTs: Bilirubin 10 μmol/L (3–17 μmol/L) Alanine aminotransferase (ALT) 115 IU/L (10–45 IU/L) Alkaline phosphatase (ALP) 95 IU/L (30–105 IU/L) Gamma-glutamyl transpeptidase (GGT) 75 IU/L (15–40 IU/L) Albumin 38 g/L (35–50 IU/L) Prothrombin time 11.7 s (9–12.7 s)
Questions 1. What is the differential diagnosis? 2. What additional tests should be done? 3. Which invasive and non-invasive investigations are you aware of to aid prognosis and guide subsequent management of liver disease?
Chapter 1
Assessment of Liver Function
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An Overview of Anatomy and Functions of the Liver The liver is the largest solid organ in the body weighing approximately 1600 g in men and 1400 g in women. It lies in the right upper quadrant of the abdomen with its upper border between the fifth and sixth ribs and its lower border along the right costal margin. Seventy-five percent of hepatic blood flow is delivered by the portal vein, whilst the hepatic artery provides 25 % [1]. The liver is important in a wide variety of metabolic and immunological functions.
Metaboli
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