Learning Outcomes Anatomy of the liver Functions of

Learning Outcomes

Anatomy of the liver

Functions of the liver

Some manifestations of liver disease

Testing Liver Function

Testing Liver Function

Tests of the liver’s synthetic function

Total Bilirubin

‘Liver function tests’

Cell injury or Hepatocyte damage pattern

ALT and AST

Primary assay reaction Indicator reaction

Primary assay reaction Indicator reaction

Alkaline phosphatase (ALP)

Alkaline phosphatase (ALP)

Gamma glutamyl transferase (GGT)

ALP and GGT assays

Hepatocellular injury versus Cholestasis

Routine LFTs

Case: Male, 55 years old

Liver enzyme patterns in liver disease

Interpret in context of the clinical picture

Diagnostic approach

Some types of liver disease

Hepatocellular damage

Hepatitis

Case: Female, 35 years old

Natural history of liver disease

Acute versus chronic liver disease

Hyperbilirubinaemia → Jaundice

Causes of hyperbilirubinaemia Neonatal unconjugated hyperbilirubinaema

Non-Alcoholic Fatty Liver Disease (NAFLD)

Progression of Fatty Liver (steatosis) Numerous small fat vesicles Liver cells engorged with fat Nuclei not displaced Nuclei displaced Inflammatory cell infiltrate +/- fibrosis Disturbed architecture Fibrosis

Case: Female, 45 years old

Cirrhosis

Cirrhosis

Summary (I)

Summary (II)