Investigations
Investigations
1. Urine: bilirubin (increased conjugated bilirubin)
2. Blood tests:
Produce different pictures:
A) Isolated Bilirubin (Gilbert’s syndrome)
B) Cholestatic picture (ÝALP w/ÝBilirubin)
- Remember, Paget’s disease can also cause this; therefore
- Use GGT to confirm liver aetiology
C) If there is no obvious obstructive feature and GGT is normal: – Liver screen:
- Immunoglobulins (IgM in PBC, IgG in chronic hepatitis)
- Autoimmune profile
- Ferritin
- Alpha-1 antitrypsin
- Alpha-fetoprotein
- Ceruloplasmin
- HbA1C
- Clotting factors
– Hepatic Picture
- Increased ALT and AST with bilirubin
- Excessive ALT increase suggests hepatic cause (e.g. Viral Hepatitis) & Paracetamol OD
- AST > ALT suggests alcohol-related
- ALT > AST suggests infection
- Low albumin is associated with chronic liver disease