Specimen Name Result Units Range
Plasma Sodium 134 mmol/L (135-145)
Potassium 4.0 mmol/L (3.5-5.5)
Chloride 109 mmol/L (100-109)
Bicarbonate 24 mmol/L (22-32)
Glucose 4.0 mmol/L (3.8-5.5)
Urea 3.0 mmol/L (2.7-7.2)
Creatinine 130 μmol/L (60-110)
Albumin 19 g/L (34-48)
Total Protein 62 g/L (60-80)
Total Bilirubin 130 μmol/L (6-24)
GGT 120 U/L (< 60)
ALP 1,750 U/L (30-110)
ALT 44 U/L (< 55)
AST 90 U/L (< 45)
Blood Hb 101 g/L (130-180)
Platelets 78 x109/L (150-450)
WCC 12.5 x109/L (4.0-11.0)
INR 2.5 (0.8-1.2)
APTT 32 Sec. (25-35)

49yo male with history of heavy alcohol intake.
Alcohol-induced Liver Failure
  • hyperbilirubinaemia, raised LFTs
  • hypoalbuminaemia
  • coagulopathy and mild thrombocytopaenia
  • low-normal creatinine/urea
  • mild hyponatraemia

Alcoholic Hepatitis

  1. ↑ AST:ALT ratio > 2.0 (R:1.5-2.0)
  2. ↑↑ GGT disproportionately
  3. Hyperbilirubinaemia

Cirrhosis

  1. Hyperbilirubinaemia
  2. Mild elevation of AST > ALT
  3. Hypoalbuminaemia
  4. Hyperglobulinaemia
  5. ↑ INR/APTT
  6. Low Na+, K+, Mg++ - dilution & 2° hyperaldosteronism
  7. Low urea, Ca++
  8. High NH3, glucose
  9. ABG : compensated respiratory alkalosis

 

Hyperbilirubinaemia - Predominantly Unconjugated

  1. Overproduction
    • haemolysis
    • reabsorption of haematoma
    • ineffective erythropoeisis
  2. Decreased hepatic uptake
    • sepsis
    • prolonged fasting
    • RV failure
    • drugs - rifampicin, probenecid
  3. Decreased conjugation
    • hepatocellular disease - hepatitis, cirrhosis
    • sepsis
    • drugs - chloramphenicol
    • inherited glucuronyl transferase deficiency
      • Gilbert's syndrome - actually ligandin deficiency
      • Crigler-Najjar - types II & I

Hyperbilirubinaemia - Predominantly Conjugated

  1. Biliary obstruction
    • biliary cirrhosis - primary | secondary
    • sclerosing cholangitis
    • extrahepatic obstruction - stone, tumour, stricture
  2. Impaired hepatic excretion
    • sepsis
    • post-operative state
    • hepatocellular disease
      • hepatitis - viral, ischaemic, drug-induced
      • cirrhosis
    • drug-induced cholestasis - OCP, methyltestosterone
    • inherited disorders
      • Dubin-Johnson, Rotor syndrome
      • benign familial cholestasis
    • cholestasis of pregnancy