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Deranged LFT(Liver Screen)  |  Hepatoma Screen  | Hepatorenal Syndrome

Ascitic Tap/Paracentesis      |  Pancreas Screen   |

Luminal & IBD/Biologics Screen 

 
*Tube colours based on BD vacutainer

*Revised 2022

 

 

H E P A T O L O G Y

 

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D E R A N G E D  L F T "LIVER SCREEN"

 

Check Medications

-http://livertox.nih.gov

 

Imaging

--US Liver

--If lesion - CT Triple Phase Scan

 

Bloods

 

General FBC, EUC, LFT, Coag    Purple, LGreen, LGreen, Blue   Serology Hep B( B S Ag, C Ab,),  Hep C Serology +/- EBV, CMV... All Gold , Except Hep C Genotype (Purple)

Autoimmune Antibodies ANA   Anti SmoothMuscle,  Anti LKM, ,Soluble liver antigen Anti Mithochondrial [Optional: ENA, ANCA, ] All Red Metabolic, Other  Creatining Kinase(extrahepatic source of transaminase) Iron Study, IgG Subclass(IgG4), alpha-1-antritripsin(antiprotenase) level Serum Ceruloplasmin, Urine Copper Purple, Gold, Red, Yellow Urine Jar

 

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H E P A T O M A  S C R E E N

6 monthly screen(HCC usual dobuling time is 117 days)

HCC Surveillance At Risk Groups -Cirrhosis - all grades CP A to B -Non Cirrhotic HBV if    —High ALT, Viral load,    —FHx HCC    —Ethinicity : African, African American, Asian(M 40+ F 50+) Note that: -Treated Hep B : Continue surveillance after treatment if Hep B S Ag(but based on Interferon) -Treated Hep C HCC risk persists even after SVR  Variceal Surveillance At Risk Groups Most patient with cirrhosis -> ie elevated portal hypertension -HCV patient with Plt 150+ and <20kPa varices risk is low

 

Imaging

-US Liver 

-Quadruple Phase CT Abdomen & MRI Liver

 

Bloods

--aFP,      ....CEA, CA19,9

All Gold

 

*Note that you can have non AFP secreting HCC

 

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H E P A T O/ R E N A L  S Y N D R O M E (HRS)

Urine

--Sodium(Dont do it if on Frusemide) - Low urine Na increases likelihood of HRS in cirrhotic patient

Yellow Urine Jar

 

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A S C I T I C   T A P (P A R A C E N T E S I S)

Body Fluid

-Body fluid MCS, Body fluid culture, 

Cytology, Albumin, Protein, LDH

Yellow urine jar & Culture Bottle -More the better for cytology

 

-Cell Count Purple EDTA to prevent clump, Can be done in yellow urine jar

 

Blood

albumin, protein, LDH at the same time

 

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P A N C R E A S

General

-Medications - Uptodate

 

Bloods

-Serum Lipase LGreen

-Lipids LGreen

-EBV, CMV All Gold

-IgG Subclass Red

 

Others

-Chronic - Stool Elastase

 

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L U M I N A L 

Anaemia For Scope

--Iron Study

 

Diarrhoea

--Bowel chart, food chart

--Please check medications

--Stool MCS, C. Diff & OCP(Parasite)

 

IBD & Biologic Screen

 

Diagnostic aid

ANA, pANCA, ASCA

Nota Bene UC & PSC association infliximab may cause drug induced lupus -> anti histone antibody

Past infection

-TB - CXR & IGRA(Inteferron Gamma Releasing Assay 'Quantiferon Gold')

-Serology Grp 1 - EBV IgM/IgM, VZV IgM/IgG, CMV IgM/IgG

-Serology Grp 2 - Hep B S Ag, Hep S Ab, Hep B C Ab, Hep C Serology, HIV

 

Treatment & Treatment Side Effect

TPMT - Thiopurine Methyltransferase Gene

6 -TG level - Supra/Infra therapeutic level whilst on 6MP or Azathiopurine

Ca & Vit D level - for Steroid

 

 

 

 

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