LFT liver function test in critically ill, ICU BASICS :DR TAPESH BANSAL🩺📽🎫

FOOD FOR THOUGHT 🤠🙋‍♂️🙋‍♀️
SGPT/OT more than 1000 in 95% of cases is caused by 3 conditions only thus giving you the diagnosis, can you name them
ANS🤷‍♂️✔
1 viruses
2 drugs
3 ischemia
TRANSCRIPT
Dr Tapesh Bansal discussed the impact of chronic liver disease and cirrhosis on notable figures and the significance of understanding liver function tests. He also highlighted the causes and conditions associated with low albumin and high prothrombin time in critically ill patients, and the importance of classifying liver function based on a hepatitis picture or an obstructed picture. Lastly, He detailed the liver function tests in various liver diseases and emphasized the need to consult with specialists for complex cases.
Summary
Chronic Liver Disease and LFT Interpretation
Dr Bansal discussed the impact of chronic liver disease and cirrhosis on notable figures such as Meena Kumari, Beethoven, and Bobby Moore. He emphasized that around 50% of liver disease cases are linked to alcohol consumption. He further explained the importance of understanding normal liver function and the components of Bilirubin, SGPT, and Alkaline Phosphatase. He noted that an increase in SGPT suggests liver disease, while an increase in Alkaline Phosphatase indicates obstruction in the biliary system. He stressed that the interpretation of these values varies depending on their upper limit, and anything exceeding 500 becomes quite specific and suggestive of underlying conditions.
Liver Function Tests and Bilirubin Metabolism
He discussed various liver function tests and their interpretations. He explained the conditions under which certain test results may indicate liver disease, including small granulomas, cancer, and high levels of alkaline phosphatase. He also discussed the metabolism of Bilirubin, the causes of increased Bilirubin levels, and the conditions associated with jaundice. Lastly, they touched on the concept of delta Bilirubin and the importance of considering the percentage of indirect Bilirubin to diagnose hyper Bilirubinemia.
Critically Ill Patients With Low Albumin and High PT
He discussed the significance and causes of low albumin and high prothrombin time (PT) in critically ill patients. He explained that low albumin can be due to various reasons including increased catabolism, volume of distribution, and losses. On the other hand, high PT is often seen in chronic liver disease, anticoagulant use, and malabsorption. The doctor emphasized the importance of arterial ammonia as a reliable marker of liver function in acute liver failure. He also discussed several causes of jaundice in patients without liver disease, such as post-operative complications, blood transfusions, and prolonged use of total parental nutrition.
Liver Function Classification and Conditions
The doctor discussed the importance of classifying liver function based on a hepatitis picture or an obstructed picture. He explained that in a hepatitis picture, SGPT and SGOT levels are greater than 500, while in an obstructive pattern, SGPT is less than 300 and alkaline phosphatase more than 4 times upper limit of normal. The doctor also highlighted various conditions that can cause hepatitis, including infections, toxins, and drugs, further detailed how to identify and address specific conditions such as environmental hepatitis, septic hepatitis, and drug-induced hepatitis. The importance of distinguishing between these patterns and their underlying causes was emphasized throughout the discussion.
Liver Function Tests and Diseases
The doctor discussed the liver function tests (LFTs) in various liver diseases, including acute liver failure, acute on chronic liver failure, and chronic liver disease with complications. He emphasized the importance of identifying the underlying cause of elevated LFTs, with 95% of cases being due to viral infections, ischemia, or drug-induced hepatitis when sgpt /ot are more than 1000. The doctor also detailed the characteristic LFT patterns in each type of liver disease and highlighted the significance of ammonia levels in diagnosing chronic liver diseases. He encouraged the team to consult with specialists for complex cases.

[@divaanshugupta]

superb sir, kindly make video for interpretation of renal function test, cbc

[@youngindiaintensivist7709]

Yes will cover all topics
👍❤

[@dryashd]

The 3 conditions possible are -
1) Viral hepatitis
2) Drug induced hepatitis
3) Ischemic hepatitis

[@youngindiaintensivist7709]

@yashd That is excellent💯. So u see its importance . Now u can know the Dx .5% it can be other rarer conditions -that is for Gastro consultation.

[@dryashd]

@@youngindiaintensivist7709 Learnt this from seeing your case discussions sir. Please keep these videos going. They are life saver :)

[@youngindiaintensivist7709]

@@dryashd videos will go on ,not to worry. And hopefully content wl kerp getting better ..that is my plan
In future all q wl be answerable from the videos more or less
Otherwise I think its difficult for many of u