According to Diabetes Australia, 10,249 Australians living with diabetes are now undergoing kidney replacement therapy, including dialysis, each year.

More than 1.5 million Australians live with diabetes, which can lead to serious complications including kidney disease.

With diabetes patients on dialysis accounting for approximately 5% of all hospitalisations, this has a significant impact on hospital capacity countrywide.

Earlier detection of kidney disease could save the Australian economy an estimated $500M per annum.²

Pathology Awareness Australia (PAA) ambassador Professor Graham Jones, a chemical pathologist who specialises in pathology testing for kidney disease, is encouraging people living with diabetes to get regular kidney checks to prevent the onset of kidney disease. Prof Jones said:

“Laboratory tests for the detection of kidney disease are crucial as it does not show clinical symptoms in its initial stages. For people living with diabetes, regular blood and urine tests play a vital role in identifying and monitoring from early onset.

“Staying proactive by scheduling GP check-ups is important to ensure timely diagnosis of kidney disease. If caught early, effective measures can be taken to prevent or slow down further kidney damage. Neglecting the condition can lead to kidney failure, dialysis, and in some cases, a kidney transplant may be required.”

Simple blood and urine checks, along with blood pressure checks, can effectively monitor kidney function and allow for early treatment, reducing the chance that people living with diabetes will require dialysis or kidney transplant.

While more than 300 Australians with diabetes currently receive a kidney transplant every year, a huge 2,024 people living with diabetes in Australia die from kidney disease each year, a concerning number for a mostly preventable condition.

PAA, Diabetes Australia and Kidney Health Australia say it is important for people with diabetes to work with their diabetes care teams and schedule annual kidney health checks.

Justine Cain, Group CEO of Diabetes Australia, said:

“More than 10,000 Australians living with diabetes are currently undergoing kidney replacement therapy. Most kidney failure can be prevented with early intervention; however, just under a quarter (23%) of people are getting their kidneys checked within recommended timeframes.”

Kidney disease occurs when the filters inside the kidneys become damaged and can no longer filter the blood properly. This can cause waste products to build up in the body and may progress to kidney failure, which in turn requires dialysis or a kidney transplant for survival.

In its earlier stages, kidney disease can be managed by various lifestyle changes, along with medication which can slow progression. Chris Forbes, CEO of Kidney Health Australia, said:

“We are championing early detection and prevention of progression of kidney disease for all Australians, with a special focus on those at greatest risk – those living with diabetes, cardiovascular disease, and high blood pressure.

“Kidney Health Australia is leading the fight to identify the 1.8 million Australians unaware they have kidney disease and help them, and their families manage the condition more effectively from start to end. We’ve developed a holistic approach that goes beyond merely screening individuals. Early diagnosis, better treatment and support post-diagnosis go hand in hand for achieving best outcomes.

Our recent Deloitte Economics Access report exposes kidney disease as a national emergency, costing the Australian economy $9.9 billion each year, including $2.3 billion in direct costs to the health system. Now is the time to invest in kidney health, for everyday Aussies, the economy, the healthcare system, and the environment.”

Diabetes was an underlying or associated cause of death in more than 2,000 people living with chronic kidney disease in Australia in 2020.³

In the coming years, this is expected to increase due to the rising prevalence of type 2 diabetes and the strong association between it and diabetic kidney disease.⁴

According to PAA pathologist Prof Jones, regular laboratory testing for kidney damage is a key factor to improve the health of people living with diabetes.

References:

1. https://www.diabetesaustralia.com.au/wp-content/uploads/2023-Diabetes-Related-Kidney-Disease-Report-1.4-DIGITAL.pdf
2. https://kidney.org.au/uploads/resources/Changing-the-CKD-landscape-Economic-benefits-of-early-detection-and-treatment.pdf
3. Australian Institute of Health and Welfare (2023) Chronic kidney disease: Australian facts, AIHW, Australian Government, accessed 11 June 2023.
4. Reutens AT. Epidemiology of diabetic kidney disease. Med Clin North Am. 2013;97(1):1-18

Image credit: Robina Weermeijer on Unsplash

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Following the announcement by the Medicines Services Advisory Committee (MSAC) in 2022, people who are planning to start a family will now have expanded access to genetic carrier screening, which began in November 2023.

This testing provides people with crucial information that can significantly impact their reproductive choices.

The three conditions covered by the expanded testing are cystic fibrosis, spinal muscular atrophy, and Fragile X syndrome. Approximately 1 in 20 people are carriers of one or more of these conditions¹. While varying in severity, these conditions, are all associated with significant health challenges, making early identification vital for making informed reproductive choices.

Genetic carrier screening is a powerful tool for identifying individuals at risk of carrying genetic changes associated with inherited conditions.

Pathology Awareness Australia (PAA) ambassador and genetic pathologist, Dr Melanie Galea, emphasises the importance of this testing:

“The three gene carrier screen enables individuals and couples to assess their risk of three common inherited conditions occurring in their children.”

“These three conditions have been chosen because of the severity of the clinical phenotypes and because they are common within the population.”

• Cystic fibrosis: Disorder that affects the lungs, pancreas, and other organs. Symptoms include frequent lung infections, malabsorption and shortened lifespan.
• Spinal muscular atrophy (SMA): Affects the nervous system and causes muscle weakness and atrophy. SMA is the leading genetic cause of infant mortality.
• Fragile X syndrome (FXS): Causes intellectual disability, behavioural and learning challenges. FXS is the most common inherited cause of intellectual disability.

Genetic carrier screening can help identify carriers of the genetic changes that result in these conditions. The expansion will significantly enhance the accessibility of these tests, potentially saving many families from the heartache of unknowingly passing on a serious genetic condition to their children.

Upon receiving results that identify them as carriers of a genetic condition, individuals and couples will have a range of options to consider, Dr Galea emphasised:

“We would recommend genetic counselling for at-risk patients identified by this screening to discuss the results, their implications and the reproductive options that are available. These options may include access to preimplantation genetic diagnosis through IVF, the use of donor gametes, prenatal diagnostic testing during pregnancy, and accepting the risk.”

In October 2017, a heartbreaking story came to light when Mackenzie Casella lost her battle with spinal muscular atrophy (SMA) at just seven months old. Her parents embarked on a quest called Mackenzie’s Mission². Their goal was clear: to make genetic carrier screening a standard and cost-free service for all Australian families preparing for parenthood. Their tireless efforts have been a driving force behind this funding allocation for expanded genetic carrier screening in Australia.

Dr Galea further added, “Reproductive carrier screening has become a mainstream test and has been available for several years in clinical laboratories across the country. The introduction of these rebates will make this testing more accessible to help inform reproductive decision making.”

The reproductive carrier screen test (CF, SMA and FXS) will be reimbursed under the Medicare Benefits Schedule starting November 2023³.

Quotes attributable to The Hon Mark Butler MP, Minister for Health and Aged Care:

“These new Medicare rebates for cutting-edge genetic testing will strengthen Medicare and make healthcare more affordable and available.” “The new Medicare rebate for reproductive carrier testing will provide confidence to women and their partners as they plan a pregnancy and start a family.”

References

1. https://www1.racgp.org.au/newsgp/clinical/three-condition-genetic-carrier-screening-to-becom
2. https://www.mackenziesmission.org.au/what-is-mackenzies-mission/ 
3. https://www.rcpa.edu.au/getattachment/2c1af2e1-b936-4948-bbbb-e1239c557cd4/Reproductive-screening-for-fragile-X-syndrome,-(1).aspx 

Image credit: Garrett Jackson on Unsplash

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PICCSI employs self-collected human papillomavirus (HPV) testing for Fijian women, to rapidly detect the virus that causes the majority of cervical cancers via point-of-care PCR testing.
Test results are returned within 45 minutes, showing whether a patient is HPV positive for a high-risk type of HPV. For those who test positive and require treatment, this can be provided on the same day.

The treatment removes pre-cancerous cells and is administered by the skilled Australian volunteer team, spearheaded by Melbourne-based obstetrician gynaecologist Dr Nicola Fitzgerald.

Dr Fitzgerald’s volunteer team is comprised of gynecologists, midwives, gynecology nurses, gynecologist trainees, and a GP, along with non-clinical administration staff.

Dr Fitzgerald commented on the importance of pre-cancerous cell detection and removal for Fijian women,

“In countries like Australia, cervical cancer diagnoses are more accessible, and treatments like chemotherapy and radiation are available. However, in the Pacific region, options for radiation as a treatment option are limited, unless individuals can afford to travel abroad to receive treatment.

This means that many women in the Pacific do not receive adequate treatment following a cervical cancer diagnosis.

This was the primary driver behind the development of PICCSI. It allows us to detect and treat women in the pre-cancerous stage, before they develop cervical cancer and the need for radiation or chemotherapy is required. In this way, the project has transformed access to cervical health services for Fijian women.”

This year’s PICCSI program took place in five different rural centres across Fiji from 7th-11th August, with a total of 302 Fijian women being screened for cervical cancer. The testing resulted in a positive HPV rate of 17%, and 25% of those women received pre-cancerous cell removal treatment.

Partnering with the Australian Centre for the Prevention of Cervical Cancer (ACPCC), who provide one of the testing machines for the program, and local partners Fiji National University and the Department of Obstetrics and Gynaecology at Lautoka Hospital, PICCSI addresses critical gaps in cervical cancer prevention and treatment in the Pacific region.

Local women aged 30-50 years were invited to be screened, with three PCR testing machines provided to the program by ACPCC and the Fiji Ministry of Health, allowing 12 cervical samples to be tested per hour.

In addition to providing PCR technology, ACPCC provides ongoing pathology services, training, technical support, and result interpretation to the program on a volunteer basis.

PICCSI aims to address several key challenges faced by Fijian women in accessing the healthcare they need, such as travel and financial considerations, healthcare workforce capacity, and infrastructure.

John Crothers, Executive Officer of Pathology Awareness Australia commented, “Collaborating with our Pacific neighbours to combat cervical cancer is a commendable initiative. Cervical cancer remains a significant health challenge, particularly in regions with limited resources and access to advanced healthcare.

By joining forces, sharing expertise, and implementing preventative measures such as HPV vaccination and early screening programs, we can make a substantial impact on reducing the burden of this preventable disease in countries such as Fiji. It’s an opportunity to not only save lives, but also to strengthen the bonds of solidarity and support within our broader healthcare community.”

Prior to this screen, test and treat program, there could be delays of up to 8 weeks in obtaining test results. Combined with transportation and family challenges, this has contributed to high rates of patients who received abnormal results remaining untreated.

Dr. Fitzgerald emphasised, “There is an urgent need to improve cervical cancer screening and treatment accessibility for Fijian women. At PICCSI, we are laying the foundation for a broader Pacific-wide screening program. Our objectives extend beyond immediate care, as we aim to boost awareness of cervical cancer screening, involve local practitioners, and gather data to advocate for a nationwide screening program in Fiji.”

PICCSI’s impact has been profound since its inception in 2018, delivering prompt testing, diagnosis, and treatment. In each five-day mission, 300-400 women are screened, with an average of 10-15% requiring treatment each time. By offering immediate results, follow-up rates have significantly improved compared to delayed result models.

Dr. Fitzgerald concluded, “PICCSI showcases the collaborative spirit of healthcare professionals across borders. By providing accessible, immediate, and sustained care, we are contributing to the larger goal of cervical cancer prevention in the Pacific.”

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According to the Cancer Council, about 15,500 Australians are diagnosed with bowel cancer every year, and although it is most common in people over 50, it can develop at any age. Bowel cancer claims the lives of 5,255 people a year.

Bowel cancer typically develops in the inner lining of the bowel and usually begins with growths called polyps, which may become cancerous if left undetected. While the risk of developing bowel cancer increases with age, if detected early there is a better chance of it being treated successfully.

Online publication, Starts at 60 sat down with the experts for an in-depth look at the symptoms, risk factors and what steps to take to prevent bowel cancer developing. Read the full article featuring Anatomical Pathologist and Ambassador for Pathology Awareness Australia, Dr Nick Musgrave

VIDEO: SBS Broadcaster Anton Enus learns about bowel cancer testing inside a pathology lab

The post Are you at risk of bowel cancer? Signs, symptoms and who should get tested first appeared on Know Pathology Know Healthcare.

The National Cervical Screening Program monitoring report 2021 from the Australian Institute of Health and Welfare (AIHW) shows that of those invited for a screening test during 2020, only 20 per cent completed the test within 12 months¹.

In the 25-29 age group, only 12 per cent of those invited to screen had their test.

The report estimates that overall only 62% of eligible people participated in the cervical screening program in 2018-2020.¹

VIDEO: Professor Marion Saville speaking to Channel 7 Sunrise

While it is unclear how much of an impact the pandemic has had on cervical screening uptake, routine healthcare participation was significantly affected, with pathology testing rates dropping by around 40 per cent² in the first months of COVID-19 restrictions.

Women aged 25-74 are recommended to have a cervical screening test every 5 years. The test looks for the Human Papillomavirus (HPV) known to cause the majority of cervical cancers.

In July 2022, self-collection of samples for cervical screening tests has become available to all people with a cervix aged 25-74. This means patients will no longer need their doctor or nurse to insert a speculum to collect the cervical sample.

On behalf of Pathology Awareness Australia, Professor Marion Saville AM said: “Australians need to be aware that prevention of cervical cancer requires regular screening as well as HPV vaccination for those who are eligible. Young people who have been vaccinated are not protected against every type of HPV so still need to be tested.”

Anyone who is unsure if they are due for a cervical screening test can ask their healthcare provider to check the National Cancer Screening Register to find out their status.

VIDEO: Prof Marion Saville speaking on 10 News

Prof Saville added; “HPV is a very common virus and most adults who are sexually active will be exposed to it during their lifetime. HPV can cause changes in the cells that lead to cancer. If this isn’t picked up early it can require more invasive treatment that can affect reproductive choices and of course in the worst cases, cervical cancer can be fatal.

From this month, people will be able to collect their own sample from the vagina using a small swab for their cervical screening test. We hope that this encourages more people to come forward for screening.”

The test is now only required every 5 years (for those testing negative to HPV) and is recommended for anyone with a cervix who is sexually active, aged between 25-74.

The National Cervical Screening Program changed to a 5 yearly cycle from a 2 yearly cycle in December 2017.

Before the pandemic, Australia was leading in cervical cancer elimination due to prevention measures. A 2018 study in The Lancet noted that with a combination of screening and vaccination, Australia could be one of the first countries in the world to eliminate cervical cancer as a public health problem and could do so by 2035.³

Liz Ham, National Health Promotion Manager at Australian Cervical Cancer Foundation said:

“Although we do have great vaccine coverage in Australia due to the vaccination program in schools, there is a cohort of middle-aged Australians who missed out on vaccination and can therefore be vulnerable to HPV infection. Migration and travel also mean that some people in Australia are not vaccinated because of where they were born. The vaccine also doesn’t cover every strain of HPV so cervical screening continues to be an important part of cervical cancer prevention.”

Eliminating cervical cancer relies on participation in the HPV vaccination and screening programs in order to effectively diagnose and prevent cancers.

A study published in Medical Journal Australia in 2019 noted the prevalence of cancer-causing HPV types other than type 16 and 18, was highest in women aged 25–29 years.⁴

Jean Hailes for Women’s Health CEO Janet Michelmore AO said: “We are keen to remind women about health checks they may have missed due to lockdowns and the pandemic creating disruption in people’s lives. It may seem easy to put off check-ups when so much else is going on, especially if you feel well, but cancer doesn’t discriminate. Early diagnosis is beneficial for almost any health condition so please don’t put off vital screening tests.”

Delayed diagnosis of cervical cancer could lead to the need for more invasive treatment. In 2019, 179 women aged 25–74 died from cervical cancer.⁵

References:

1. https://www.aihw.gov.au/getmedia/2a26ae22-2f84-4d75-a656-23c329e476bb/aihw-can-141.pdf.aspx?inline=true
2. https://www1.racgp.org.au/newsgp/clinical/drastic-drops-in-cancer-and-heart-attack-patients
3. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2818%2930183-X/fulltext
4. https://www.mja.com.au/journal/2019/211/3/routine-cervical-screening-primary-hpv-testing-early-findings-renewed-national
5. https://www.aihw.gov.au/reports/cancer-screening/national-cervical-screening-program-monitoring-rep/formats

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In most cases, Rapid Antigen Tests are being completed in home settings meaning responsibility is placed on the patient to ensure their positive infection is recorded and reflected in Australia’s healthcare data.

This is the first time that the public have been given this duty.

Before the pandemic, recording of specific communicable diseases was managed by healthcare professionals and pathology laboratories through the National Notifiable Diseases Surveillance System (NNDSS).

The system captures a long list of notifiable diseases including laboratory confirmed influenza, syphilis, hepatitis and measles, plus diseases rarely seen in Australia such as leprosy.

For these diseases health professional consultation and pathology test results confirm the diagnosis, which is then reported to the NNDSS, ensuring there is an accurate record and disease outbreaks can be tracked.

Pathologists are concerned that without a full picture of all COVID-19 infections in the community, recording both laboratory and RAT results, public health data will become inaccurate.

Pathology Awareness Australia ambassador Dr Caitlin Keighley is a microbiologist and infectious diseases physician. She is urging the public to report their positive COVID-19 tests, she said:

“Without accurate public health data on COVID-19 infections, we have no way of knowing what the true number of positive infections in the community. Reporting every positive Rapid Antigen Test is the only way we can count positives. This data is vital to planning public health responses and assessing the impact of treatments and vaccines for COVID-19.”

When a positive RAT is reported via phone or online to state health departments, every patient receives a survey to fill out, clarifying their ability to safely manage COVID-19 symptoms while isolating at home.
Patients filling out this survey provide the health department with information on the number of COVID-19 patients that can manage their symptoms effectively, as well as those who require assistance, and the number of people who are at high risk of more severe disease.

This is also important for patients to ensure they are provided information about accessing treatment for COVID-19, particularly those who are higher risk such as the immunocompromised and older Australians.

While Rapid Antigen Tests have assisted COVID-19 testing in terms of accessibility and convenience, there is some concern among pathologists around the accuracy of the test and the reporting of test results. PCR testing is still the most accurate test, therefore if there is uncertainty around RAT results, pathologists recommend getting a PCR test.

Tests performed in a home setting are more open to user error and the obligation to record positive results rests with patients, who may not be aware of this duty, or of reporting mechanisms.

Dr Keighley said, “I urge Australians to report all positive Rapid Antigen Tests to their state health department. When you are unwell, reporting your positive test may not seem like a priority, but it is so important to take the time to do so. It informs us of the public’s resistance to the virus and allows us to take steps to reduce its effect on patients.”

Accurate infectious disease data is critical for microbiologists and infectious disease experts, like Dr Keighley, in the long-term management of viral community outbreaks and new COVID-19 variants.

COVID-19 Polymerase Chain Reaction (PCR) tests performed in a pathology laboratory are still widely available and Australians can find local testing sites through their state health department or contact their healthcare provider about testing. All PCR results are then sent to state health departments by pathology laboratories.

In Australia, all positive COVID-19 test results are required to be reported.

Australia currently has the highest per capita rate of COVID infections of any comparable country in the world. High rates of infection allow high rates of mutation and the possibility of new variants emerging. Continued testing and accurate reporting will minimise transmission and in turn, COVID infections.

For those with concerns over language barriers, online forms to report a positive COVID-19 test result is compatible with most translation reader technology.

Read media coverage on this topic here:

SBS News

The New Daily

7News

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LFTs encompass tests that are specific to a protein or enzyme, and when these multiple tests are ordered together, their results may help piece together a puzzle to provide insight as to what may be going on with your liver health.

What is being tested?

A Liver Function Test (LFT) can detect a range of substances in the blood including different proteins (such as albumin and total protein) and enzymes (such as ALT, AST, ALP and GGT) that are produced by liver cells or released when these cells become damaged. Some common enzymes and proteins the tests look for include:

1. Alanine aminotransferase (ALT): measures levels of the ALT enzyme which metabolises protein and is found mainly in the liver. ALT is typically found at a low level and high levels may be an early indication of liver disease.
2. Aspartate transaminase (AST): an enzyme relates to the function of bile ducts but is found in many other areas of the body.
3. Alkaline phosphate (ALP): ALP is an enzyme that can be found in the liver, bones, bile ducts, heart and other muscles. It is often ordered in conjunction with other LFTs.
4. Albumin and total protein: Albumin is an essential protein synthesised by the liver, where the level of albumin in your bloodstream indicates how well the liver is functioning. Total protein tests measure both albumin and all other proteins in the blood including antibodies that make up part of the body’s immune system.
5. Total bilirubin: Bilirubin is a yellow pigment that can be found in the blood that is formed as a waste product of spent red blood cells. It passes through the liver before being removed from the body.
6. Gamma-glutamyl transferase (GGT): GGT is an enzyme that is found in the liver.
7. Lactate dehydrogenase (LHD): LHD is an enzyme found in the liver.

How do I know what test I need, or which disease I should be screened for?

Your healthcare professional will be able to best determine which tests to order based on your symptoms and history. If you have been potentially exposed to a hepatitis virus, for instance, they may look at your ALT levels and may also require further tests that look for hepatitis antigens or antibodies. Further, LFTs may be ordered if you have added risk factors for liver dysfunction such as heavy consumption of alcohol, a family history of liver disease or the consumption of drugs that can damage the liver.

Symptoms that can also warrant LFTs include weakness, fatigue, nausea, vomiting, abdominal swelling or pain, jaundice, itching, loss of appetite and dark urine or light-coloured stools.

Diseases or conditions that could be indicated by LFTs include;

Hepatitis A, B and C

High levels of ALT can indicate liver disease and very high ALT levels may be due to an acute hepatitis infection.

Alcohol use disorder

The GGT enzyme can leak into the blood when the liver is damaged. Although high GGT levels are not limited to alcohol related liver disease, GGT levels are widely used as an indicator of heavy alcohol consumption.

Liver cancer

Alongside a standard LFT, to investigate potential liver cancer a test may be ordered to detect the levels of alpha-fetoprotein (AFP) in the blood. Higher levels of AFP are seen in pregnancy but AFP is also a tumour marker for liver cancer.

Diabetes

An increase in the levels of ALT and AST seen in an LFT may be associated with type 2 diabetes.

Find out more about conditions that an LFT can help detect.

Why do I need a liver function test?

Your healthcare professional may order an LFT if you are an at-risk individual for liver disease or damage, or if you are experiencing symptoms that may indicate liver disease such as jaundice, dark urine, pale stools, tiredness or weakness, loss of appetite, nausea and vomiting, abdominal pain or swelling or itching.

Preparing for the test 

For the majority of pathology tests, no specific preparation is needed. If you are having a test you have not had before, check with your doctor or whoever ordered the test whether you need to fast, or if there are any foods you should avoid before the test. You should also let your doctor know any medications or supplements you are taking as this could affect the test results.

Do I need to fast before a liver function test?

Liver function tests do not usually require fasting, but for any pathology test it is best to discuss preparation with your health professional before the test.

What happens during the test? 

In your local GP clinic or health service, most pathology samples will be taken by a trained pathology collector, also called a phlebotomist, or sometimes by a nurse. A blood test usually involves taking a sample from a vein in your arm.

Find out more about what happens during your blood test.

What do my liver function test results mean?

The results of LFTs may help piece together a puzzle to provide insight on what may be going on with your liver health. If your LFT was ordered due to symptoms, then normal LFT results will help your doctor rule out liver problems and look for other causes. The meaning of abnormal LFT results will depend on a number of factors including your symptoms, individual circumstances and medical history. Your health professional will explain the results to you. They may request further pathology tests or refer you for other investigations such as diagnostic imaging or a specialist appointment.

All pathology test results are interpreted by a pathologist who provides a report to the General Practitioner, specialist doctor or other medical personnel who ordered the tests. The healthcare professional will use the pathology report and consideration of the clinical context to decide on the next steps for their patient. Test results, treatment and medical questions should always be discussed with your treating health professional.

The post What is a Liver Function Test? first appeared on Know Pathology Know Healthcare.

Your healthcare professional can use data from tests along with information about your medical history, personal circumstances and any symptoms you have to decide what is wrong and what treatment you may need. For example, if you have been potentially exposed to a hepatitis virus, they may look at your ALT levels and may also require further tests that look for hepatitis antigens or antibodies. Further, LFTs may be ordered if you have added risk factors for liver dysfunction such as heavy consumption of alcohol, a family history of liver disease or the consumption of drugs that can damage the liver.

Symptoms that can also warrant LFTs include weakness, fatigue, nausea, vomiting, abdominal swelling or pain, jaundice, itching, loss of appetite and dark urine or light-coloured stools.

Diseases or conditions that could be indicated by LFTs include;

Hepatitis

A liver function test typically includes measuring levels of alanine aminotransferase (ALT), an enzyme which metabolises protein and is found mainly in the liver. High levels can indicate liver disease and very high ALT levels may be due to an acute hepatitis infection.

Hepatitis B

Hepatitis B is a serious disease caused by the hepatitis B virus that can lead to inflammation of the liver. It can manifest as an acute infection with or without symptoms, but around 1 in 20 people affected develop a chronic infection. It can be spread between individuals through exposure to infected blood and some other body fluids. The disease affects people of all ages, but certain groups are more at risk. These groups include individuals engaging in unprotected sex, newborns of mothers with chronic hepatitis B and individuals who share needles used for intravenous drugs.

Symptoms include a loss of appetite, nausea and vomiting, pain in the right side of the abdominal area, fatigue, fever, sore joints, rashes and jaundice. Jaundice gives the appearance of yellow skin and yellow whites of the eyes. Symptom onset is 2 – 3 months after contracting the virus and may last up to 6 months.

Hepatitis B can be vaccinated against and the Hepatitis B vaccine is part of the standard immunisation schedule for babies in Australia. While most people who become infected make a full recovery, some hepatitis B infections can become long-lasting which may lead to further liver problems such as cirrhosis, and liver cancer.

Hepatitis C

Hepatitis C is an infectious disease caused by the hepatitis C virus. Hepatitis C is a serious disease, causing liver inflammation that can damage the liver and can manifest as both an acute infection and a chronic condition. Approximately 75% of people who contract hepatitis C will develop a chronic infection.

It can be spread between individuals of all ages through blood but is mostly spread through contaminated needles used to inject intravenous drugs being shared between individuals. The majority of people infected with the hepatitis C virus will not experience symptoms, but once they do this may be indicative of advanced liver disease. If symptoms become present, their onset ranges between 2 – 6 months after infection with acute symptoms consisting of fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, joint pain and jaundice.

Hepatitis C can be cured using direct-acting antiviral therapy which has been made widely available in Australia since 2016 through the Pharmaceutical Benefits Scheme (PBS).

Hepatitis A

Hepatitis A is an infectious disease caused by the hepatitis A virus that is not common in Australia. Unlike hepatitis B and C, it is spread through faecal-oral transmission. This is when someone ingests small particles of infected faeces. This may happen when someone consumes water or food contaminated by sewage, or if an infected person prepares food without thoroughly washing their hands. Some oral-anal sexual practices can also lead to transmission. The disease may affect people of all ages, but people who have travelled to, or lived in, low- and middle-income countries with poorer sanitation are more at risk.

Symptoms of hepatitis A include fever, nausea, pain in the abdominal area, dark urine and jaundice. Symptom onset is typically 2 – 4 weeks after contracting the virus.

Hepatitis A can be vaccinated against with the hepatitis A vaccine, but if an individual becomes infected the symptoms can last for several weeks followed by a full recovery in most cases.

Alcohol use disorder

The gamma-glutamyl transferase (GGT) test which is usually part of an LFT shows if GGT is present in the bloodstream, outside the liver. The enzyme can leak into the blood when the liver is damaged, such as in cases of liver disease. GGT levels are widely used as an indicator of heavy drinking, when suspected.

Heavy alcohol consumption can lead to severe liver diseases such as liver fibrosis and end-stage cirrhosis. Of those suffering from cirrhosis of the liver with concurrent alcoholic hepatitis, 60% have a life expectancy of about four years.

Alcohol use disorder can lead to significant liver damage, but also has serious long-term consequences on mental and physical health and wellbeing. Symptoms include individuals being unable to limit their alcohol consumption and craving it when they are not drinking, failing to fulfil obligations due to repeated alcohol use, using alcohol in unsafe situations such as driving and suffering from withdrawal symptoms.

Liver cancer

Alongside a standard LFT, to investigate potential liver cancer a test may be ordered to detect the levels of alpha-fetoprotein (AFP) in the blood. High levels of AFP in adults (who are not pregnant) can indicate the presence of liver cancer. Primary liver cancer is a malignant tumour that originates in the liver. It can be caused by fatty liver disease or genetic disorders. Other risk factors include type 2 diabetes, hepatitis B or C, high alcohol consumption, obesity, tobacco exposure and exposure to hazardous chemicals. Symptoms of liver cancer are similar to other liver diseases and include weakness and tiredness, abdominal pain and swelling, pain in the right shoulder, appetite loss, weight loss, fever, jaundice, dark urine and pale stools.

Diabetes

Another chemical typically included in an LFT is aspartate transaminase (AST). An increase in the levels of AST and ALT may be associated with type 2 diabetes.

Diabetes is a non-infectious disease that revolves around the body’s impeded ability to regulate blood sugar levels through the release of hormones. It can be both caused by genetic predisposition and age as well as lifestyle factors such as obesity and physical inactivity. Insulin is a hormone that is released by the pancreas when blood sugar levels rise to signal the liver and other tissue to store the sugar, hence lowering its concentration in the blood. There are three main kinds of diabetes: type 1, type 2 and gestational diabetes. Type 2 diabetes is the most common, representing 85-90% of cases, and occurs when the body becomes resistant to insulin and loses the ability to produce insulin from the pancreas adequately. As a result, those living with type 2 diabetes often have chronically higher-than-normal blood sugar concentrations. Symptoms include being excessively thirsty, increased urination, fatigue and lethargy, increase appetite, poor circulation, itching, declining eyesight, increased weight gain, mood swings, headaches, dizziness and leg cramps.

All pathology test results are interpreted by a pathologist who provides a report to the General Practitioner, specialist doctor or other medical personnel who ordered the tests. The healthcare professional will use the pathology report and consideration of the clinical context to decide on the next steps for their patient. Test results, treatment and medical questions should always be discussed with your treating health professional.

The post What diseases does a Liver Function Test look for? first appeared on Know Pathology Know Healthcare.

There are a number of conditions [link to article on diseases] that an LFT can help to detect, including hepatitis and liver cancer.

Your healthcare professional may order an LFT if you are at higher risk for liver disease or damage, or if you are experiencing symptoms that may indicate liver disease such as jaundice, dark urine, pale stools, tiredness or weakness, loss of appetite, nausea and vomiting, abdominal pain or swelling or itching.

If your LFT was ordered due to symptoms, then normal LFT results will help your doctor rule out liver problems and look for other causes. The meaning of abnormal LFT results will depend on a number of factors including your symptoms, individual circumstances and medical history. Your health professional will explain the results to you. They may request further pathology tests or refer you for other investigations such as diagnostic imaging or a specialist appointment.

Some of the possible results from LFTs:

• Alanine aminotransferase (ALT) test: high levels of ALT in the bloodstream may indicate liver disease, very high levels can be due to acute hepatitis.
• Aspartate transaminase (AST) test: AST may increase when bile ducts become obstructed. An increased concentration of AST may also indicate muscle or liver issues.
• Alkaline phosphate (ALP test): A high concentration of ALP in the bloodstream can indicate inflammation, bone disease or bile duct blockage.
• Albumin and total protein test: Low albumin levels indicate that the liver’s function may be being hampered. High levels of albumin can point towards dehydration or the use of certain drugs including steroids, insulin and hormones. Low total protein also indicates abnormal liver function or a deficiency in the immune system. High levels of total protein in the bloodstream may also indicate dehydration, inflammation or infection.
• Total bilirubin test: High levels of bilirubin in the blood can lead to jaundice and indicates that the liver isn’t functioning optimally.
• Gamma-glutamyl transferase (GGT) test: GGT leaks into the bloodstream when the liver becomes damaged. Therefore, high GGT levels in the bloodstream can indicate liver disease or damage.
• Lactate dehydrogenase (LHD) test: An LHD test is used as a general marker for liver cell damage. Liver or bile duct damage can be signified by higher-than-expected LHD concentration in the bloodstream.

All pathology test results are interpreted by a pathologist who provides a report to the General Practitioner, specialist doctor or other medical personnel who ordered the tests. The healthcare professional will use the pathology report and consideration of the clinical context to decide on the next steps for their patient. Test results, treatment and medical questions should always be discussed with your treating health professional.

The post Why might you need a liver function test and what the results mean first appeared on Know Pathology Know Healthcare.