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Liver function tests

  1. 1. Dr. Shameera Begum
  2. 2. FUNCTIONS OF THE LIVER Excretory Function Synthetic Function Metabolic Function Detoxification Function Storage Function
  3. 3. TESTS TO ASSESS EXCRETORY FUNCTION Serum bilirubin Urine and fecal urobilinogen Urine bile pigments Urine bile salts
  4. 4. TOTAL SERUM BILIRUBIN Conjugated bilirubin (direct bilirubin) Soluble in water Excreted in kidney Unconjugated bilirubin (indirect bilirubin) Insoluble in water Bound to albumin in blood Cannot pass through glomeruli
  5. 5. • Normal range: 0.3 to 1.0 mg/dl Total serum bilirubin • Normal range: 0 to 0.2 mg/dl Direct (conjugated ) bilirubin • Normal range : 0 to 0.8 mg/dl Indirect (unconjugated) bilirubin
  6. 6. JAUNDICE – Serum bilirubin > 2 mg/dl
  7. 7. TESTS WHICH ASSESS HEPATIC INJURY (LIVER ENZYMES)  Serum Transaminases  Aspartate aminotransferase (AST)/ Serum glutamic - oxaloacetic transaminase (SGOT)  Alanine aminotransferase (ALT) / Serum glutamic-pyruvic aminotransferase(SGPT)  Alkaline phosphatase (ALP)  Gamma glutamyl transferase(GGT)  5’nucleotidase (5’NT)
  8. 8. • Normal range: 5 - 40 U/L AST • Normal range: 5 - 42 U/L ALT • 0.7 – 1.4 • > 2.0 in alcoholic hepatitis • < 1.0 in acute viral hepatitis AST/ALT ratio
  9. 9. • Children : 25 – 350 U/L • Males: 25 -120 U/L • Females: 25 -90 U/L Serum ALP • Normal range: 2-17 IU/L Serum 5’-Nucleotidase • Normal range – males: Upto 40 U/L • females : Upto 25 U/L Serum GGT
  10. 10. Serum aminotransferases  Marker of acute hepatocellular injury  Necrosis or death of cells containing these enzymes leads to their release into the circulation  Level correlates with extent of tissue damage  Marked elevation of AST and ALT (> 15 times normal)  Acute Viral hepatitis  toxin induced hepatocellular damage  Moderate elevation (5-15 times)  Chronic hepatitis  alcoholic hepatitis  Mild elevation (1-3 times)  Cirrhosis  Cholestasis
  11. 11. Serum alkaline phosphatase  Distributed widely in various tissues – liver, bones, intestine, kidney and placenta  Causes of Increased ALP – hepatobiliary causes, diseases of bone, pregnancy  hepatobiliary – Bile duct obstruction,primary biliary cirrhosis,infiltrative diseases of liver SERUM GGT  Alcoholism (markedly elevated in acute alcoholic hepatitis)  Cholestasis
  12. 12. TESTS WHICH ASSESS SYNTHETIC METABOLIC FUNCTIONS OF LIVER Total serum proteins Normal - 5.5 to 8.0 gm/dl Serum albumin Normal - 3.5 to 5.0 gm/dl Serum albumin / globulin ratio Normal - > 1.5
  13. 13. PROTHROMBIN TIME  Most coagulation proteins are synthesised in liver  Vitamin K dependent factors – II, VII, IX and X  PT measures three factors (II, VII and X)  PT prolonged in hepatocellular and obstructive jaundice  NORMAL VALUE: 11 -13 sec
  14. 14. PHYSIOLOGICAL JAUNDICE OF NEWBORN  Transient increase in unconjugated bilirubin observed in almost all newborns  First appears during 24 – 72 hours of life  Disappears by 7th to 10th day  Does not exceed 15mg/dl  Deficiency of glucuronyl transferase  Treatment: Phototherapy ( unconjugated bilirubin to lumirubin)

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