Tutorial on Liver function test

1. Pictionary
Dr. Vibha Sakhare
MD BIOCHEMISTRY
AIIMS NAGPUR

3. 1. Icterus

4. Icterus:
• Sclera contains a lot of elastin (bilirubin has a strong affinity for elastic
tissue)
• Sclera is white in colour
Jaundice :
• Yellow discolouration in sclera, mucuous membrane and skin.
• It is a symptom not a disease
• Classified as pre, intra and post hepatic
• Hyperbilirubinemia when > 1.0 mg/dl (Latent Jaundice)
• Jaundice manifests when serum bilirubin > 3.0 mg/dl (Overt
Jaundice)

5. • Jaundice is a yellowish discoloration of the skin, the conjunctival
membranes and other mucous membranes caused by
hyperbilirubinemia.
• Choluric jaundice refers to presence of bile pigments in urine. Only
conjugated or water-soluble bilirubin seen in obstructive jaundice
(Regurgitation jaundice) can be excreted in urine.
• Acholuric jaundice seen in unconjugated hyper bilirubinemia (as in
haemolytic jaundice) urine will be negative for bile pigments.

6. Haemolytic Hepatocellular Obstructive
Serum bilirubin
elevated
Unconjugated Both fractions Conjugated
Urine bilirubin Not detectable + (Increased)* ++ (Increased)
Urine
urobilinogen
Increased Decreased Not detectable
Serum ALP
(KA units)
3-13 <30 >30

7. 2.

8. Hemolysis of Red Blood cells leading to unconjugated hyperbilirubinemia

9. 3.

10. Cholestasis : prevents passage of
conjugated bilirubin into intestines
Symptoms:
GI pain
Nausea
Clay coloured stools
Liver enzymes:
ALP is markedly raised along with
GGT, 5’ Nucleotidase

11. 4.

13. 4. Liver cirrhosis
• Scarring of liver leads to decreased conjugation of bilirubin
• UCB is more
• Urobilinogen is increased in urine because of hepatic damage
decreasing its enterohepatic circulaton.
• AST , ALT are elevated
• In biliary cirrhosis, ceruloplasmin is elevated
• Alpha feto protein is mildly elevated
• Decrease in total proteins

14. Enzymes elevated in serum in hepatocyte injury:
1. Serum transaminases (ALT, AST)
2. Glutamate dehydrogenase
3. α-glutathione-S-transferase

15. Alcohol Addiction

16. 5.

17. 5. Ascites

18. 5. Ascites
• Ascites refers to collection of ‘free’ fluid within the peritoneal cavity.
• The Greek word ‘askitos’ means bag or sac.
• Causes of ascites (7 Fs)
• 1. Fat—Obesity
• 2. Faeces—low gut obstruction
• 3. Foetus—Pregnancy (foetal parts are palpable; central dullness).
• 4. Flatus—Gaseous distension .
• 5. Fluid—Ovarian cyst, ascites.
• 6. Full (urinary) bladder
• 7. Fibroid or fatal tumour

19. Order of ascites appearance
1.Liver cirrhosis
2. Portal hypertension
3. Ascites

20. 6.

21. 6. Kernicterus

22. 6. Kernicterus
• Kernicterus: Deposition of bilirubin in brain tissues (basal ganglia)
causing seizures, encephalitis and mental retardation.
• In infants, blood brain barrier is not matured hence bilirubin easily
enters the brain.
• Treatment: Phototherapy blue light (420-470nm) gets converted to
lumirubin.

23. Phototherapy
• Blue fluoroscent light (450 to 495 nm) is given to newborns.
• Converts bilirubin to more polar, water soluble isomers like lumirubin
• These somers can be easily excreted into bile without conjugation to
glucuronic acid.
• Jaundice in Newborns
• Rise in UCB in postnatal week because of low activity of Uronyl
glucose transferase.
• Elevated UCB exceeds albumin levels and gets deposited in brain as
lipophilic and conjugated bilirubin appears in urine.

24. 7.

25. 7. Dubin Johnson syndrome
• Biochemical defect – defective transport , mutation in MRP-2 gene
• Conjugated hyperbilirubinemia
• Dark pigmented liver
• Asymptomatic
• No special treatment needed

26. 8.

27. 8. Carotenaemia / Carotenoderma
• Carotenaemia (carotenoderma)—Skin is yellow (mainly the palms and
soles) but the sclera and
• mucous membrane are unaffected. The serum is also yellow in colour;
• the stool and urine are of normal colour

28. 9.
SLIT LAMP EXAMINATION

29. 9. Wilsons disease

31. 10.

32. 10. GILBERT SYNDROME

33. 11.

35. 12.

36. 12. Erythroblastosis foetalis
Rise in unconjugated
bilirubin

37. 13.

40. 14.

42. 15.

43. 15. Cancer of head of pancreas

44. Enzymes elevated in serum in cholestasis:
1. Alkaline phosphatase
2. 2. 5’-Nucleotidase
3. 3. Gamma Glutamyl transferase