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Liver function test
• The liver has a wide range of functions, including
detoxification of various metabolites,
protein synthesis, and production of biochemicals
necessary for digestion. The liver is necessary for
survival, and there is currently no way to
compensate for the absence of liver function in the
long term.
LIVER FUNCTION TEST
USED TO
• Detect presence of liver disease
• Distinguish among different types of liver
disaease.
• Gauge the extent of known liver damage
• Follow the response of treatment
Tests based on detoxification &
excretory functions
• Serum bilirubin
• Urine bilirubin
• Blood ammonia
• Serum enzymes : AST, ALT, GGT,
5’Nucleotidase,ALP
Tests that measure Biosynthetic
function of liver
• Serum Albumin
• Serum Globulins
• PT ,INR
Serum Bilirubin
• A break down product of porphyrin ring of
heme – containing proteins , found in blood in
2 fractions – conj/unconj
• Conjugated : water soluble , so excreted by
kidneys
• Unconjugated : insoluble in water , bound to
albumin in blood
• About 300 mg of bilirubin is formed per day
Serum Bilirubin
• Normal total serum bilirubin: 0.3 – 1.3 mg/dl
• Direct/conjugated bilirubin: 0.1 – 0.4 mg/dl
• Indirect/unconjugated bilirubin: 0.2 – 0.9mg/dl
• Measured by Van Den Bergh method
• Bilirubin reacts with diazo reagent to produce
coloured azo pigment . At pH 5 – pigment
purple .
Serum Bilirubin
• Plasma bilirubin exceeds 1mg/dl –
hyperbilirubinemia
• B/w 1-2 mg/dl – latent jaundice
• >2 mg/dl – yellowish discolouration of sclera,
conjunctiva, skin , mucous memberane
resulting in jaundice.
•  Bilirubin is taken up into hepatocytes
, conjugated (modified to make it watersoluble) by UDP-glucuronyl-transferase, and 
secreted into the bile by CMOAT (MRP2), 
which is excreted into the intestine.
•  In the intestine, conjugated bilirubin may be 
(1) metabolized by colonic bacteria, (2) 
eliminated, (3) reabsorbed. Metabolism of 
bilirubin into urobilinogen followed by 
reabsorption of urobilinogen accounts for the 
yellow color of urine as we urinate a 
downstream product of urobilinogen. Further 
metabolism of urobilinogen into stercobilin 
while in the bowels accounts for the brown 
color of stool. 
• Increased total bilirubin (TBIL) causes jaundice, and can 
indicate a number of problems:
• 1. Prehepatic: Increased bilirubin production. This can be 
due to a number of causes, including hemolytic anemias
 and internal hemorrhage.
• 2. Hepatic: Problems with the liver, which are reflected 
as deficiencies in bilirubin metabolism (e.g., reduced 
hepatocyte uptake, impaired conjugation of bilirubin, 
and reduced hepatocyte secretion of bilirubin). Some 
examples would be cirrhosis and viral hepatitis.
• 3. Posthepatic: Obstruction of the bile ducts, reflected as 
deficiencies in bilirubin excretion. (Obstruction can be 
located either within the liver or in the bile duct)
• Direct bilirubin (conjugated bilirubin)
• Reference range0.1–0.4 mg/dLThe diagnosis is 
narrowed down further by looking at the levels of 
direct bilirubin.
• If direct (i.e. conjugated) bilirubin is normal, then the 
problem is an excess of unconjugated bilirubin 
(indirect bilirubin), and the location of the problem is 
upstream of bilirubin conjugation in the liver. 
Hemolysis, viral hepatitis, or cirrhosis can be 
suspected.
• If direct bilirubin is elevated, then the liver is 
conjugating bilirubin normally, but is not able to 
excrete it. Bile duct obstruction by gallstones or 
cancer should be suspected.
High Bilirubin in neonates
• Neonates are especially vulnerable to bilirubin 
levels due to an immature blood-brain barrier 
that predisposed them to kernicterus / 
bilirubin encephalopathy which can result in 
permanent neurological damage. Neonates 
also have a low amount of functional 
UDP-glucuronyl-transferase and can have 
elevated unconjugated bilirubin since 
conjugated is limited. 
Urine Bilirubin
• The conjugated bilirubin being water soluble is 
excreted in urine.
• This s contrast to unconjugated bilrirubin 
which is not excreted
• Biluribin in urine can be detected by fouchets 
test or gmelins test.
Serum Enzymes – reflect damage to
hepatocytes
• Aminotransferases (AST,ALT) – sensitive 
indicators of liver cell injury
• Helpful in recognizing hepatocellular diseasess 
such as hepatitis.
Aspartate Aminotransferase
(SGOT) Reference range6-40 IU/L
• Aspartate transaminase (AST) also called serum glutamic 
oxaloacetic transaminase (SGOT) or aspartate 
aminotransferase (ASAT) is similar to ALT in that it is another 
enzyme associated with liver parenchymal cells.
•  It is raised in acute liver damage, but is also present in red 
blood cells, and cardiac and skeletal muscle and is therefore 
not specific to the liver. 
• The ratio of AST to ALT is sometimes useful in differentiating 
between causes of liver damage.[6][7] Elevated AST levels are not 
specific for liver damage, and AST has also been used as 
a cardiac marker
Alanine
Aminotransferase(SGPT)
• Normal : 7 – 41 U/L
• ALT found primarily in liver.
• Upto 300U/L – nonspecific , any type of liver
disorder(cirrhosis /malignancy)
• >1000U/L – extensive hepatocellular damage
( viral hepatitis, ischemic liver injury , toxin
/drug induced liver injury )
• Acute hepatocellular diseases – ALT >AST
Serum Enzymes – that reflect
cholestasis
3 enzymes
• Alkaline Phosphatase
• 5’Nucleotidase
• Gamma glutamyl transpeptidase
Alkaline Phosphatase
• Normal :40 – 125 U/L
• Alpha -1 ALP – epithelial cells of biliary canaliculi ,
increased in obs.jaundice.
• Alpha-2 heat labile ALP – hepatic cells , increased in
hepatitis
• Alpha -2 heat stable ALP – placental origin, normal
pregnancy
• Pre Beta ALP – bone origin , increased in bone diseases
• Gamma ALP – Intestinal cells, increased in Ulcerative
colitis.
Alkaline Phosphatase
• Elevation of liver derived ALP – not totally
specific for cholestasis .
• < 3 fold rise can be seen in many types of liver
ds ( infective, alcoholic hepatitis )
• >4 times – cholestatic liver diseases, infiltrative
liver diseases, bone diseases with rapid bone
turnover .
• Isolated rise of ALP – hodgkins lymphoma,
diabetes
hyperthyrodism
amyloidosis
inf.bowel diseases
 Not helpful in diff b/w intrahep & extrahep
cholestasis
5’Nucleotidase
• Normal :2 – 10 U/L
• Moderate elevated – hepatitis
• Highly elevated – biliary obstruction
• Unlike ALP , the level is unrelated with
osteoblastic activity ie.. Unaffected by bone
diseases.
Gamma glutamyl transpeptidase
• Used in body for synthesis of glutathione
• Seen in liver, kidney, pancreas, intestinal cells,
prostate
• Normal : 9 – 58 U/L
GGT
• Rised even when other LFT are normal in
alcohalics.
• GGT falls rapidly within few days after
abstinence.
• Mod rise – infective hepatitis, prostate Cancer
• High rise – alcoholism,
obstructive jaundice,
neoplasms of liver
Tests that measure Biosynthetic
function of liver – Serum Albumin
• Produced by hepatocytes
• Normal : 3.5 – 5 g/dl
• Long half life :18 -20 days
• Because of slow turnover Serum Albumin not a good
indicator of acute/mild hepatic dysfunction.
Serum Globulins
• Normal : 2 – 3.5 g/dl
• > 4 g/dl - CLD
• Gamma globulins – B lymphocytes
• Alpha , beta globulins – hepatocytes
• Increased gamma globulins – CLD
Gamma globulins
• IgG – Auto immune hepatitis
• IgM – Primary biliary cirrhosis
• Ig A – Alcoholic liver ds
Prothrombin Time ,INR
• Normal : 11.5 – 12.5 sec
• Prolongation of PT by 2 sec / more – Abnormal
• PT – factors I,V, VII, X
PT prolonged – hepatitis, cirrhosis, vit K
deficiency( obsyructive jaundice, fat
malabsorption )
Liver function test

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Liver function test

Editor's Notes

  1. Asparate transaminase(sgot),alanine transaminase(sgpt), alkaline phosphate, gamma glutamyl transpeptidase
  2. Brekdown product of heme catabolism
  3. Neonatal bil,-Dubin–Johnson syndrome is an autosomal recessive disorder that causes an increase of conjugated bilirubin in the serum without elevation of liverenzymes (ALT, AST).,, cirrohsis,sulfonamides,antipsychotic,hepatitis, Crigler–Najjar syndrome or CNS is a rare disorder affecting the metabolism of bilirubingilbert syn
  4. Canalicular multispecific organic anion transporter
  5. newborns are often treated with UV light to turn the hydrophobic, albumin-binding unconjugated bilirubin into a form that is more hydrophilic and able to be secreted out via urine, sparing the neonate&apos;s brain.
  6. cholestasis is a condition where bile cannot flow from the liver to the duodenum