Interpretation of Liver Function Tests

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Interpretation of Liver Function Tests

  1. 1. INTERPRETATION OF LIVER FUNCTION TESTS PROF.(DR)G.SUNDARAMURTHY M2 UNIT SECOND YEAR JUNIOR RESIDENT DR.DILIP HARINDRAN
  2. 2. INTRODUCTION Better term is liver biochemical tests. Lab tests are an effective and sensitive method for screening for  The presence and pattern of hepatic dysfunction  Directing further diagnostic evaluation of identified abnormalities  Assessing the severity of disease and follow course  Response to treatment Liver performs various important functions in our body like metabolism of drugs and toxins, protein lipid and carbohydrate metabolism, synthesis of clotting factors.
  3. 3. INTRODUCTION(CONTD.) LIVER FUNCTION TESTS CAPACITY DETECTION OF INJURY CHRONIC INFLAM OF LIVER MATION TO TRANS- NECROSIS CHOLESTASIS BIOSYNTHETIC -HYALUR PORT ANI- -AST -ALP FUNCTION ONAN ONS AND -ALT -GGT -ALBUMIN -IMMUNO METABOLISE -LDH -5’NT -PT GLOBULIN DRUGS -GDH -FIBROTEST -SERUM BILIRUBIN -CERULOPLASMIN -TRANSIENT -URINARY BILIRUBIN -FERRITIN ELASTOGRA -BSP,ICG,SERUM BILE ACIDS, -ALPHA1 ANTITRYPSIN PHY BREATH TESTS AND METABOLITE -LIPOPROTEINS TESTS
  4. 4. CASE 1:A 22 YEAR MALE CAME WITH COMPLAINTS OF JAUNDICE FOR 6 MONTHS, FATIGUABLITY AND MUSCLE PAIN FOR 2 YEARS. TEST PATIENT VALUE LAB VALUE SERUM BILIRUBIN (T) 5.84 0-1mg/dl SERUM BILIRUBIN(D) 2.24 0-0.25mg/dl AST(SGOT) 146 UPTO 40 IU ALT(SGPT) 57 UPTO 37 IU ALP 250 80-290 U/L GGT 45 MALE-7-32 U/L TOTAL PROTEIN 7.2 6.4-8.3 G/DL ALBUMIN 2.9 3.8-4.4 G/DL PROTHROMBIN TIME TEST-44 CONTROL-26 14-16 SEC INR 1.8
  5. 5. CASE 1:A 22 YEAR MALE CAME WITH COMPLAINTS OF JAUNDICE FOR 6 MONTHS,FATIGUABLITY AND MUSCLE PAIN FOR 2 YEARS. TEST PATIENT VALUE LAB VALUE SERUM BILIRUBIN (T) 5.84 0-1mg/dl SERUM BILIRUBIN(D) 2.24 0-0.25mg/dl AST(SGOT) 146 UPTO 40 IU ALT(SGPT) 57 UPTO 37 IU ALP 250 80-290 U/L GGT 45 MALE-7-32 U/L TOTAL PROTEIN 7.2 6.4-8.3 G/DL ALBUMIN 2.9 3.8-4.4 G/DL PROTHROMBIN TIME TEST-44 CONTROL-26 14-16 SEC INR 1.8
  6. 6. INTERPRETATION A CASE OF INDIRECT HYPERBILIRUBENEMIA (DIRECT<50% OF TOTAL BILIRUBIN) WITH 3 TIMES ELEVATION OF AST, REDUCED ALBUMIN(AG REVERSAL) AND RAISED PT AND INR SUGGESTIVE OF A CHRONIC LIVER DISEASE.
  7. 7. CASE 2:A 19 YEAR OLD FEMALE WITH HISTORY OF CHICKEN POX 8 MONTHS BACK DEVELOPED JAUNDICE, PALE STOOL AND PRURITUS GRADUALLY. TEST PATIENT VALUE LAB VALUE SERUM BILIRUBIN (T) 32.7 0-1mg/dl SERUM BILIRUBIN(D) 27.5 0-0.25mg/dl AST(SGOT) 181 UPTO 40 IU ALT(SGPT) 65 UPTO 37 IU ALP 914 80-290 U/L GGT 34 FEMALE-6-29 U/L TOTAL PROTEIN 5.7 6.4-8.3 G/DL ALBUMIN 2.2 3.8-4.4 G/DL
  8. 8. INTERPRETATION A CASE OF DIRECT HYPERBILIRUBINEMIA WITH RAISED AST(6 TIMES) AND ALT(MILD) AND MARKEDLY RAISED ALP SUGGESTIVE OF A CHOLESTATIC PICTURE WITH ONGOING ACTIVITY. ALBUMIN ALSO IS LOW SUGGESTIVE OF LIVER DISEASE.
  9. 9. CASE 3:A 32 year old male a chronic alcoholic and known case of DCLD, with history of alcohol intake 3 days before admission. TEST PATIENT VALUE LAB VALUE SERUM BILIRUBIN (T) 38.63 0-1mg/dl SERUM BILIRUBIN(D) 31.4 0-0.25mg/dl AST(SGOT) 54 UPTO 40 IU ALT(SGPT) 19 UPTO 37 IU ALP 211 80-290 U/L GGT 78 MALE-7-32 U/L TOTAL PROTEIN 7.8 6.4-8.3 G/DL ALBUMIN 2.5 3.8-4.4 G/DL PROTHOMBIN TIME TEST-34 SEC CONTROL- 22SEC 14-16SEC
  10. 10. INTERPRETATION A CASE OF DIRECT HYPERBLIRUBENIMIA WITH MILD ELEVATED AST AND AST/ALT~ 3:1 AND GGT RAISED SUGGESTIVE OF ALCHOLIC LIVER DISEASE WITH ONGOING ACTIVITY. AG REVERSAL SUGGESTIVE OF CHRONIC LIVER DISEASE. THE LIVER ENZYMES ARE NOT ELEVATED MUCH AS THE LIVER HAS ALREADY UNDERGONE CIRRHOSIS.
  11. 11. CASE 4:A 40 year old male asymptomatic came, after routine master health check up. TEST PATIENT VALUE LAB VALUE SERUM BILIRUBIN (T) 0.8 0-1mg/dl SERUM BILIRUBIN(D) 0.15 0-0.25mg/dl AST(SGOT) 125 UPTO 40 IU ALT(SGPT) 80 UPTO 37 IU ALP 190 80-290 U/L GGT 30 MALE-7-32 U/L TOTAL PROTEIN 8.0 6.4-8.3 G/DL ALBUMIN 4.0 3.8-4.4 G/DL
  12. 12. INTERPRETATION A CASE OF MILDLY ELEVATED TRANSAMINASES WITH NO OTHER ABNORMALITY.HAS TO BE WORKED UP FURTHER FOR ANY OCCULT LIVER PROBLEM.
  13. 13. EVALUATION OF ELEVATED TRANSMINASE LEVELS
  14. 14. CHOLESTASIS INTRA HEPATI C EXTR A HEPA TIC
  15. 15. Causes of Elevated Serum Aminotransferase Levels ALT > AST AST > ALT HEPATIC CAUSES α1-antitrypsin deficiency Autoimmune hepatitis Chronic viral hepatitis (B, C, and D) Hemochromatosis Steatosis and steatohepatitis Wilson disease medication and toxins NON HEPATIC CAUSES Celiac disease Hyperthyroidism (Chronic, Mild < 5 fold)( Acute severe>20 fold ) Acute bile duct obstruction Acute Budd-Chiari syndrome Acute viral hepatitis Autoimmune hepatitis Ischemic hepatitis Medications/toxins Wilson disease ( Acute severe>20 fold )( Chronic, Mild < 5 fold ) Hepatic Causes Alcohol-related liver injury Cirrhosis. Nonhepatic Causes Hypothyroidism Myopathy Strenuous exercise Hepatic Cause Medications or toxins in a patient with underlying alcoholic liver injury Nonhepatic Cause Acute rhabdomyolysis
  16. 16. EVALUATION OF RAISED ALKALINE PHOSPHATASE
  17. 17. KEY CONCEPTS • Elevations in serum levels of ALT and AST are nonspecific indicators of hepatocellular damage except that AST/ALT ratio(de riti’s ratio)greater than 2 suggests alcoholic liver disease. • Elevation of serum level of ALP in liver injury is caused by regurgitation of alkaline phosphatase from damaged hepatocytes into the serum. • The rate-limiting step in hepatic bilirubin production is excretion of conjugated bilirubin into canalicular bile-explains why patients having hepatocellular dysfunction have a predominantly conjugated fraction in hyperbilirubinemia. • Prolongation of PT that is unresponsive to vitamin K infusions-poor prognosis.

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