PRESENTATION BY Dr. Muhammad Hamza Khawaja Family medicine LAHORE , Pakistan

1. INTERPRETATION
OF LIVER
FUNCTION TESTS
Dr . Muhammad HAMZA Khawaja
MEDICAL OFFICER
FAMILY MEDICINE

3. LIVER
 LIVER IS REDDISH-BROWN ORGAN WHICH
IS RUBBERY IN TEXTURE.
 IT IS THE 2ND LARGEST ORGAN OF THE
BODY.
 WEIGHS BETWEEN 3.17-3.66 LBS.(1.44-1.66
KG).

4. CONSISTS OF TWO LOBES : LARGER RIGHT
AND SMALLER LEFT
OUTSIDE OF LIVER IS COVERED BY FIBROUS
TISSUE – GLISSON’S CAPSULE
TWO MAJOR BLOOD SUPPLIES : PORTAL &
HEPATIC VESSELS.
A VITAL ORGAN WHICH CARRIES ABOUT 500
TASKS IN THE BODY.

6. CONTENTS
 Definition
 Epidemiology
 Risk factors
 Pathogenesis
 Pathology
 ASTHMA vs COPD
 Management

7. FUNCTIONS
1. EXCRETORY :
EXCRETES BILE PIGMENTS AND BILE SALTS
2. SYNTHETIC :
PLASMA PROTEINS , CLOTTING FACTORS,
FIBRINOGEN, BLOOD (EMBRYO)

8. 3. METABOLIC :
HELPS IN METABOLISM OF
CARBOHYDRATES, LIPIDS , PROTEINS AND
VITAMINS
4. DETOXIFICATION
5. STORAGE :
GLYCOGEN, VITAMIN A , D & B12

10. TO CONFIRM CLINICAL SUSPICION OF
POTENTIAL LIVER INJURY OR DISEASE.
TO DISTINGUISH BETWEEN
HEPATOCELLULAR INJURY OR
CHOLESTAISIS.
NON-INVASIVE METHOD OF SCREENING
ANY LIVER DYSFUNCTIONS.
PURPOSE OF LFTS

12. BLOOD TESTS TO ASSESS LFTS
 ALANINE TRANSAMINASE (ALT)
 ASPARTATE AMINOTRANSFERASE (AST)
 ALKALINE PHOSPHATASE (ALP)
 GAMA-GLUTAMYLTRANSFERASE (GGT)
 BILIRUBIN
 ALBUMIN
 PROTHROMBIN TIME (PT)

14. CLASSIFICATION OF LFTS
GROUP -1 = MARKERS FOR
HEPATOCELLULAR INJURY
1) ALANINE TRANSAMINASE (ALT)
2) ASPARTATE AMINOTRANSFERASE
(AST)

15. GROUP -2 =
MARKERS FOR CHOLESTASIS
1) ALKALINE PHOSPHATASE (ALP)
2) GAMA-GLUTAMYLTRANSFERASE
(GGT)

16. GROUP -3 =
MARKERS FOR LIVER SYNTHETIC
DYSFUNCTION
1)BILIRUBIN
2) ALBUMIN
3) PROTHROMBIN TIME (PT)

17. ALANINE TRANSAMINASE
(ALT)
• TRANSAMINASE ENZYME
• ALSO KNOWN AS ALANINE
AMINOTRANSFERASE
• FORMERLY WAS CALLED SERUM
GLUTAMATE PYRUVATE TRANSAMINASE
(SGPT)

18. ASPARTATE TRANSAMINASE
(AST)
• PYRIDOXAL PHOSPHATE DEPENDENT
TRANSAMINASE ENZYME
• ALSO KNOWN AS ASPARTATE
AMINOTRANSFERASE
• FORMERLY WAS CALLED SERUM GLUTAMIC
OXALOACETIC TRANSAMINASE (SGOT)

21. ALKALINE PHOSPHATASE
• HOMODIMERIC PROTEIN ENZYME
• PRESENT IN HEPATOCYTE MEMBRANE
• PRODUCED BY OSTEOBLAST (HENCED
ENHANCED DURING BONE DISEASES)

22. GAMA-GLUTAMYLTRANSFERASE
(GGT)
• A TRANSFERASE ENZYME
• ALSO KNOWN AS GAMA-
GLUTAMYLTRANSPEPTIDASE
• SYNTHESIZES GLUTATHIONE
• HIGHLY SENSITIVE FOR DETECTING
ALCOHOL ABUSE

25. BILIRUBIN
IT IS A TETRAPYRROLE AND A BREAKDOWN PRODUCT
OF HEME CATABOLISM.
UNCONJUGATED BILIRUBIN (INDIRECT)
DURING HEMOLYSIS, WHEN HEME IS RELEASED FROM
HEMOGLOBIN, THE REMAINDER IS CONVERTED INTO
UNCONJUGATED BILIRUBIN. IT IS NOT WATER
SOLUBLE.
CONJUGATED BILIRUBIN (DIRECT)
WHEN A SUGAR IS ATTACHED TO UNCONJUGATED
BILIRUBIN. THIS IS WATER SOLUBLE.

30. .

32. ALBUMIN
SYNTHESISED IN LIVER
HELPS TO BIND WATER,FATTY
ACIDS. BILIRUBIN & CATIONS
MAINTAINS ONCOTIC PRESSURE
OF BLOOD

33. CAUSES OF DECREASE IN
ALBUMIN
I. DECREASE PRODUCTION OF ALBUMIN
(LIVER CIRRHOSIS)
II. PROTEIN LOSING ENTEROPATHIES
(CROHN’S AND CELIAC DISEASE)
III.NEPHROTIC SYNDROME

34. PROTHROMBIN TIME
IT IS A MEASURE OF BLOOD COAGULATION
TENDENCY ESPECIALLY EXTRINSIC
PATHWAY
IT CAN INDICATE LIVER DISEASE OR
DYSFUNCTION AS LIVER IS RESPONSIBLE
FOR CLOTTING FACTORS SYNTHESIS
HENCE THERE IS INCREASE IN
PROTHROMBIN TIME.

35. CHILD PUGH SCORE
a. A CRITERIA TO ASSESS THE PROGNOSIS
OF CHRONIC LIVER DISEASE MAINLY
CIRRHOSIS
b. IT ALSO DETERMINES THE STRENGTH
OF TREATMENT REQUIRED
c. NECESSITY OF LIVER TRANSPLANT

37. CASE STUDY
A 35 YR OLD MALE CAME IN OPD WITH
GENERALZED SEVERE ITCHING FOR 9
MONTHS.
HE HAD NO OTHER SYMPTOMS.
ON CLINICAL EXAMINATION HE WAS
JAUNDICED.

39. REFERENCES
 Johnston DE (1999). "Special considerations in interpreting
liver function tests". Am Fam Physician. 59 (8): 2223–30. PMID
10221307.
 McClatchey, Kenneth D. (2002). Clinical laboratory medicine.
Lippincott Williams & Wilkins. p. 288. ISBN 978-0-683-30751-1.
 Mengel, Mark B.; Schwiebert, L. Peter (2005). Family medicine:
ambulatory care & prevention. McGraw-Hill Professional. p.
268. ISBN 978-0-07-142322-9.

40.  Cleveland Clinic [Internet]. Cleveland (OH): Cleveland Clinic;
c2019. Liver Function Tests: Test Details [cited 2019 Aug 26];
[about 3 screens]. Available from:
https://my.clevelandclinic.org/health/diagnostics/17662-
liver-function-tests/test-details
 Kids Health from Nemours [Internet]. Jacksonville (FL): The
Nemours Foundation; c1995–2019. Blood Test: Liver Function
Tests [cited 2019 Aug 26]; [about 3 screens]. Available from:
https://kidshealth.org/en/teens/test-liver-function.html