Liver function tests

1. LIVER FUNCTION TESTS
MODY ********************** MODAK
)IN brief u can t live without liver(
)1(PROTEIN METABOLISM
***********************
N.Bs
) ****1(total plasma proteins.....6-8 gm%
)2(serum albumin..............4-5 gm%
)3(globulins......................2-3 gm%
)4(A / G ratio...................2 : 1
*albumin................................totally formed in the liver
SO,,,,,,,hypoalbuminaemia
1
2
globulins
*globulins
alpha & beta.........formed in the liver
gamma............... formed in RES
*GLOBULINS..........INCREASED IN CHRONIC LIVER DISEASES

2. *gamma globulins....anti bodiesagainst
*necrosed liver tissues
*toxic materials absorbed from
intestine & not cleared by diseased liver
SO....ALBUMINGAMMA GLOBULINSCHRONIC LIVER DISEASE
ALBUMINS & GLOBULINSNEPHROTIC SYNDROME
N.B
* ***ALBUMIN....NORMAL IN acute liver diseases only decreased in
chronic
*WHEN ALBUMIN / GLOBULIN RATIO.....REVERSED....1:2......IN
CHRONIC LIVER DISEASES
*HIGH IG a...........alcoholic liver disease
~~~~~~~*m...........primary biliary ciirhosis
~~~~~~*g............chronic active hepatitis
)2(FAT METABOLISM
*******************
.NORMAL CHOLESTEROL LEVEL....150-250 mg%
)esterfication & excretion in bile(
SO,,
IN obstructive jaundice......high cholesterol level
in hepatocellular failure.....NORMAL

3. )3(CHO METABOLISM
*******************
)LIVER IS THE GLUCOSTATE OF THE BODY(
DURING FASTING
AFTER FEEDING
SO
)1(CHRONIC LIVER DISEASE
)2(GASTRECTOMY
)3(THYROTOXICOSIS
)4(LIVER ENZYMES
******************
)1(SGOT (AST).........normal S = 5 G = 4 O=0 SO ( 5 -
40 U / L(
)2(SGPT ( ALT ).......NORMAL ( 5 - 30 U /L(
)3(ALKALINE PHOSPHATASE.....( 3 - 13 king armstrung
unit(
N.Bs
......
who is specific to LIVER ......sPecific.............sgPt
......Liver.................aLt
SGOT
SOSGPT
SGOT & SGPT.......marked increased ( up to 20 fold ) in ACUTE liver diseases
moderate increase ( 3 - 5 folds ) in CHRONIC
ALKALINE PHOSPHATASE

4. ...........MODERATE INCREASE ( 13 - 30 KAU ) in
hepatocellular failure
...........MARKED INCREASEI ( MORE THAN 30 KAU )
in
*obstructive jaundice
*space occupying lesion ( amoebic abcess(
*bone lesions
..............gamma glutamyl transpeptidase
OBSTRUCTIVE JAUNDICE
)4(PROTHROMBIN TIME
*********************
NORMAL...........12 - 1 4 SEC.
PROLONGED IN
*HEPATOCELLULAR FAILURE
COAGULATION FACTORS
*OBSTRUCTIVE JAUNDICEVIT.K
VIT K
OBSTRUCTIVE
HEPATOCELLULAR
)5(HEPATOMA MARKERS
***********************
)1(ALPHA FETOPROTEIN
NORMAL ...< 20 ng / ml
highly suggestive to hepatoma
when2000

5. )2(CARBOXY PROTHROMBIN.....MORE DIAGNOSTIC
)6(BILIRUBIN
***********
TOTAL SERUM BILIRUBIN..............1 mg%
unConjugated................................0.8 mg%
conjugated...................................0.2 mg%
*************
1
)2haemobilirubin ( un CONGUGATED(
)3
FIRST STEPUPTAKE
SECONDCONJUGATION ( conjucated bilirubin(
thirdexcretion
conjugated bilirubin
stercobilinogen3
excreted in stoolstercobilin
escape to kidneyurobilinogen
liverenterohepatic circulation
***************************

6. in any jaundice...........high total serum bilirubin .....) 3 mg%
************
in haemolytic
un conjugated
high stercobilinogen
*high stercobilin in stool....dark
*high urobilinogen in urine..normal
urine
in obstructive
***********
unconjugated.......normal
uptake ...............normal
conjugation
excretion
conjugateddark urine
stercobilinogen
stercobilinvery pale stool
uro bilinogen
in hepatocellular
*************
uptake & conjugationhigh unconjugated
excretionhigh conjugated...dark urine
stercobilinogen
*stercobilinpale stool
*urobilinogen

7. 3
)7(HEPATITIS MARKERS
**********************
VIRAL HEPATITIS...........A ,,,,,,B,,,,,,,C,,,,,D,,,,,,,,E
)1ANTIGEN...detected by...PCR
)2ANTIBODY..detected by..ELISA & RIBA
A ,,,,, C,,,,,,,,D,,,,,,,,,,EANTIGEN
AB
*Ig M.......Modern....recent infection
*ig Gold infection
N.Bs
****
*hepatitis AANTIGEN IN STOOL NOT IN BLOOD
*hepatitis DHEPATITIS B
DHBsAg
*ALL VIRUSES ........RNA....EXCEPT B ....DNA
EXCEPT D
)HEPATITIS B MARKERS(
*********************
3ANTIGENS + 3 ANTIBODIES = 6 MARKERS
**************************************

8. SURFACE
*********Ag3
Ab3
SO
***
WINDOW GAB?
********************************
.CORE AB.......POSITIVE in window gap
********
CORE Ag
....... ********precent only in hepatocytes........not done
envelope
********
Ag..........viral replications & highly infectivity
Ab..........low infectivity
HBe Ag & Ab
HBs Ab....if positive ....no vaccination