This document discusses biochemical parameters for diagnosing alcoholic liver disease (ALD). Key tests include liver enzymes AST, ALT, GGT, ALP, and the AST/ALT ratio known as the DeRitis ratio. For ALD patients, the DeRitis ratio is typically greater than 2 compared to 1.1 for normal individuals. Other markers like bilirubin, albumin, globulin ratio, and prothrombin time are also elevated in ALD. Interpretation charts provide guidance on enzyme levels that indicate mild, moderate or severe disease states. The document concludes by emphasizing the DeRitis ratio is the most important biochemical indicator for diagnosing ALD.

1. LAB DIAGNOSIS
IN
ALCOHOLIC
LIVER DISEASE
RESOURCE FACULTY-Dr.S.MAJHI
PRESENTED BY-PRATEEK SINGH

2. OBJECTIVE
 To enumerate the biochemical parameters for
diagnosis of ALD
 To interpret the above parameters

3. BIOCHEMICAL TESTS
TEST FOR LIVER
BIOSYNTHETIC ACTIVITY
*Serum bilirubin
*Serum albumin
*Albumin/Globulin ratio
*Prothrombin time

4. SERUM ENZYME TEST
*Aspartate aminotransferase (AST)
*Alanine amino transferase (ALT)
* Alkaline phosphatase (ALP)
* Gammaglutamyl transferase (GGT)
*5'nucleotidase (5'-NT)
*DE-RITIS ratio (AST/ALT)

5. INTERPRETATIONS OF
BIOCHEMICAL FINDINGS
DE-RITIS RATIO
*THIS IS THE MOST IMPORTANT
BIOCHEMICAL INDICATOR OF
ALCOHOLIC LIVER DISEASE.
*This is the ratio of Aspartate aminotransferase
and Alanine aminotransferase

6. *In normal individuals the DE-RITIS
ratio is 1.10:1
*But in patients of alcoholic liver disease
it is more than 2.
*Studies in regard to deritis ratio has also been
conducted in b.p.k.i.h.s by. Dr S.majhi, Dr N.Baral and Dr Lamsal

7. ALKALINE PAHOSPHATASE
*Not specific for liver disease
*Normal value is 25-90IU/l
*It will be elevated in ALD
*If its rise is in parallel to GGT it can be
said that this elevation is due to ALD.

8. ASPARTATE
AMINOTRANSFERASE
*Normal value is 35.00 +/- 23.49 IU/L
*It will be elevated in ALD 2-7 folds,
but not more than 400IU/L
*AST will be elevated more than ALT

9. ALANINE
AMINOTRANSFERASE
*Normal value is 31.48 +/- 17.79 IU/L
*It will be elevated 2-5 folds in ALD,
but not more than 400IU/L.

10. GAMMA
GLUTAMYLTRANSFERASE
*Normal value is 70.55 +/- 27.35 IU/L
*It will be moderately increased in
chronic alcoholics & All forms of fatty
liver.
*It is an Inducible enzyme.
*So,it is not a specific marker of ALD

11. BILLIRUBIN
*Normal serum concentration is
0.3-1mg/dl
*It will be increased in ALD >5mg/dl.
ALBUMIN
*Normal serum concentration is 3.5-
5gm/dl
*It decreases in ALD upto 2-3gm/dl

12. GLOBULIN
*Serum globulin will increase during
liver disease in response to antigenic
stimulation reflecting the immune
changes associated with alcoholic liver
disease.
*Normal Globulin level is 2.5-3.5gm/dl

13. OUT OF THREE GAMMA
GLOBULIN
IgA-Increases in 90% of cases.
IgG-Increases in 64% of cases.
IgM-Increases in 25% of cases.

14. ALBUMIN GLOBULIN RATIO
The normal A/G ratio is 1.2-1.5:1
*But in alcoholic liver disease this ratio is
reversed

15. PROTHROMBIN TIME
*Normal Prothrombin time is 12-16secs.
*In ALD Prothrombin time increases
Due to decrease synthesis of clotting
factors.

16. INTERPRETATION CHART
MILD MODERATE SEVERE
GGT 70.35+/-
17.79 IU/L
AST 35+/-
23.49 IU/L
ALT 31.48+/-
17.79 IU/L

17. MILD MODERATE SEVERE
ALP
25-90U/L
BILLIRUBIN N
25-90U/L
PROTHROMB
IN TIME
12-16secs

18. MILD MODERATE SEVERE
SERUM
ALBUMIN
3.5-5gm/dl
5‘NUCLEOTIDas
e
0-11mg/dl

19. THANK YOU