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LFT nursing.PPT
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- 2. Definition of LFT •These are a group of biochemical investigations done to assess the functioning of the liver. • Indications: • 1. Patients with hepatitis, jaundice( to know the type of jaundice) • 2. to know the severity of liver disease • 3. before chemotherapy • 4. when patients are on drugs which affect liver • 5. As a routine before surgery
- 3. LFT • In clinicalpractice, LFT includes • Serum bilirubin – total & direct • Enzymes( ALT, AST and ALP) • Total protein / Albumin • Prothrombin time • To investigate a case of jaundice: urine & stool tests are also done • For diagnosis of viral hepatitis, serology is done
- 4. I. Tests basedon excretory functions of liver a. Serum Bilirubin estimation b. Urine bile pigment c. Urine bile salts d. Urine Urobilinogen
- 5. a. Serum Bilirubin •Normal Total - 0.2 – 0.8 mg% • Unconjugated – 0.2 – 0.6 mg% • Conjugated – 0 – 0.2 mg% • > 1mg /dl– Latent jaundice • > 2mg/dl – Jaundice – yellow discoloration of skin, sclera & mucous membrane
- 6. II. Tests basedon synthetic functions of liver a. Serum Albumin – - almost all plasma proteins except Ig synthesized by liver - Albumin quantitatively most important – reflects extent of functioning liver cell mass - Half life – 20 days – so albumin ↓ in all chronic diseases of liver
- 7. • Total protein– 6 - 8 g% • Albumin - 3.5 – 5 g% • Globulin - 2.5 – 3.5 g% • A : G ratio - 1.2 : 1 to 1.5 : 1 • A : G reversal – liver cirrhosis – hypoalbuminemia with compensatory hypergammaglobulinemia • Albumin < 2g% - edema all over body
- 8. • B. Prothrombintime (PT) • Factors II,VII,IX and X are synthesized by liver • Half life 6hrs – indicates present function of liver: Rise in acute liver injury. • PT prolonged in Hepatocellular & Obstructive Jaundice
- 9. IV. Liver EnzymePanel A. Markers of Hepatocellular damage - Alanine Amino Transferase (ALT) - Aspartate Amino Transferase (AST) B. Markers of obstructive liver disease - Alkaline Phosphatase (ALP) - Gamma Glutamyl Transferase (GGT) - 5’ Nucleotidase / Nucleotide phosphatase (5’NT)
- 10. A. Markers ofhepatocellular damage • ALT – 13 - 35 IU/L • AST - 8 – 20 IU/L • Very high values > 1000 IU/L seen in acute hepatitis – both viral & toxic • Moderate rise (100-300 IU/L) in Wilson’s disease, non-alcoholic chronic hepatitis • Minor rise (<100 IU/L) in Hepatitis C, fatty liver
- 11. B. Markers ofobstructive liver disease • ALP : (40 – 125 IU/L) • Synthesized by cells lining biliary canaliculi. Obstruction of bile causes irritation of cells leads to secretion of ALP into serum • Very high values (10-12 times the upper normal limit ) in Extra hepatic obstruction – gall stones or pressure on bile duct by cancer of head of pancreas
- 12. • moderate rise(2-3 times) - In hepatic diseases – hepatocellular carcinoma , alcoholic hepatitis • But in later stages of hepatitis, inflammatory edema – obstructive phase – ALP ↑ • In neoplasms of liver, Regan isoenzyme ↑ • ALP ↑ in bone diseases (bone form)
- 13. • GGT -10 – 30 IU/L • Marker enzyme for alcohol abuse • In liver diseases GGT rise parellels that of ALP • Also in pancreatic disease, prostate cancer
- 14. • 5’ NT- 2 – 10 IU/L • Very high in biliary obstruction. • Moderate rise in hepatitis • More specific for obstructive liver disease since not increased in childhood or pregnancy
- 16. Laboratory findings inJaundice Enzyme Estimation Hemolytic Jaundice Hepatic Jaundice Obstructive Jaundice Serum ALP (40-120 IU/L) N ↑ 2-3 times ↑ ↑ ↑ (10-12 times of upper normal in extrahepatic obstruction) Serum AST & ALT N ↑ ↑ ↑ moderate ↑ Serum 5’ NT N moderate ↑ ↑ ↑ ↑
- 17. Laboratory investigations inJaundice Hemolytic Jaundice Hepatic Jaundice Obstructive Jaundice Prothrombin time ( PT) N Prolonged Prolonged A:G ratio N Decreases as albumin levels decrease N
- 18. Laboratory investigations inJaundice Hemolytic Jaundice Hepatocellular Jaundice Obstructive Jaundice Urine bile salts Absent ↑↑ ↑↑ Urine Bilirubin Absent ↑↑↑ ↑↑↑ Urine UBG ↑↑ N or ↓ ↓ or Absent Fecal SBG ↑↑ N or ↓ ↓ or Absent (clay colored