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Liver Chemistry and liver function tests
- 1. Liver Chemistry & FunctionTests Dr Rayidi Rajesh Senior Resident General Medicine
- 3. Traditional liver functiontests • Total Bilirubin • Conjugated Bilirubin • Alkaline Phosphatase • Gamma Glutamyl Transferase • Alanine Transaminase (sgot) • Aspartate Transaminase (sgpt) • Total Protein • Albumin • Misnomer because ?
- 4. other tests • Syntheticfunction albumin, prealbumin, globulins prothrombin time, coagulation factors, fibrinogen ferritin, ceruloplasmin, alpha 1 anti-trypsin • Carbohydrate metabolism Galactose tolerance test Fructose tolerance test
- 5. other tests • Proteinmetabolism urine oxalate levels, tyrosine levels • Lipid metabolism Total cholesterol, lipoproteins serum bile acids • Detoxifying and excretion function Hippuric acid test Bromosulphapthalein test, Indocyanin green tests
- 6. tests for liverfibrosis • Serum Hyaluronic acid, Procollagen • Biopsy • Indirect : AST/ALT ratio • Radiologic - fibroscan, MRE
- 7. Scope of traditionaltests • identify and monitor liver disease • pattern recognition • to identify damage severity • classifying patient for certain treatment/ prognosis using scores
- 9. Case 2 • 50yrs male with complaints of pain in right hypochondrium with yellowish discoloration of body associated with itching and clay colored stool without any history of weight loss, fever and chronic alcohol intake. • T. bil -14, D. bil 10, ALP -340, GGT- 721 • USG done showed stones in common bile duct
- 11. Pattern recognition • Enzymessuggesting hepatic injury :-AST, ALT • Enzymes suggesting obstructive pattern :- ALP, GGT • Decreased Albumin - chronic disease
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- 30. 5'- Nucleotidase • seenin canalicular membrane, sinusoidal membrane. • other sources : intestine, brain, heart • increases with age • do not increase in bone disorders
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- 36. Drug induced liverinjury • can be hepatic or cholestatic pattern • R Value= ALT/ ALT UNL ÷ ALP/ ALP UNL • R value more than 5 - hepatic pattern • R value less than 2 - cholestatic pattern
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