The patient, a 45-year-old female, presented with right upper quadrant pain, decreased appetite, vomiting, and pruritis. On examination, she was obese and the right hypochondriac region was tender. The probable diagnosis is obstructive jaundice. Biochemical investigations to confirm include elevated conjugated bilirubin and alkaline phosphatase on liver function tests, and bile salts and bile pigments in the urine.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
Prof. Mridul M. Panditrao has added another of his very important, useful and in vogue topic to his collection. This is his well acclaimed andwell received faculty lecture at recently concluded International conference on Pain... ISSPCON 2014, at Mumbai/ Bombay from 6th to 9th Feb. 2014.
Hyperthyroidism, Reference: Hyperthyroid, Harrison's Principles of Internal Medicine, Soheil Elahi, Islamic Azad University of Medicine- International Branch (IAUM-int)
contains liver function test overall description in clinical scenario.Contains adequate information on anatomy of liver,functions, classifications of LFT , indications,bilirubin metabolism,Van den berg reaction,liver enzyme panel,special tests.
#LFT
LIVER FUNCTION TESTS BY DR. PREMJEET KAUR, ASSISTANT PROFESSOR BIOCHEMISTRY Premjeet Kaur
BY THE END OF THIS PRESENTATION YOU WILL BE ABLE TO ANSWER WHAT, WHY, WHICH ABOUT LIVER FUNCTION TESTS , WHAT IS JAUNDICE , METABOLISM OF HEME , FORMATION OF BILE PIGMENTS FROM HEME , TRASFER OF LILIRUBIN FROM BLOOD TO BILE , DETERMINATION OF SERUM BILIRUBIN, RETENTION JAUNDICE , REGURGITATION JAUNDICE ,DETERMINATION OF AMMONIA IN BLOOD ,ANTIPYRINE TEST, SERUM ENZYMES IN LIVER DISEASE, ASSESING EXTENT OF LIVER DAMAGE , DIAGNOSIS OF SUBCLINICAL JAUNDICE , BCG TEST , PLASMA PROTEINS , DETOXIFICATION FUNCTION OF LIVER
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. A clinician noticed pallor & icterus on a 12 year
old boy who came to OPD. General physical
examination revealed the boy was poorly built
and nourished. On abdominal examination,
boy had spleenomegaly with ulcers around
ankle.
What is your probable diagnosis?
Suggest the biochemical investigations to
confirm your diagnosis.
2
3. Classification – Liver Function Test
Based on Liver Function & Clinical Utility
Group I Markers of liver Serum bilirubin – Total and
dysfunction Conjugated
Urine – Bile salts, Bile pigments,
Urobilinogen
Group II Synthetic function Total protein, Albumin and A/G ratio
Prothrombin time
Serum Cholesterol
Group III Markers of hepatocellular Alanine transaminase (ALT)
injury Aspartate transaminase (AST)
Group IV Markers of obstructive Alkaline phosphatase
liver disease Gamma glutamyl transferase
Group V Metabolic capacity Blood ammonia
Galactose tolerance test
Group VI Excretory & Detoxifying Bromsulfthalein excretory test
capacity Hippuric acid test 3
4. Tests based on
Excretory capacity of liver
Bromsulpthalein (BSP) test
Dye used to assess excretory function of the liver
Non-toxic compound exclusively excreted through
bile
Dose: 5mg/Kg body weight
Administration: Intravenously
Procedure: Serum concentration is measured at 45
min and at 2 hours
Result: > 5% of dye retained → abnormality in
excretory function of the liver
4
5. Tests based on
Detoxifying capacity of liver
Hippuric acid test
Hippuric acid synthesis → assess detoxification function
Benzoic acid + Glycine = Hippuric acid
Procedure:
- 6g sodium benzoate dissolved in 250ml water is given
orally 2hrs after light breakfast and after emptying bladder
- Urine is collected for next 4 hours
- Amount of hippuric acid excreted is estimated
- Normal: > 4.5 g of hippuric acid (60% of sodium benzoate)
- Abnormal: < 3g indicates hepatic dysfunction
5
6. Serum Bilirubin
Excretory product
Formation: Catabolism of heme
Types:
- Unconjugated: water insoluble
- Conjugated: water soluble
Estimation: ‘van den Bergh’ reaction
Reagents:
- Diazotised sulfanilic acid: Sulfanilic acid in
hydrochloric acid + sodium nitrite
- Methanol
6
7. Serum Bilirubin – Estimation
Principle: When diazotised sulfanilic acid
reacts with bilirubin, it forms ‘azobilirubin’, a
purple coloured product
↑ Conjugated bilirubin → gives colour
immediately → ‘Direct positive’
↑ Unconjugated bilirubin → gives colour
only after addition of methanol → ‘Indirect
positive’
↑ Both conjugated and unconjugated →
‘Biphasic’
7
8. Serum Bilirubin – Applications
Type of van den Class of Causes
Bilirubin Bergh Jaundice
Reaction
Unconjugated Indirect positive Pre-hepatic or Neonatal jaundice
Hemolytic Sickle cell anaemia
Thalassemia
Gilbert’s syndrome
Crigler-Najjar syndrome
Mismatch blood transfusion
Both Biphasic Hepatic Viral hepatitis
Unconjugated Alcoholic hepatitis
and Conjugated Drug induced hepatitis
Conjugated Direct positive Post-hepatic or Gall stones
Obstructive Biliary atresia
Tumours of biliary tract
Carcinoma head of pancreas
8
9. Urine – Urobilinogen
Ehrlich’s test
Principle: Urobilinogen reacts with p-
dimethylamino-benzaldehyde in chloroform
to form a pink coloured aldehyde complex.
Reagents:
- Ehrlich’s reagent
- Saturate sodium acetate
- Chloroform
9
10. Urine – Urobilinogen
Procedure:
5 ml Urine + 5 ml Ehrlich’s reagent → Mix
and allow to stand for 10 min → + 5 ml
saturated sodium acetate and mix → + 5 ml
chloroform → shake vigourously and allow
layers to separate
Appearance of pink colour in the chloroform
layer indicates presence of urobilinogen
Colour is easily detected when viewed from
top of the test tube
10
11. Urine – Bile salts & Bile pigments
Bile salts: Hay’s test
Principle: Bile salts have the property of
lowering surface tension. Hence when sulphur
poweder is sprinkled to urine containing bile
salts, it sinks to the bottom.
Bile pigments: Fouchet’s test
Principle: Bile pigments adhare to the
precipitate of barium sulphate. On addition of
Fouchet’s reagent, ferric chloride in the
presence of trichloroacetic acid oxidises yellow
colour bilirubin to green colour biliverdin.
11
12. A 45 year female patient was admitted to
casualty with the complaints of severe pain in
the right hypocondriac region, decreased
appetite and vomiting. She also complained of
pruritis. General physical examination revealed
that the female was obese. Per abdomen
examination showed tenderness in right
hypochondriac region.
What is your probable diagnosis?
Suggest the biochemical investigations to
confirm your diagnosis.
12
13. Urinary findings in Jaundice
Type of Urobilinogen Bile salts Bile pigments
Jaundice
Pre-hepatic or +++ NIL NIL
Hemolytic
Hepatic Normal / ↓ + ++
Post-hepatic of NIL +++ ++++
Obstructive
13
14. Tests based on synthetic function
Seum total proteins: estimated by ‘Biuret method’
Serum alboumin: estimated by BCG-dye binding
method
Total proteins – Albumin = Globulin
Calculation of Albumin/Globulin ratio
Prothrombin Time
- ½ life of prothrombin is 6 hours
- indicates present functioning status of liver
Serum cholesterol: estimation by ‘cholesterol
oxidase’ method
14
15. Application of tests based on
synthetic functions of liver
- ↓ Serum albumin levels
- ↓ Serum total protein levels
- Reversal of A/G ratio
- ↓ Serum total cholesterol levels
- Prolonged prothrombin time
Chronic diseases of liver and in cirrhosis of liver
15
16. Enzymes indicating Hepatocellular damage
and Obstructive liver disease
Name of Enzyme Diseases associated with increase
Alanine transaminase (ALT) Acute viral hepatitis
Aspartate transaminase (AST) Alcoholic liver disease
Autoimmune hepatitis
Chronic viral hepatitis
Non-alcoholic steatohepatitis
Alkaline Phosphatase Cholestatic jaundice
Hepatic carcinoma
Gall stones
Biliary atresia
Tumours of Biliary tract
Carcinoma head of the pancreas
Gamma Glutamyl transferase Chronic alcoholism
5’ Nucleotidase Biliary obstruction 16
17. Tests based on
Metabolic capacity of liver
Blood Ammonia levels
Index of urea synthesis by the liver
Sample: Arterial blood
Accumulation of ammonia → ↑ levels in CNS →
coma
Use: Hepatic encephalopathy
Galactose tolerance test
17
18. Liver Function Test - Summary
Estimation of serum bilirubin van den Bergh reaction
↑Conjugated bilirubin , ↑ alkaline Obstructive jaundice
phosphatase
with bile salts and bile pigments
Estimation of urobilinogen Ehrlich’s test
↑ Urobilinogen Hemolytic jaundice
Markers of Hepatocellular damage ALT & AST
Marker of alcoholic liver disease Gamma glutamyl transferase
Tests to detect synthetic functions of liver Serum albumin
Prothrombin time
Test to assess excretory function of liver Bromsulphthalein Test
Test to assess detoxification function of liver Hippuric acid test
↑ Blood ammonia levels Hepatic encephalopathy
18
19. Examination Tips
• Classify liver function tests. Describe any three
tests with its clinical importance.
• van den Bergh reaction
• Test based on synthetic functions of the liver
• Enzyme markers for liver disease
• Ehrlich’s test
• Bromsulpthalein test
• Hippuric acid test
19