1) The liver plays a key role in protein, fat, and carbohydrate metabolism. Abnormal levels of albumin, globulins, cholesterol, and blood sugar can indicate liver disease. 2) Liver enzymes like SGOT, SGPT, and alkaline phosphatase are elevated in acute and chronic liver conditions and can help diagnose the type of liver damage. 3) Bilirubin levels and the ratio of conjugated to unconjugated bilirubin provide clues about whether liver disease is due to obstruction, hepatocellular failure, or hemolysis. Viral hepatitis is diagnosed through antigens and antibodies to hepatitis A, B, C, D, and E viruses.

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