assessment of liver functions u062f u0635u0627u0628u0631
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�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 separated into a right
and left lobe, separated by the
falciform ligament. The right is
much larger than the left .
The liver performs
thousands of tasks that
impact all body systems.
Liver have two channels
that can supply and oxygen
nutriment : hepatic artery
and hepatic portal vein .
The corresponding
channels is hepatic vein
and bile ducts.
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The working cells of the liver are
known as hepatocytes, which have a
unique capacity to reproduce in
response to liver injury.
Liver regeneration can occur after
surgical removal of a portion of the
liver or after injuries that destroy
parts of the liver.
Although the liver's ability to react
to damage and repair itself is
remarkable, repetitive insults can
produce liver failure and death.
Functions of liver① Excretory function: bile pigments,
bile salts and cholesterol are excreted in
bile into intestine.
② Metabolic function: liver actively
participates in carbohydrate, lipid,
protein, mineral and vitamin
metabolisms.
③ Hematological function: liver is also
produces clotting factors like factor V,
VII. Fibrinogen involved in blood
coagulation is also synthesized in liver.
It synthesize plasma proteins and
destruction of erythrocytes.
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④ Storage functions:
glycogen, vitamins A, D and
B12,and trace element iron
are stored in liver.
⑤ Protective functions and
detoxification: Ammonia is
detoxified to urea. kupffer
cells of liver perform
phagocytosis to eliminate
foreign compounds.
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What is Purpose of LFTs?
• LFTs alone do not give the
physician full information,
but used in combination
with a careful history,
physical examination
(particularly ultrasound and
CT Scanning), can
contribute to making an
accurate diagnosis of the
specific liver disorder.
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liver function tests1. Detect the presence of liver disease
2. Distinguish different types of liver
disorders
3. Extent of liver damage
4. Follow the response to treatment
A. Can be normal in serious liver
disease
B. Can be abnormal in non hepatic
diseases
C. Rarely suggest a specific diagnosis
D. They suggest a general category of
liver disease, such as hepatocellular
or cholestatic
•LFTs are divided into
� True tests of liver function,
such as serum albumin,
bilirubin, and prothrombine
time,
� Tests that are indicators of
liver injury or biliary tract
disease.
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Classification of liver functions test①Excretion: Measurement of bile
pigments, bile salts.
②Serum enzymes: Transaminase (ALT,
AST), alkaline phosphate(ALP), 5’-
nucleotidase, LDH isoenzyme.
③Synthetic function: Prothrombin time,
serum albumin.
④Metabolic capacity: Galactose
tolerance and antipyrine clearance
⑤Detoxification: Serum ammonia
Excretion : Bilirubin
�Bilirubin is the main bile
pigment that is formed
from the breakdown of
heme in red blood cells.
�The broken down heme
travels to the liver, where it
is secreted into the bile by
the liver.
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via bile duct to intestines
Stercobilin
excreted in feces
Urobilinogen
formed by bacteria KIDNEY
Urobilin
excreted in urine
BLOOD
CELLS
CO
Biliverdin IXα
Heme oxygenase
O2
Bilirubin (water-insoluble)
NADP+
NADPH
Biliverdin
reductase
Heme
Globin
Hemoglobin
reabsorbed
into blood
LIVER
Bilirubin diglucuronide
(water-soluble)
2 UDP-glucuronic acid
Bilirubin
(water-insoluble)via blood
to the
liver
INTESTINE
Metabolism of bilirubin
�A. Indirect bilirubin
(normal value = 0.3 - 1.2 mg/dl)
1. Serum Bilirubin:
�B. Direct bilirubin
(normal value ≤ 0.4 mg/dl)
�C. Total bilirubin Normal value for = 0.3- 1.2 mg/dl.
�Normally, a small amount of bilirubin circulates in the blood.
�Serum bilirubin is considered a true test of liver function, as it reflects
the liver's ability to take up, process, and secrete bilirubin into the bile.
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Indirect bilirubin
Direct bilirubin
Binding with Glucuronic acid
no yes
Reacting with the diazoreagent
Slow and indirect
Rapid and direct
solubility in water small large
Discharged via kidney no yes
Pass through the membrane of cell
yes no
Pass blood brain barrier
yes no
Difference of two bilirubins
� Urobilinogen :Conjugated bilirubin is excreted via
bile salts to intestine.
Bacteria in the intestine break down
bilirubin to urobilinogen for
excretion in the feces (normal value
for fecal urobilinogen = 40 - 280
mg/day)
2. Urine & Stool
Normally there are mere traces of urobilinogen in the urine. average is
0.64mg , maximum normal 4mg/24hours.
� UrobilinUrobilin is the final product of oxidation of urobilinogen by oxygen in
air. The amount change with the amount of urobilinogen excretion .
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� Bilirubin urine:
�Bilirubin is not normally present in
urine and faese since bacteria in intestine
reduce it to urobilinogen.
�The kidneys do not filter unconjugated
bilirubin because of its binding to albumin.
�Conjugated bilirubin can pass through
glomerular filter.
�Bilirubin is found in the urine in
obstructive jaundice due to various causes
and in cholestasis.
� Bilirubin in the urine may be detected
even before clinical jaundice is noted.
Who is a candidate for the test?
�Bilirubin is used to diagnosis of jaundice.
�Abnormal bilirubin levels can be found in
many disorders, including:
Hemolytic Jaundice
Hepatic Jaundice
Obstructive jaundice ( Cholestasis)
Congenital Jaundice
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Sample Indices Hemolytic
Jaundice
Hepatic
Jaundice
Obstructive
Jaundice
Serum Total Bil >1mg/dl >1mg/dl >1mg/dl
Direct Bil ↑ ↑↑
Indirect Bil ↑↑
Urine Color deeper deep deep
Bilirubin ― ++ ++
Urobilinogen ↑ uncertain ↓
Urobilin ↑ uncertain ↓
Stool Color deeper lighter or normal
Argilous(complete
obstruction)
Aproach to isolated elevation of bilirubin
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Aproach familial elevation of bilirubin
Familial hyperbilirubinaemia , Congenital hyperbilirubinaemia
Degree of elevation of bilirubin
� Not as a prognostic marker
�But is important in :
1. Viral hepatitis: higher bilirubin→greater hepatocellular damage.
2.Alcoholic hepatitis: total serum
bilirubin correlates with poor outcomes
3.Component of the model for end stage
liver disease (MELD)
4.Drug-induced liver disease: elevated
total serum bilirubin indicates more
severe injury.
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Serum Enzymes�The liver contains thousands of enzymes
�These enzymes have no known function
�probably cleared by reticuloendothelial cells
�liver cells damage → entrance of Enzymes into serum
3 type of Liver enzyme tests
1. Enzymes whose elevation reflects damage to
hepatocytes
2. Enzymes whose elevation reflects cholestasis
3. Enzyme tests that do not fit either pattern.
Enzymes that Reflect Damage to Hepatocytes
Aspartate aminotransferase (AST) = serum
glutamic oxaloacetic transaminase (sGOT)
Alanine aminotransferase (ALT) = Serum glutamic
pyruvic transaminase (sGPT)
�Sensitive indicators of liver cell injury
�Most helpful in recognizing acute hepatocellular
diseases (hepatitis)
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Alanine transaminase (ALT)
GPTGPT
Aspartate aminotransferase (AST)
GOT
AST ( sGOT) is found in
�Liver
�Cardiac muscle
�Skeletal muscle
� Kidneys
� Brain
� Pancreas
� Lungs
� Leukocytes, and
erythrocytes
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organ GOT GPT
heart 156000 7100
liver 142000 44000
skeletal 99000 4800
kidney 91000 19000
organ GOT GPT
pancrease
spleen
lung
serum
28000 2000
14000 1200
10000 700
20 16
GPT:
Normal range: 2-59 U/L
GOT:
Normal range: 10-34 U/L
Therefore, when the liver is injured, GPT is
released into the bloodstream.
� sGOT also reflects damage to the hepatic
cells and is less specific for liver disease. It
can also be released with heart, muscle and
brain disorders.
�Therefore, this test may be ordered to help
diagnose various heart, muscle or brain
disorders, such as a myocardial infarct .
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Alcoholic liver disease
Cancer of the liver
Cholestasis or congestion of the bile ducts
Cirrhosis or scarring of the liver with loss of
function
Death of liver tissue
Hepatitis or inflammation of the liver
Noncancerous tumor of the liver
Use of medicines or drugs toxic to the liver
Acute hemolytic anemia,
Acute pancreatitis or inflammation of the pancreas.
Acute renal failure or loss of kidney function.
Cirrhosis of the liver.
Hepatitis
Heart attack
Primary muscle disease
Recent surgery
Severe burns
Muscle injury
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Levels of aminotransferases
�<300 U/L are nonspecific and may be found in any
type of liver disorder.
�Minimal ALT elevations
� Asymptomatic blood donors
� Severe liver disease
� Fatty liver is the most cause.
�Extensive hepatocellular injury such:
1) Viral hepatitis
2) Ischemic liver injury (prolonged hypotension or
acute heart failure)
3) Toxin- or drug-induced liver injury.
The pattern of the aminotransferase
�Acute hepatocellular disorders: ALT ≥ AST.
�Chronic viral hepatitis : ALT ≥ AST
�Cirrhosis : AST ≥ ALT
AST/ALT ratio
Normal - 1 or slightly > 1
<1 : NASH or hepatitis
without cirrhosis
2-4:ALD
>4 : Wilsonian hepatitis
Causes of AST /ALT > 2
ALD
Acute wilsonian hepatitis
DDP
Metastasis
cirrhosis
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Approach to asymptomatic elevation of serum aminotransferase
Alcoholic liver disease
�AST/ALT >2:1 is suggestive
�AST/ALT >3:1 is highly suggestive
�The AST is rarely >300 U/L
�ALT is often normal.
�A low level of ALT in the serum is due to an alcohol-induced
deficiency of pyridoxal phosphate.
Obstructive jaundice�Aminotransferases not greatly elevated
�Exception: passage of a gallstone into the common bile duct →
acute biliary obstruction → aminotransferases 1000–2000 →
decrease quickly → liver-function tests rapidly evolve typical of
cholestasis.
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Enzymes that Reflect Cholestasis
Are usually elevated in cholestasis
Alkaline phosphatase
5'-nucleotidase
Gama glutamyl transpeptidase (GGT)
Alkaline phosphatase (ALP)
ALP occurs in all tissues,
especially liver and bone.
The alkaline phosphatase
test is often used to help
diagnose certain liver
diseases and bone
disorders .
Normal range: 30 - 95
IU/L (3-13 kings unit)
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Alkaline phosphatase
�ALP is a hydrolase enzyme responsible for removing phosphate
groups from many types of molecules, including nucleotides and
proteins.
�Most effective in an alkaline environment
�In humans it is present in all tissues throughout the entire body,
but is particularly concentrated in
Liver
Bile duct
Kidney
Bone
The placenta.
Heat-stable :
placenta or a tumor is the source.
Heat –unstable:
intestinal, liver, and bone
Higher levels of ALP than normal
may indicate:
� Liver disease
� Bone disease
� Leukemia
Lower levels of ALP than
normal may indicate:
� Anemia, or a low red blood cell count
� Malnutrition
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Mechanism of increase in ALP in liver disease:
�Increase in the activity of ALP in liver disease is not
due to hepatic cell disruption , nor to a failure of
clearance , but rather to increased synthesis of hepatic
ALP .
�The stimulus for this increased synthesis in patients
with liver disease has been attributed to bile duct
obstruction by stone ,tumors , intrahepatically by
infiltrative disorders or space-occupying lesions.
ALP Non Pathologically Elevated
�Age > 60
�Blood types O and B after
fatty meal (influx of
intestinal ALKP into the
blood.)
�Children and adolescents
undergoing rapid bone
growth, (bone)
�Late in normalpregnancies (influx of
placental )
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Elevation of liver-derived alkaline phosphatase
� Not specific for
cholestasis
�< 3 fold occur in :
Any type of liver disease.
�>4 fold occur in:
Cholestatic liver disorders
Infiltrative liver diseases
such as cancer and
amyloidosis
Level of ALPis not helpful indistinguishing
�Between intrahepatic and
extrahepatic cholestasis
�Obstructive jaundice due to
cancer, common duct stone,
sclerosing cholangitis, or bile
duct stricture.
Aproach to elevation of ALP
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5' NTSensitive and specific for
hepatobiliary disorders (HBD)
Normal pregnancy, bone growth and
bone diseases do not affect 5' NT
In pts with HBD, changes in ALP are
usually followed by similar changes
in 5' NT
GGT
�Inducible microsomal enzyme.
�N levels – 5- 40 IU/L.
�Less specific than 5' NT as a marker for
HBD
�Unlike 5' NT, GGT may be released from
many sites beside the hepatobiliary tree.
�Bone – important source of ALP, has little
GGT thus GGT useful for differentiating
hepatic & osseous sources of ALP
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� This test measures the total level of the
enzyme lactic dehydrogenase, also called LDH,
in the blood.
� LDH is found in body tissues and organs.
lactate dehydrogenase
Enzymes that do not fit either pattern.
LDH isoenzymes
۩ Tissue or organ injury can release LDH into
the bloodstream, thereby raising the level.
۩ If he or she suspects a heart attack or liver
tissue damage in the body.
۩Normal range: 115-225 IU/L
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Tests based on livers function:
� Carbohydrate metabolism
� Lipid metabolism
� Protein metabolism
�Not of much value in liver diseases
� It is often difficult to separate the part
played by the liver from other factors
influencing glucose metabolism.
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Basis:�For galactose is a monosaccharide, almost
exclusively metabolized by the liver.
�The normal liver is able to convert galactose
into glucose.
�This function is impaired in intrahepatic disease
and the amount of blood galactose and urine
galactose is excessive.
�The liver can be assessed by measuring the
utilization of galactose.
It is used primarily to detect liver cell injury.
It can be performed in presence of jaundice.
As it measured an intrinsic hepatic function, it may be
used to distinguish obstruction and non obstruction
jaundice.
Method :
�Oral galactose tolerance test
�IV galactose tolerance test(intravenous injection )
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Normally or obstructive jaundice:
3gm or less of galactose are excreted in the urinewithin 3 to 5 hours and the blood galactose returns tonormal within one hour.
Result:
Intrahepatic jaundice:
The excretion amounts to 4 to 5gm or more during the first 5 hours.
Normal response:
Shows little or no rise in the blood sugar level.
The highest blood sugar value reached during the test
should not exceed the fasting level by more than 30 mg%.
In infectious hepatitis or
parenchymatous liver
cells damage:
Rise in blood sugar is
greater than above, but the
increases obtained are
never very great.
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Tests Based On Lipids Metabolism
Cholesterol-cholesteryl Ester Ratio:
The liver plays an active and important role in
the metabolism of cholesterol including its
synthesis,esterification,oxidation and excretion.
Normal total blood cholesterol ranges from 150 ~
250mg/dl and approx 60 to 70% of this is in erterified
form.
In parenchymatous liver disease:
Their is either no rise or even decrease
in total cholesterol and the ester fraction is
always definitely reduced.
The degree of reduction roughly parallels
the degree of liver damage.
In severe acute hepatic necrosis:
The total serum cholesterol is usually
low and may fall below 100mg/dl, while
there is marked reduction in the % present
as esters.
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Tests based on amino acid metabolism
Determination of
blood NH3:
Nitrogen part of aminoacid is converted toNH3 in the liver mainlyby transamination anddeamination and it isconverted to urea inliver only .
Synthetic functions
1. Total plasma proteins/ albumin/ globulin/
A:G ratio
2. Formation of prothrombin by liver
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Normal value:
�Total plasma proteins: 80~110mg/dl
�Albumin:40-50mg/dl
�Globulin:25~35mg/dl
�A:G ratio: 1.5~2.5
This yields most useful information in chronic liver
disease.
Liver is the site of albumin synthesis and also
possibly of some of α and β globulins.
In infectious hepatitis:�Quantitative estimations of albumin and
globulin may give normal results in the early
stages.
�Qualititative changes may be present,in
early stage rise in β -globulins and in later
stages γ-globulins shows rise.
In cirrhosis liver or parenchymalliver disease:
The albumin is grossly dicreased and the
globulins are often increased,so that A:G ratio
is reversed, is characteristically seen in
cirrhosis liver.
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�Albumin is an important blood protein that is made
only by the liver and excreted by the kidneys.
�Albumin is essential for maintaining
the osmotic pressure in the vascular
system.
�low albumin level produce ascites.
�Albumin is also very important in the
transportation of many substances
such as drugs, lipids, hormones and
toxins that are bound to albumin in the
bloodstream.
Synthesized exclusively by hepatocytes.
Long half-life: 18–20 days
Normal range: 34 - 54 g/L
Not a good indicator of acute or mild hepatic
dysfunction (slow turnover)
This test is normally performed to assist in
diagnosing diseases that affect proteins in the
body, such as cancer, liver disease, renal or
intestinal problems, and immune disorders.
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Abnormally low contents of albumin may indicate:
�Ascites
� Extensive burns
� Kidney disease
� Liver disease
� Malabsorption syndromes
�Protein-losing enteropathies
�Chronic infections that inhibit albumin synthesis.
Common in chronic liver disorders such as cirrhosis than
in acute liver disease
Reflects severe liver damage and decreased albumin
synthesis.
Immunoglobulins produced by B
lymphocytes
Globulins are increased in chronic
hepatitis and cirrhosis.
In cirrhosis: due to the increased
synthesis of antibodies against
intestinal bacteria.
Cause : cirrhotic liver fails to
clear bacterial antigens that
normally reach through the
hepatic circulation.
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Diffuse polyclonal IgG ↑ in autoimmunehepatitis
IgM ↑in primary biliary cirrhosis
IgA ↑ in alcoholic liver disease
�At least 12 different proteins are involved in clotting.
Blood clotting factors are proteins made by the liver and are
associated with the incorporation of vitamin K metabolites
into a protein.
�When the liver is significantly injured, these proteins are
not normally produced.
�PT (Prothrombin time)
�Estimation of plasma fibrinogen
�APTT(activated partial thromboplastin time)
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Prothrombin is a plasma protein that is converted
into thrombin during blood clotting.
Prothrombin is formed in the liver from inactive
“preprothrombin” in presence of vitamin K.
thrombin Prothrombin
in presence of vitamin K
Ca2+, PL
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PT is used to assess the activity of extrinsic blood clotting
pathway .
PT is also a useful test of liver function, since there is a
good correlation between abnormalities in coagulation
measured by PT and the degree of liver dysfunction.
PT is usually expressed in seconds and compared to a
normal control patient’s blood.
Prothrombin time is measured as prothrombin activity.
The term prothrombin time was given to time required for
clotting to take place in plasma to III factor and Ca+ have
been added.
This test may be done:
�When a person has a bleeding problem
�Monitor a person who is taking oral anticoagulants
�Before surgery to make sure a person will not bleed too
much during the operation.
�Prothrombin activity is also sometimes expressed as
“prothrombin index”, which is the ratio of prothrombin
time of the normal control to the patient’s prothrombin time:
Prothrombin index = PT of normal control
PT OF patientx100
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High PT values may occur when a person:
�Is taking blood-thinning medicines like warfarin
�Is taking other medicines, such as certain
antibiotics, that interfere with the test
�Has severe liver disease
�Has DIC :a complex blood disorder that occurs
when clotting mechanisms are activated
throughout the body
�Has certain rare, inherited bleeding disorders
�Has a vitamin K deficiency
Abnormally low PT values are usually notsignificant.
However, they may occur when a person:
�Has cancer
�Has blood clots
�Is taking certain medicines, such as oral
contraceptive pills
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Protective functions and detoxification
Blood AmmoniaBlood Ammonia�Produced
�During normal protein metabolism
�Intestinal bacteria in the colon.
�liver plays : detoxification of ammonia by converting it
to urea→ excreted by the kidneys
�Striated muscle → detoxification of ammonia
(combination with glutamic acid )
Elevated ammonia levelsElevated ammonia levelsHas very poor correlation with:
� Presence or severity of acute encephalopathy
�Hepatic function.
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Elevated ammonia levels Elevated ammonia levels Occasionally useful for occult liver disease in
mental changes.
Correlate with outcome in fulminant hepatic
failure.
In severe portal hypertension and shunting around
the liver even in normal or near-normal hepatic
function.
Some Other Tests For LFTsSome Other Tests For LFTs
�Mitochondrial Antibodies Test
The presence of these antibodies can indicate primary biliary
cirrhosis, chronic active hepatitis, and certain other
autoimmune disorders.
� Platelet count:
In cases of chronic liver disease where cirrhosis exists, the
platelet count can be lowered — although this can occur due
to many conditions other than liver disease.
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�Fibrinogen
�Synthesized exclusively by hepatocytes
�Plasma fibrinogen – 100-700 mg/dl
�Functions – polymerizes into long fibrin threads by the
action of thrombin � formation of clot
�Haptoglobins
�Forms stable complexes with free Hb � prevents loss of
iron through urinary excretion, protects kidney from damage
�Ceruloplasmin
� Binds with copper and helps in its transport and storage
�Bromosulphathein excretion test
�BSP dye- same mechanism as bilirubin
�Binding
�Conjugation
�Excretion
�BSP – i/v – 45 mins- levels in venous blood
�Normally- <5%.
�Slightly higher in old age
�Sensitive test to detect mild impairement of liver
�Indocyanine green
�This dye is removed by the liver after intravenous injection. A
blood level is obtained 20 min after administration.
� Compared with BSP its hepatic clearance is more efficient, and
it is nontoxic.
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�Serum bile acids
�Synthesized from cholesterol in the liver, conjugated to
glycine or taurine, and excreted in the bile.
�Bile acids facilitate fat digestion and absorption within the
small intestine. They recycle through the enterohepatic
circulation.
�Detection of an elevated level of serum bile acids is a
sensitive marker of hepatobiliary dysfunction
�A number of different bile acid tests have been described,
including fasting and postprandial levels and determination of
levels after a bile acid load.
�Normal bile acid levels in the presence of
hyperbilirubinemia suggests hemolysis or Gilbert’s syndrome
�ᾳ- feto protein
�Resembles albumin genetically &
functionally
�Formation sites- yolksac,
hepatocytes, enterocytes
�Fetal & neonatal life- major
determinant of plasma oncotic
pressure
� 1 year of age- albumin largely
replaces AFP
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�There is no ideal study to evaluate the liver’s
diverse functions.
�Abnormal liver biochemistries are often the first
indication of liver disease.
�The widespread inclusion of these tests in routine
blood chemistry panels uncovers many patients with
unsuspected hepatic dysfunction.
�Laboratory testing may provide information about
the severity of liver disease and its prognosis
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�USG, CT scan - 1st line
investigation
�ERCP visualization of
biliary tract
�Doppler & MRI hepatic
vasculature & heamody-
namics
�CT & MRI- hepatic masses
& tumours
HepatobiliaryHepatobiliary imagingimaging
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Despite advances in serological testing
and imaging, liver biopsy remains the
golden standerd to confirm the
diagnosis of specific liver diseases such
as
�Wilson disease
�Nonalcoholic steatohepatitis
�Assess prognosis in many forms of
parenchymal liver disease such as
chronic viral hepatitis
�Evaluate allograft dysfunction in liver
transplant recipients.
Biopsy Biopsy
Indications for liver biopsy
� Evaluation of abnormal liver biochemical tests and hepatomegaly
� Evaluation and staging of chronic hepatitis
� Identification and staging of alcoholic liver disease
� Recognition of systemic inflammatory or granulomatous disorders
� Evaluation of fever of unknown origin
� Evaluation of the type and extent of drug-induced liver injury
� Identification and determination of the nature of intrahepatic masses
� Diagnosis of multisystem infiltrative disorders
� Evaluation and staging of cholestatic liver disease (primary biliary
cirrhosis, primary sclerosing cholangitis)
� Screening of relatives of patients with familial diseases
� Obtaining of tissue to culture infectious agents (e.g., mycobacteria)
� Evaluation of effectiveness of therapies for liver diseases (e.g., Wilson
disease, hemochromatosis, autoimmune hepatitis, chronic viral
hepatitis)
� Evaluation of liver test abnormalities following transplantation
٢٥/٠٤/١٤٣٦
٤٤
Contraindications to liver biopsy
Complications�Post-biopsy pain with or without radiation to the right shoulder
occurs in up to one-third of patients.
� Intraperitoneal bleeding is the most serious complication.
Increasing age, presence of hepatic malignancy, and the number
of passes made are predictors of the likelihood of bleeding, as is
the use of a cutting rather than a suction needle
�Pneumothorax may require a chest tube, whereas serious
bleeding may be controlled by selective embolization at
angiography or, if necessary, ligation of the right hepatic artery
or hepatic resection
� Biopsy of a malignant neoplasm carries a 1–3% risk of seeding
of the biopsy track with tumor
٢٥/٠٤/١٤٣٦
٤٥
Abnormal in... Liver Test
Cirrhosis, severe hepatocellular injuryAlbumin
Cholestasis, hepatocellular enzyme induction, canalicular injury, children during bone growth, bone disease, pregnancy (placenta origin)
Alkaline phosphatase
Hepatocellular injury (ethanol, drug-induced hepatitis, hepatitis B and C,
ischemic injury, chronic liver disease, NAFLD, chronic viral hepatitis,
alcoholism, nonspecific viral injury, and cholestatic or replacement disease);
acute biliary obstruction; rarely in hyperthyroidism, celiac disease, skeletal muscle disease
Aminotransferases (AST, ALT)
Any acute or chronic liver disease; congenital disorders of bilirubin metabolism.
Bilirubin
Cholestasis5′ nucleotidase
Cholestasis; medications, ethanol; rarely anorexia nervosa, hyperthyroidism, myotonic dystrophy
GGT
Impaired synthesis of vitamin K-dependent coagulation factorsINR
Ischemic injury, Epstein-Barr virus infection, hemolysis, solid tumorLactate dehydrogenase
Alcohol consumption, goutUric acid
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