Liver Function Tests

Abnormal Liver Function Tests

What are Liver Function Tests ?Liver Function tests are panel of blood markers used toAsses and monitor several diseasesIndications of LFTsHistory and examination suggesting liver disease.Poisoning ( paracetamol )Alcohol abuse.Family history of autoimmune disease.Jaundice.Ascites

Indications for Liver Function Tests

ScreeningHigh risk groupsHepatitis.Illicit drug use.TransfusionsNon liver Diseases.MalignancyHypoxia.Monitoring hepatotoxic drugs like valproate , methotrxate

What to tell the patient before testA blood test is required.No special preparation like fasting.Results will be available in 24 hrs ( usually)Attracts medicare benefitsWhat are included in LFTsGamma Glut amyl Tranferase GGTAlkaline Phosphatase. ALP.Alanine Transaminase ALTAspartate transaminase AST.Total protein.Albumin.Bilurubin

What does the result mean.

Overall result is used to differentiate between cholestasis and hepatocellular damageCholestais Hepatocellular damageCHOLESTASISInterruption of bile flow from hepatocyte to gut.Alkaline Phosphatase > 200 IU/LitOr alkaline phosphatase ALP >3times Alanine transaminase ALTHepatocellular damageInsult to hepatocyteAlanine transaminase >200IU/lirOr Alananine transaminase >3 times alkaline phosphataseConditionscholestasisBiliary obstruction like gall stones.PregnancyDrugs.malignancyHepatocellular damageInfectionsAlcoholFatty liverMetal over loadHypoxia.Autoimmune diseasesIndividual results.Raised transaminasesUsually seen in hepatocellular damage.10 times the upper limit seen in acute or severe insult1.Drugs2.Viral hepatitis.3.HypoxiaRaised Transaminases5 times the upper limit seen in1. Infections.2.Alcohol.3.Fatty liver.4. Medication.However transaminases do not directly correlate to extent of liver damage .In cirrhosis they are in normal rangeRaised GGT and ALP1. Cholestasis.2.Medication.3.Alcohol.4.Isolated GGT is seen in 70% alcohol use.Takes 2-3 weeks to return to normal.5.Isolated ALP seen in 1.Bone disease.2.pagets disease

Isolated ALP3. Vitamin D deficiency.4.Metastasis.ALP also produced by bone, intestines and placenta.Specific ALP cane be requested Raised Bilurubin.Seen both cholestasis and hepatocullular damage.1.Fasting.2. Acute illnessAdults usually conjugated.Only in Gilbert syndrome unconjugated bilurubin is seen.Gilbert syndrome is where there is impairement of bilurubin conjugation

AlbuminLow levels 1.Physiological conditions like pregnancy2.Inflamation.3.Malnutrition.4.protein losing states.5.Severe liver diseaseTotal proteinEstimate globulin fractionIncreased in Inflammation.Cirrhosis low albumin and increased bilurubin indicate low survival rates.

What is next step ?Repeat blood tests Minor abnormalities return to normal in 1 week.Existing liver disease} repeat 4 weeks timeHepatotoxic medication}Acute insult/ toxic insult ; done daily.But cane be done 2 weeks onceFurther investigations.Follow up investigations like1. hepatitis serology.2. Ferritin levels.3. auto immune disease.4 .copper overload.Cholestasis : ultrasoundThank you for your Patience and time