Blood StudiesBlood Studies

Liver function test (LFT)Liver function test (LFT) Group of biochemical testsGroup of biochemical tests

Uses of liver function test (LFTs)Uses of liver function test (LFTs) Differential diagnosis & prognosis of jaundice Differential diagnosis & prognosis of jaundice To assess the extend of liver damage To assess the extend of liver damage To follow the progress of liver damage To follow the progress of liver damage

Liver function test (LFT)Liver function test (LFT) Serum Bilirubin Serum Bilirubin Hepatic enzymes – AST, ALT, Alkaline Phosphatase Hepatic enzymes – AST, ALT, Alkaline Phosphatase Prothrombin time Prothrombin time Serum proteins (with albumin & globulin ratio A/G ratio)Serum proteins (with albumin & globulin ratio A/G ratio)

1. Serum Bilirubin 1. Serum Bilirubin

2. Serum Enzymes2. Serum Enzymes

Serum AminotransferaseSerum Aminotransferase - AST (SGOT), ALT (SGPT) - AST (SGOT), ALT (SGPT)

Elevated levels usually indicate cellular damage to the liverElevated levels usually indicate cellular damage to the liver

ALT – alanine amonitransferaseALT – alanine amonitransferase Cytosol enzymeCytosol enzyme It is more specific than AST for the liver It is more specific than AST for the liver

AST – asparate amninotransferaaseAST – asparate amninotransferaase Mitochondrial enzyme Mitochondrial enzyme Also present in heart, brain, kidney & musles Also present in heart, brain, kidney & musles High levels are seen in hepatic necrosis, myocardial High levels are seen in hepatic necrosis, myocardial

infarction, muscle injury infarction, muscle injury

Alkaline phosphataseAlkaline phosphatase Present in canalicular membranes of hepatocyte Present in canalicular membranes of hepatocyte Secreted in bile, Blockage of Alkaline Phosphatase excretion Secreted in bile, Blockage of Alkaline Phosphatase excretion

(via bile) will induce more synthesis, leading to high blood (via bile) will induce more synthesis, leading to high blood levels.levels.

Raised in cholestatic jaundice (4-6 times normal)Raised in cholestatic jaundice (4-6 times normal) Also raised in Metastatis & cirrhosis Also raised in Metastatis & cirrhosis Present in liver, bone , intestine & plasma Present in liver, bone , intestine & plasma

Gamma glutamyl transferase (Gamma glutamyl transferase (γγGT)GT) Raised value is good guide to alcohol intake Raised value is good guide to alcohol intake

Prothrombin Time (PT)Prothrombin Time (PT) Time required for a firm fibrin clot to formTime required for a firm fibrin clot to form It is a sensitive indicator of both acute & chronic liver disease It is a sensitive indicator of both acute & chronic liver disease Prolonged PT occurs due to Vit K deficiency, which is Prolonged PT occurs due to Vit K deficiency, which is

excluded by giving 10mg of Vit K IVexcluded by giving 10mg of Vit K IV In liver dysfunction, increase clotting time with increased risk In liver dysfunction, increase clotting time with increased risk

of bleedingof bleeding

Protein StudiesProtein Studies Serum albuminSerum albumin

Low levels indicates severity of chronic liver disease Low levels indicates severity of chronic liver disease Falling serum albumin is a bad prognostic sign liver disease Falling serum albumin is a bad prognostic sign liver disease

Serum globulinSerum globulin Hyperglobulinaemia occurs in chronic liver disease due to Hyperglobulinaemia occurs in chronic liver disease due to

immunological mechanisms immunological mechanisms High globulin & low albumin is a characteristic feature of CLDHigh globulin & low albumin is a characteristic feature of CLD

AmmoniaAmmonia Liver converts ammonia to urea. Ammonia rises in liver Liver converts ammonia to urea. Ammonia rises in liver

failurefailure

Tumor MarkerTumor Marker Alpha-fetoprotein (AFP)Alpha-fetoprotein (AFP) Increased levels are seen with hepatic carcinomaIncreased levels are seen with hepatic carcinoma

Liver BiopsyLiver Biopsy Used to obtain a specimen of liver tissueUsed to obtain a specimen of liver tissue Done under local anesthesiaDone under local anesthesia

Imaging Imaging USG of LiverUSG of Liver

Imaging Imaging CT of LiverCT of Liver MRI of LiverMRI of Liver

Cholangiography Cholangiography

X-ray examination of the biliary system, using a radiopaque X-ray examination of the biliary system, using a radiopaque dye given intravenously or orally, as contrast mediumdye given intravenously or orally, as contrast medium

Types Types Oralcholecystography /OCGOralcholecystography /OCG Intravenous cholangio graphy/ICGIntravenous cholangio graphy/ICG Endoscopic Retrograde Cholangio – Pancreatography /ERCPEndoscopic Retrograde Cholangio – Pancreatography /ERCP Percutaneous transhepatic cholangiography /PTCPercutaneous transhepatic cholangiography /PTC Operative cholangiographyOperative cholangiography Operative T tube cholangiographyOperative T tube cholangiography

1010Dr S ChakradharDr S Chakradhar

Magnetic Resonance cholangio-pancreatography/MRCPMagnetic Resonance cholangio-pancreatography/MRCP

1111Dr S ChakradharDr S Chakradhar