LAB DIAGNOSIS IN

ALCOHOLIC LIVER DISEASE

RESOURCE FACULTY-Dr.S.MAJHI PRESENTED BY-PRATEEK SINGH

OBJECTIVE

To enumerate the biochemical parameters for diagnosis of ALD

To interpret the above parameters

BIOCHEMICAL TESTS

TEST FOR LIVER BIOSYNTHETIC ACTIVITY

*Serum bilirubin

*Serum albumin

*Albumin/Globulin ratio

*Prothrombin time

SERUM ENZYME TEST*Aspartate aminotransferase (AST)

*Alanine amino transferase (ALT)

* Alkaline phosphatase (ALP)

* Gammaglutamyl transferase (GGT)

*5'nucleotidase (5'-NT)

*DE-RITIS ratio (AST/ALT)

INTERPRETATIONS OF BIOCHEMICAL FINDINGS

DE-RITIS RATIO*THIS IS THE MOST IMPORTANT

BIOCHEMICAL INDICATOR OF ALCOHOLIC LIVER DISEASE.

*This is the ratio of Aspartate aminotransferase and Alanine aminotransferase

*In normal individuals the DE-RITIS ratio is 1.10:1

*But in patients of alcoholic liver disease it is more than 2.

*Studies in regard to deritis ratio has also been conducted in b.p.k.i.h.s by. Dr S.majhi, Dr N.Baral and Dr Lamsal

ALKALINE PAHOSPHATASE*Not specific for liver disease

*Normal value is 25-90IU/l

*It will be elevated in ALD

*If its rise is in parallel to GGT it can be said that this elevation is due to ALD.

ASPARTATE AMINOTRANSFERASE

*Normal value is 35.00 +/- 23.49 IU/L *It will be elevated in ALD 2-7 folds, but not more than 400IU/L

*AST will be elevated more than ALT

ALANINE AMINOTRANSFERASE

*Normal value is 31.48 +/- 17.79 IU/L *It will be elevated 2-5 folds in ALD, but not more than 400IU/L.

GAMMA GLUTAMYLTRANSFERASE

*Normal value is 70.55 +/- 27.35 IU/L

*It will be moderately increased in chronic alcoholics & All forms of fatty liver.

*It is an Inducible enzyme.

*So,it is not a specific marker of ALD

BILLIRUBIN*Normal serum concentration is

0.3-1mg/dl*It will be increased in ALD >5mg/dl.ALBUMIN*Normal serum concentration is 3.5-

5gm/dl*It decreases in ALD upto 2-3gm/dl

GLOBULIN*Serum globulin will increase during

liver disease in response to antigenic stimulation reflecting the immune changes associated with alcoholic liver disease.

*Normal Globulin level is 2.5-3.5gm/dl

OUT OF THREE GAMMA GLOBULIN

IgA-Increases in 90% of cases.

IgG-Increases in 64% of cases.

IgM-Increases in 25% of cases.

ALBUMIN GLOBULIN RATIO The normal A/G ratio is 1.2-1.5:1

*But in alcoholic liver disease this ratio is

reversed

PROTHROMBIN TIME *Normal Prothrombin time is 12-16secs.

*In ALD Prothrombin time increases

Due to decrease synthesis of clotting factors.

INTERPRETATION CHART

MILD MODERATE SEVERE

GGT 70.35+/-17.79 IU/L

AST 35+/-23.49 IU/L

ALT 31.48+/-17.79 IU/L

MILD MODERATE SEVERE

ALP25-90U/L

BILLIRUBIN25-90U/L

N

PROTHROMBIN TIME12-16secs

MILD MODERATE SEVERE

SERUM ALBUMIN3.5-5gm/dl

5‘NUCLEOTIDase0-11mg/dl

THANK YOUTHANK YOU