Liver Funtion Test(d)
Transcript of Liver Funtion Test(d)
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LIVER FUNCTIONTESTS
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Tests that are of very much useful todiagnose and monitor the liver diseases arecalled as liver function tests.
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Functions of liver Excretion of bile pigments,
bile salts,BSP(Bromsulphthalein ) andICG(indocyanin green)
Metabolism of
carbohydrates, amino acidsand lipids.
Synthesis of serum proteins albumin and prothrombin.
Detoxification of ammoniaand hippuric acid.
Serum enzymes.
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Classifiation
Tests based on Excretory function
Tests based on synthetic function.
Tests based on metabolic capacity of liver
Tests based on serum enzymes.
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Tests based on Excretory function
BILIRUBIN
It is the excretory product formed due tocatabolism of heme.
It is conjugated by the liver to form bilirubindiglucuronide and excreted through bile.
Normal levels varies from 0.2-0.8mg/dl
Unconjugated bilirubin- 0.2 0.6mg/dl Conjugated bilirubin- 0-0.2mg/dl
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Estimation of bilirubin in serum
By Van den bergh reaction.
Diazotised sulfanilic acid + bilirubin
Azobilirubin( The red-violet compound)
Conjugated bilirubin Direct positive
Unconjugated bilirubin Indirect positiveBoth - biphasic
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Urinary findings in jaundice
Type of
jaundice
Bile
pigment
Bile
salt
Uro
bilinogen
Prehepatic Nil Nil ++
Hepatocellular
++ + Normal ordecreased
Posthepatic
+++ ++ Nil ordecreased
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Tests in urine
Bile pigmentsFouchets test.
Bile salts Hays test
Urobilinogen Ehrlichs test.
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Jaundice Jaundice is increased levels of Ser Bil > 1.0 mg%.
Latent jaundice - >1mg%,
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Table of diagnostic tests
Function test Pre-hepaticJaundice
HepaticJaundice
Post-hepaticJaundice
Total bilirubin Normal /Increased
Increased
Conjugated bilirubin Normal Increased
Unconjugated bilirubin Normal /
Increased
Normal
Urobilinogen Normal /Increased
Decreased /Negative
Urine Color Dark
Stool Color Pale
Alkaline phosphatase levels Increased
ALT and AST levels Increased
Conjugated Bilirubin in Urine Present
Increased
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BSP(Bromsulphthalein RETENTION TEST)
The ability of the liver to excrete certain dyes isutilized in this test.
PROCEDURE
A single bolus dose of BSP 50g/L, is given & theserum concentration is measured at 45mins & at
2hrs.
Normal response the retention at 45mins is
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Tests based on metabolic capacity of liverGalactose tolerance test
Galactose is almost exclusively metabolised byliver.
The rate of utilisation of galactose is proportionalto the functional liver mass.
Procedure- 350mg galactose/kg body weight isgiven intravenously within 3mins. Then blood iscollected at 10mins interval for 1hour.
The half life of galactose in blood is about 10-15mins in normal people.
The half life is increased in cirrhosis and infectivehepatitis patients.
C14 labelled galactose given CO2 eliminated may be assessed.
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Plasma amino acids
Theamino acid profile is abnormal in hepatic coma.
The level of aromatic amino acids is increased.
Tests based on abnormalities of lipids
Total cholesterol 150-250mg%, & 60 -70% of this isesterified.
Obstructive jaundice increase in TC A/c Hepatic necrosis TC is usually low and may fall
below 100mg%, and also marked decrease in % ofesters.
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Tests based on synthetic function
Blood albumin level
1.all serum proteins are synthesised by the liverexcept immunoglobulins.
2.Serum albumin is quantitatively the mostimportant protein synthesised by the liver andreflects the functioning of liver cell mass.
3.it is not a good indicator of acute liver diseasesas its half life is long. In chronic diseases its level
is decreased.4.normal level Albumin 3.5 5g/dl.
Globulin 2.5 3.5g/dl
Reversal cirrhosis
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Prothrombin time
Prothrombin is synthesised by the liver.
Vit K deficiency as the cause for prolonged PTmay be ruled out by estimating the PT beforeand after parenteral administration of Vit K.
In case of liver disease the PT remainsprolonged even after administration of vit K.
Prolonged PT poor prognosis.
T t b d d t ifi ti f ti f
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Tests based on detoxification function ofliver
HIPPURIC ACID TEST
Liver removes benzoic acid by combining withamino acid glycine forming hippuric acid.
Test depends on 2 factors
1. ability of the liver to produce and provide sufficientglycine
2. the capacity of liver cells to conjugate with benzoicacid
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ProcedureDissolve 6 gms of sodium benzoate in200 ml of water . The patient is asked to drink this
solution and time is noted . (bladder should be
emptied before consuming the solution).
The bladder is again emptied 4 hours later.
The amount of hippuric acid excreated in this 4 hours
is estimated. Interpretation normally 3 gm of hippuric acid
should be excreted.
In liver disorders - either acute or chronic small
amounts are excreted.
T t b d
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Tests based on serum enzymes.
SGOT (AST) -
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Marker enzymes for obstructive liver disease ALP - 12-115U
GGT- 10
30U/L 5nucleotidase - 2-10U/L
Leucine amino peptidase.
ALP
ALP is an ecto
enzyme that is localised in cellmembranes & is associated with transportmechanisms in liver, kidney & intestinal mucosa.
Very high levels cholestasis or hepatic ca.
The bile duct obstruction induces the synthesis by thebiliary tract epithelial cells.
Parenchymal liver diseases mild elevation
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GGT :
It transfers gamma glutamyl residues.
Moderate elevations seen in infectivehepatitis and prostrate cancer, MI, panreaticdisease, renal failure, COPD.
Highly elevated in alcoholism, obstructivejaundice and neoplasms of the liver.
GGT elevation parallels that of ALP & is
very sensitive to biliary tract disease.
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5'Nucleotidase It is a marker enzyme for plasma
membranes ans is seen as an ecto-enzyme.
It is moderately increased in hepatits
and highly elevated in biliary obstruction. It parallels the levels of ALP.
Leucine amino peptidase
Elevated levels noticed in hepatobiliary disease,obstructive jaundice and pregnancy.
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