LIVER FUNCTION TESTS

Functions of The Liver

Metabolism Carbohydrate
Amino Acid
Lipids
Synthesis Urea
serum Proteins
Degradation Proteins
Drugs
Hormones
Endogenous subs.
Excretion
ANALYTE INDICATOR

AST/ALT/LDH liver necrosis

ALP/GGT cholestasis

BILIRUBIN Excretion defects

ALBUMIN Synthesis defects

Aminotransferase

Alanine Aminotransferase (ALT)

- serum glutamate pyruvate transaminase

(SGPT)
- Microsomal portion
- liver (predominant), kidney, heart
skeletal muscle
- Values:
25-65 IU/L newborn
10-40 IU/L adults
- half-life: 47 +/- 11 hours
Aminotransferase

Aspartate Aminotransferase (AST)

- serum glutamate oxaloacetate transferase

(SGOT)
- Mitochondrial/ Microsomal
- Liver, skin, heart, skeletal muscle, rbc
- Values:
25-65 IU/L newborn
10-40 IU/L adult
- half-life: 17+/- 3 hours ( cytoplasmic)
87 hours (mitochondrial)
Aminotransferase

Decrease values:

- poor nutrition
Pyridoxine (Vitamin B6)

- Dec. plasma pyridoxine

Oral contraceptives
Chronic Renal Failure

- hepatic fibrosis/cirrhosis
Aminotransferase

Increased values:

Deritis Quotient - AST/ALT ratio = 1:1

viral hepatitis - 1:1 or less

Alcohol hepatitis - 3-4:1

Aminotransferase

Increased values:

Chronic Hepatitis - <1 (Inc ALT)

Cirrhosis - >1 (dec ALT)

therapeutic drug monitoring(AST)

borderline - 3x normal

ALT more specific in detecting liver disease in

Non-alcoholic, asymptomatic patients
Alkaline Phosphatase

- liver, biliary tract epithelium, lower

intestinal mucosa, placenta, bone

- Physiologic elevation
Growth
Pregnancy

- Reference Values:
25-350 IU/L 1-12 years
25-100 IU/L men
25-90 IU/L women
Alkaline Phosphatase

Decreased values:

Hypophosphatasia
Hypothyroidism
Pernicious Anemia
Anticoagulated specimen
Hepatic diseases with elevated ALP

2x increase Acute viral hepatitis

Acute toxic hepatitis
Acute alcoholic hepatitis
Cirrhosis
Acute Fatty liver

5x increase Infectious mononucleosis

Postnecrotic cirrhosis
Hepatic diseases with elevated ALP

10x increase Drug cholestatic hepatitis

Carcinoma of the head of
pancreas
Choledocholithiasis

15-20x increase Primary Biliary Cirrhosis

Metastatic/Primary Carcinoma
Other causes of ALP elevation

Bone
Physiologic
Metastatic tumor
Fracture Healing
Paget’s disease of the bone
Capillary Endothelial Origin
Granulation tissue formation
Placental Origin
Pregnancy
albumin preparation
Gamma Glutamyl transferase (GGT)

- liver, kidney, biliary tract epithelium

pancreas, spleen, intestine, heart
brain
- highest sensitivity to liver disease
- Values:
40 IU/L male
25 IU/L female
- Significance:
Malignancy 5x normal
Chronic alcoholism 5x normal
Hepatitis <5 normal URL
Gamma Glutamyl transferase (GGT)

- Enzyme inducing drugs

Coumarin Phenytoin
Clofibrate Carbamazepine
Estrogen Acetaminophen

- elevated in other diseases:

Pancreatitis
Renal Disease
diabetes mellitus
Prostate Carcinoma
LACTATE DEHYDROGENASE

- cytosolic glycolytic enzyme

- 5 isoenzymes
- LD4 and LD5 - Liver
- Significance
Hepatic malignancy inc LDH, ALP
N bilirubin
Hemolytic Disease Inc LDH, Bilirubin
N ALP
Hepatitis inc LDH, (3x)
inc Bilirubin & ALP
Cirrhosis/Cholestasis Normal LDH
Prothrombin Time

- coagulation proteins produced in the liver

Factor II, VII, IX, X
- vitamin K dependent

- PT prolongation:
Vitamin K administration - normal PT
nonhepatic
Vitamin K administration - elevated PT
hepatic
Ammonia
- product of amino acid and nucleic acid
- liver - urea cycle
- Specimen
Heparin
EDTA
- Elevated in:
Cirrhosis
Reye Syndrome
Genetic Disease
Organic acidemia
acute fulminant hepatic failure
Bilirubin
Hemoglobin
Kidney Phagocytic System
Urinary Bilirubin
Urobilinogen Blood
Bilirubin-Albumin
Liver
Portal blood Intracellular bilirubin

Bilirubin diglucuronide
Intestine
Urobilinogen
Urobilin
Fecal Excretion
Bilirubin

- two forms:
Direct - Conjugated/Delta
water soluble bilirubin
B1
Indirect - Unconjugated
water insoluble bilirubin
B2
- measurement:
Van den Bergh method
bilirubin + diazonium salt = color reaction
Bilirubin

- Jendrassik-Grof Method
Caffeine-benzoate-acetate as accelerator
- specimen collection
fasting/non-lipemic
non hemolyzed
- Values:
Total - 0.2 -1.0 mg/dl
B1 - 0 - 0.2 mg/dl
B2 - 0.2 - 0.8 mg/dl
Bilirubin

- Hepatitis
elevated conjugated/unconjugated
- Elevated Conjugated Bilirubin
Cholestasis, intrahepatic/extrahepatic
Postoperative, intrahepatic and extra-
hepatic cholestasis
Recurrent intrahepatic cholestasis
during pregnancy
Dubin johnson syndrome
Rotor Syndrome
Bilirubin

- elevated unconjugated bilirubin

Gilbert Syndrome
Crigler-Najjar Syndrome
Type I
Type II (Arias Syndrome)
Hemolytic anemia
Resolving hematoma
Postoperative elevations
Physiologic jaundice