Department of practice of medicine

LIVER FUNCTION
Seminar presentation on

TEST
[ LFTs ]

Submitted by KARTHIYAYINI. S. J LFTs

3rd BHMS [2023 – 2024 Batch ]
Excel homoeopathy medical college.
LIVER FUNCTION TEST
Liver function test are blood tests used to help to diagnosis and moniter diseases or damage of liver.
However,
1.Conditions other than liver diseases or damage can lead to abnormal LFT result.
2.The test results can be normal in people who have liver diseases or damage.
MAJOR METABOLIC FUNCTIONS OF LIVER:
1.synthetic functions
2.Detoxification and excretion function
3. Storage function
4.production of bile salts.
LFT is divided into 2,
1.True tests of liver function-serum albumin,serum bilirubin, protime.
2.Test that indicator of liver injury or biliary tract diseases.

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CLASSIFICATION BASED ON FUNCTIONS OF LIVER :
1.Tests based on excretory functions.
2.Tests based on metabolic functions.
3.Tests based on the capacity for detoxication.
4.Test based on enzymes of liver.
LIVER FUNCTION TEST CAN BE USED TO:
1.Check certain enzymes and proteins levels in blood that if are high or lower than normal can indicate liver problems.
2.screen for liver infections, such as hepatitis.
3.Monitor the progression of a liver disease such as viral and alcoholic hepatitis and determine how well the treatment
is working.
4.Measure the severity of liver diseases, especially in liver cirrhosis.
5.Monitor possible side effects of medication on liver.

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TESTS BASED ON EXCRETORY FUNCTIONS:
The main excretory product of liver is bile. It is formed and stored in liver. When the formation of bile and
its circulation within and outside the liver encounter any obstrucle bile pigments escape into the blood and urine in
an abnormally large amount, resulting in jaundice. The liver function tests based on the excretory function of liver.
1.The for bile pigments in blood
- van den bergh reaction
- serum bilirubin estimation
- icterus index
2.Serum alkaline phosphatase estimation
3.Test for bile salts and bile pigmaents in urine
- Gmelin’s test for bilirubin
- Fouchet’s test for bilirubin
- Hay’s test for urobilinogen
- Schlesinger‘s the for urobilinogen
- Wallace- diamond test for urobilinogen

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4. Dye excretion test :
- bromsulphalein test
- Rose bengal test
VAN DE BERGH REACTION AND SERUM BILIRUBIN ESTIMATION :
 Direct bilirubin + Diazotized sulfonilic acid  azobilirubin [ reddish purple ]
 Total bilirubin + dimethyl sulfoxide + methanol + diazotize sulfonilic acid  azobilirubin

 Indirect bilirubin reacts with diazoitized sulfonitic acid after the addition of methanol.

Serum bilirubin:
- Normal value:
 Indirect bilirubin  0.3 – 1.2 mg /dl
 Direct bilirubin  < 0.4_ mg / dl
 Total bilirubin  0.3 – 1.2 mg /dl
ICTERUS INDEX ( Meulengrach test ):
Icterus index is a measure of yellow colour of serum.
 Icterus index  4 – 6 units

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 - Yellow colour of the serum is compared with 0.01 g/ dl potassium dichromate solution.
Icterus index = volume of diluted serum /volume of serum used
 latent jaundice = 6 – 14 units
 clinical jaundice = > 15 units
SERUM ALKALINE PHOSPHATASE ESTIMATION :
Normal value : 53 – 128 IU / L
 Higher levels of ALP indicates :
1. Liver disease
2. Bone disease
3. Leukemia
4. Various hormone problems
 Lower levels of ALP indicates :
1. Anemia
2. Malnutrition
3. Various hormone problems

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TEST FOR BILE SALTS AND BILE PIGMENTS IN URINE :
1.GMELIN’S TEST:
3 ml of urine taken in test tube layered with 5ml of concentrated nitric acid  rings of colour green, blue, red,
yellow appear at the junction b/w two liquids, if bilirubin present.
2.FOUCHET’S TEST:
10 ml of urine + 5 ml of barium chloride  mixed and filtered
Add 1or 2 drops of fouchets reagent to the precipitate  green / blue Colour indicates presence of bilirubin.
3. HAY’S TEST ( test for bile salts ):
50 ml of urine sample + sulphur powder is sprinkled  if bile salts are present, sulphur powder sinks to the
bottom of test tube.
4. SCHLESINGER’S TEST (test for urobilinogen ):
Urine + alcoholic solution of zinc acetate  green fluoresence is produced, if urobilinogen is present in urine.
5. WALLACE – DIAMOND TEST :
3 min colour change to red, urobilinogen is present.
10ml of urine + 1 ml of ehrlich’s reagent --------------

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DYE EXCRETION TEST:
1.BROMSULPHALEIN TEST (BSP ) :
Bromsulphalein is injected intravenously ( 5 mg per kg body weight )
95% of dye disappears in 30 min and entire amount in 45 min from the blood

- removal of BSP is delayed and impared in hepatic insufficiency due to liver cell damage.
2. ROSE BENGAL TEST:
10 Mml of 1% solution of dye is injected intravenously.
Normally, 50% dye disappears in 8 minutes.

TEST BASED ON METABOLIC FUNCTIONS:

Liver plays an important role in metabolism of carbohydrates, protein and lipids. It also involves metabolism
of minerals and vitamins.
1. carbohydrates metabolism
2. protein metabolism
3. lipid metabolism

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CARBOHYDRATES METABOLISM :
Test based on carbohydrates metabolism are:
 Glucose tolerance test
 Galactose tolerance test

 GLUCOSE TOLERANCE TEST (GTT):

Glucose tolerance means the ability of the body to utilize the glucose in blood circulation .
 2 types of GTT :

1.Oral glucose tolerance test (OGTT):

- Injestion of 75mg of oral glucose solution.
- it is the most common form of GTT
- fasting blood sugar is measured before ingestion and 1 hr post glucose load
2.Intravenous glucose tolerance test ( IGGT ) :
- glucose is injected into the vein.
- blood insulin levels are measured before the injection.

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Glucose tolerance test in normal person :
Fasting 60 - 100 mg / dl

After 1hr 200 mg / dl

After 2 hr 140 mg /dl

 prediabetes - 140 to 199 mg/dl

 diabetes - 200 mg /dl and higher

-Most commonly done to check :

1. Obese patients
2. Pregnant patients
3. Patients with non- healing skin infection or recurrent attacks of skin infections.
4. Patient with family history of diabetes.

• GALACTOSE TOLERANCE TEST:

Normal liver >> galactose into glucose, but this function is impaired in intrahepatic diseases and
the amount of blood galactose and galactose in urine is excessive.
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 - 40 gm of galactose in oral administration
- Estimation of blood galactose over next 2 hrs.
- normal : reach fasting level at 2 hrs.
- decrease in cirrhosis and hepatitis.
LIPID METABOLISM :
 Cholesterol – cholesteryl ester ratio :

The liver plays an active and important role in the metabolism of cholesterol including its synthesis,
esterification, oxidation and excretion.
Normal : total blood cholesterol ranges from 150 – 250 mg /dl and approx 60 – 70% of this is in esterified form.
In parenchymatous liver diseases :
there is either no rise or even decrease in total cholesterol and the ester fraction is always definitely reduced. The
degree of reduction roughly parallels the degree of liver damage.
In sever acute hepatic necrosis :
total serum cholesterol is usually low and may fall below 100mg/ dl, whilst there is marked reduction in % present
as esters

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AMINO ACID METABOLISM :
 Determination of blood NH3 :

Nitrogen part of amino acid is converted to NH3 in the liver mainly by transmination and deamination and it is
converted to urea in liver only.
Normal range :
Blood ammonia varies from 40 m g ammonia / 100 ml of blood
In parenchymatous liver diseases:
Increases in NH3 can be found more advanced cases of cirrhosis liver, particular when there are associated
neurological complicate in such case blood levels may be over 200 m g/ml.

TESTS BASED ON THE CAPACITY FOR DETOXICATION :

Liver deals with toxic substances by cojugating themwith glycine and glucuronic acid to produce less toxic
substances. The well known detoxication occuring in liver is the conjugation of benzoic acid with glycine to form
hippuric acid, which is excreted in urine.
Excretion of hippuric acis is a measure of hepatic function connected with detoxication.

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 Hippuric acid test :

The test may be carried out either by oral or intravenous methods.

- the oral test consists in the administration of standard dose of sodium benzoate ( 6 grams ) orally followed by a 4 hrs
collection of urine.
- the amount of hippuric acid excreted is estimated
-in normal subjects, 2.5 grams or more of hippuric acid are excreted in 1 hr.
- the output of hippuric acid is low in intrahepatic rather than extrahepatic diseases.

TESTS BASED ON ENZYMES OF LIVER :

Enzymes such as alkaline phosphatase, transaminase, lactic dehydrogenase, cholinestrase, aldolase,
phosphohexose, isomerase and isocitric dehydrogenase are derived from liver and are elevated in liver diseases.
Measurement of these enzymes is useful
1. Most commonly and routinely done in laboratory
- serum transaminase (ALT / AST )
- serum alkaline phosphate (ALP)
2.Not routinely done in laboratory 12
Analine transaminase(ALT):
ALT or sGPT ( serum glutamate pyruvate transaminase)

Asparate aminotransferase (AST ):

AST or sGOT ( serum glutamate oxaloacetate transaminase)

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Normal value :
GPT = 2 – 59 U/ L
GOT = 10 – 34 U / L

elevated levels of GPT may indicate :

1. Alcoholic liver diseases

2. Cancer of liver
3. Cholestrasis or congestion of bile duct
4. Cirrhosis or scaring of liver with loss of function
5. Death of liver tissue
6. Hepatitis or inflammation of liver
7. Noncancerous tumor of liver
8. Use of medicines ore drug toxic to liver

GOT also reflects damage to hepatic cells and is less specific for liver disease. It can also be released with heart,
muscle and brain disorders.

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Elevated levels of GOT may indicate:
1. Acute hemolytic anemia
2. Acute pancreatitis or inflammation of pancreas
3. Acute renal failure or loss of kidney function
4. Cirrhosis of liver
5. Hepatitis
6. Heart attack
7. Primary muscle disease
8. Severe burns
9. Muscle injury
10. Recent surgery
Although GOT is not specific for liver as the GPT, the ratio b/w GPT and GOT are useful in assessing the etiology
of liver enzyme abnormalities.
Normally :
GPT and GOT is normal, GPT/ GOT is about 1.15
Viral hepatitis :
GPT is increased, GOT is normal, GPT / GOT >1, even more than 2.5
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Chronic hepatitis :
GPT is increased, GOT is increased, GPT / GOT is about 1.
Liver cancer, cirrhosis, alcohol – induced hepatitis :
GPT is increased, GOT is increased, GPT/GOT < 1,about 0.6 ~ 0.7
Acute myocardial infract :
GPT / GOT < 1

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