LIVER FUNCTION

TESTS
MARKERS OF HEPATIC DYSFUNCTION
I.Measurement of hepatic dysfunction:
1.SERUM BILIRUBIN:
Normal :0.2-0.8mg/dl
Unconjugated:0.2-0.6mg/dl
Conjugated:0-0.2mg/dl
>1mg/dl-latent jaundice
>2mg/dl-jaundice
Estimated by VAN DENBERGH reaction:
Diazotised sulfanilic acid reacts with Bb –purple
complex=azobilirubin
Conjugated Bb-direct positive
Unconjugated Bb-color is obtained after adding alcohol-indirect
positive
Both present-biphasic
Hemolytic-indirect +
Obstructive-direct +
Hepatocellular-biphasic
2.URINARY BILIRUBIN:
BS,BP,Urobilinogen
ACHOLURIC-hemolytic
CHOLURIC-obstructive
3.URINARY UROBILINOGEN:
Hemolytic-inc
Obstructive-absent
Hepatocellular-inc initially,disappears when obstruction
sets in
II.SYNTHETIC FUNCTIONS
1.SERUM ALBUMIN:
Marker for functioning liver cell mass
T1/2=20days-chronic
Normal:3.5-5mg/dl
globulin:2.5-3.5mg/dl
A:G=1.2-1.5:1
REVERSAL-cirrhosis
Haptoglobin & transferrin-acute
2.PROTHROMBIN TIME:
T1/2=60hours
PT prolongation-80% of liver capacity lost & vit K def
But in liver disease,PT continues to prolong even after Vit
K administtration
SERUM ENZYMES
I.HEPATOCELLULAR DAMAGE:
1.ALT,AST
Normal:10-35U/L
Very high->1000U/L-acute hepatitis
ALT>AST-acute diseases
AST>ALT:>2=alcoholic
Moderate -100-300U/L-Alcoholic hepatitis,autoimmune
hepatitis,wilson
Minor-<100U/L:fatty liver,NASH,chronic hepatitis
2.OBSTRUCTIVE:
ALP:synthesised by biliary tract epithelial cells
Inc in cholestasis,cancer,hepatitis
Cancer-regan isoenzyme inc
Bone diseases-alp isoenzyme inc
GGT:
INC in chronic alcoholics,pancreatic
disease,MI,COPD,renal failure,DM
NON SPECIFIC
NUCLEOTIDASE:
Specific for obstructive type
GLUTATHIONE S TRANSFERASE
ALPHA FETO PROTEIN-HCC,chronic hepatitis
SUMMARY
COMMON TESTS:
Serum Bb,Albumin,ALP,ALT,AST,GGT
Albumin-chronicity
PT-severity
ALT & ALP-pattern of disease