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Tests that are of very much useful to diagnose and monitor the liver diseases are called as liver function tests.
Functions of liver
Excretion of bile pigments, bile salts, BSP(Bromsulphthalein ) and ICG(indocyanin green) Metabolism of carbohydrates, amino acids and lipids. Synthesis of serum proteins albumin and prothrombin. Detoxification of ammonia and hippuric acid. Serum enzymes.
Classifiation
Tests based on Excretory function Tests based on synthetic function. Tests based on metabolic capacity of liver Tests based on serum enzymes.
Tests in urine
Bile pigments Fouchets test. Bile salts Hays test
Jaundice
Jaundice is increased levels of Ser Bil > 1.0 mg%. Latent jaundice - >1mg%, <2mg% Types of Jaundice : 1.Pre hepatic From hemolysis of RBC (Hemolytic) 2.Hepatic - Hepatocellular dysfunction in handling bilirubin - Uptake, Metabolism and Excretion of bilirubin 3.Post hepatic - Obstruction to bile flow (Obstructive)
Intrahepatic cholestasis Extrahepatic Obstruction (Surgical Jaundice
Table of diagnostic tests Function test Total bilirubin Conjugated bilirubin Unconjugated bilirubin Urobilinogen Urine Color Stool Color Alkaline phosphatase levels ALT and AST levels Conjugated Bilirubin in Urine Increased Present Increased Pre-hepatic Jaundice Normal / Increased Hepatic Jaundice Increased Normal Normal / Increased Normal / Increased Dark Pale Increased Increased Normal Decreased / Negative Post-hepatic Jaundice
The amino 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 is esterified. Obstructive jaundice increase in TC A/c Hepatic necrosis TC is usually low and may fall below 100mg%, and also marked decrease in % of esters.
Tests based on synthetic function Blood albumin level 1.all serum proteins are synthesised by the liver
except immunoglobulins. 2.Serum albumin is quantitatively the most important protein synthesised by the liver and reflects the functioning of liver cell mass. 3.it is not a good indicator of acute liver diseases as 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
Prothrombin time Prothrombin is synthesised by the liver. Vit K deficiency as the cause for prolonged PT may be ruled out by estimating the PT before and after parenteral administration of Vit K. In case of liver disease the PT remains prolonged even after administration of vit K. Prolonged PT poor prognosis.
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 cell membranes & is associated with transport mechanisms in liver, kidney & intestinal mucosa. Very high levels cholestasis or hepatic ca. The bile duct obstruction induces the synthesis by the biliary tract epithelial cells. Parenchymal liver diseases mild elevation
GGT : It transfers gamma glutamyl residues. Moderate elevations seen in infective hepatitis and prostrate cancer, MI, panreatic disease, renal failure, COPD. Highly elevated in alcoholism, obstructive jaundice and neoplasms of the liver. GGT elevation parallels that of ALP & is very sensitive to biliary tract disease.
5'Nucleotidase
It is a marker enzyme for plasma membranes ans is seen as an ectoenzyme. 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.