Liver function test(lft) 09.05.16

Liver Function Test :Normally this is used in Routine lab test .Prescribed by Consultant or General Physician.

1. Liver Function Test(LFT) By: Shahid Nawaz

2. Functions The liver is a reddish brown wedge-shaped organ with four lobes of unequal size and shape. A human liver normally weighs 1.44– 1.66 kg  ( 3.2– 3.7 lb ).

3. It’s important to remember that diagnosis of liver disease depends on a combination of patient history, physical examination, laboratory testing, biopsy and sometimes imaging studies such as ultrasound scans. What are liver function tests?

4. Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in our blood . Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Definition

5. The Role of the Liver is to keep the Body’s Complex Internal Chemistry in balance. It takes Raw Nutrients From Our Digestive System In the form of carbohydrates, protein, amino acids Processes them so they can be stored and sent to different parts of our body in the right form and quantity. Liver regulates the level of sugars in our blood and manufactures bile (which breaks down fats in our stomach). It also helps to remove Toxins, Drugs and Hormones from our Bloodstream. This brief explanation does the liver little justice - it actually carries out over 1,500 complex biochemical functions. Role of The Liver

6. Liver function tests can be used to: Screen for liver infections, such as hepatitis Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working Measure the severity of a disease, particularly scarring of the liver (cirrhosis) Monitor possible side effects of medications Why it's done

7. ALT is an enzyme made by cells in the liver. The liver is the body’s largest gland. It has several important functions, including: making proteins storing vitamins and iron removing toxins from the blood producing bile, which aids in digestion Alanine transaminase (ALT)

8. ALT Is an enzyme produced in hepatocytes (the major type of liver cells). ALT level in the blood is increased when hepatocytes are damaged or die - all types of hepatitis (viral, alcoholic, drug induced etc ) cause hepatocyte damage. Levels of ALT may equate to the degree of cell damage but this is not always the case, particularly with hepatitis C. An accurate estimate of liver cell damage can only be made by liver biopsy. Alanine transaminase (ALT)

9. Relatively low concentrations in other tissues so more specific than AST . Levels fluctuate during the day Rise may occur with the use of certain drugs or during periods of strenuous exercise. Alanine Transaminase (ALT)

10. The ALT test is usually used to determine whether someone has liver injury or failure. symptoms of liver disease, including : jaundice, which is yellowing of the eyes or skin dark urine nausea vomiting right upper quadrant abdominal pain Alanine transaminase (ALT)

11.   Proteins called enzymes help the liver break down proteins so the body can absorb them more easily. ALT is one of these enzymes. It plays a crucial role in metabolism, the process that turns food into energy . ALT is normally found inside liver cells . when the liver is damaged or inflamed, ALT can be released into your bloodstream. This causes serum ALT levels to rise . Normal Values :  7 to 55 ( U/L) Alanine transaminase (ALT)

12. AST is an enzyme found in various parts of the body. The highest concentrations are found in muscle, heart, and liver. A small amount of AST is typically found in the bloodstream. Elevated amounts of this enzyme may signal a health problem. Aspartate aminotransferase (AST)

13. Symptoms weakness loss of appetite nausea or vomiting swelling in the abdomen yellow skin or eyes (jaundice) dark urine severe skin itching Aspartate Transaminase (AST)

14. AST Is similar to ALT , but less specific for liver disease because it is also produced in body muscle cells. It does tend to be higher than ALT in cases of alcohol-related liver disease. Aspartate Transaminase (AST)

15. • Occurs in two Isoenzyme, indistinguishable on standard AST assays. • The mitochondrial Isoenzyme is produced in hepatocytes and reacts to membrane stresses in a similar way to ALT. • The cytosolic Isoenzyme is present in skeletal muscle, heart muscle and kidney tissue. • Caution must be exercised in its use to evaluate hepatocellular damage. • Usually rises in conjunction with ALT to indicate hepatocellular injury: a Hepatitic picture. Aspartate Transaminase (AST)

16. This test may also be ordered for people at high risk of developing liver problems. exposure to viruses that cause hepatitis heavy alcohol use family history of liver disease diabetes being overweight Normal Values: 8 to 48 U/L Aspartate Transaminase (AST)

17. Alkaline phosphatase is an enzyme found in our bloodstream . ALP helps break down proteins in the body and exists in different forms, depending on where it originates. It is mostly produced in our liver, but some is also made in our bones, intestines, and kidneys. Alkaline phosphatase (ALP).

18. ALK Phosphatase Refers to Alkaline Phosphatase, a family of enzymes produced in the bile ducts, intestine, kidneys, placenta and bones. These levels may rise when disease of the bile ducts or bone disorders occur. ALK Phosphatase

19. • A group of Isoenzyme that act to dephosphorylate a variety of molecules throughout the body. • Produced in the membranes of cells lining bile ducts and canaliculi. • Released in response to the accumulation of bile salts or cholestasis. • Non-hepatic production in the kidney, intestine, leukocytes, placenta and bone. • Physiological rise in pregnancy or in growing children. • Pathological rise in Paget’s disease, renal disease and with bone metastases. ALK Phosphatase

20.   Higher levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases . Abnormal levels of ALP also indicate malnutrition, kidney tumors, or a serious infection. The normal range of ALP varies from person to person and depends on your age, blood type, gender. Normal Values : 45 to 115 U/L ALK Phosphatase

21. Proteins are important building blocks of all cells and tissues. Proteins are necessary for our body’s growth, development, and health. Total Protein contains albumin and globulin. Albumin proteins keep fluid from leaking out of your blood vessels. Globulin proteins play an important role in our immune system. Total Protein

22. Low total protein may indicate : bleeding liver disorder kidney disorder, such as a nephrotic disorder or glomerulonephritis malnutrition extensive burns inflammatory conditions delayed post-surgery recovery Total Protein

23. Elevated total protein may indicate: inflammation or infections, such as viral hepatitis B or C, or HIV bone marrow disorders, such as multiple myeloma disease Normal Values Total Protein : 6.3 to 7.9 g/dL Total Protein

24. Albumin Provides a gauge of nutritional status. Can be reduced due to liver damage and kidney disease. Because albumin is made in the liver, levels tend to drop with cirrhosis. Albumin

25. Globulin Describes the specific level of globulins - which include antibodies. This measure can be raised when liver cells are damaged due to autoimmune liver damage or to long-standing liver disease of many types, particularly when cirrhosis exists. Globulin

26. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia. Bilirubin

27.  In an adult, high bilirubin may be due to problems with the liver, bile ducts, or gallbladder. Examples include: drug toxicity liver diseases like hepatitis cirrhosis (scarring of the liver) cancer of the gallbladder or pancreas Gallstones Normal Values : 0.1 to 1.2 mg/dL Bilirubin

28. GGT test measures the amount of the enzyme GGT in our blood. Enzymes are molecules that are necessary for chemical reactions in our body. GGT functions in the body as a transport molecule, helping to move other molecules around the body. It plays a significant role in helping the liver metabolize drugs and other toxins. gamma-Glutamyl transpeptidase (GGT)

29. GGT is concentrated in the  liver.   it’s also present in the gallbladder, spleen, pancreas, and kidneys. GGT blood levels are usually high when the liver is damaged.  gamma-Glutamyl transpeptidase (GGT)

30. The symptoms of liver problems include: decreased appetite vomiting or nausea lack of energy abdominal pain jaundice, which is a yellowing of the skin unusually dark urine light-colored feces itchy skin Normal Values : 9 to 48 U/L gamma-Glutamyl transpeptidase (GGT)

31. Normal Values & Changes