Liver function tests

Biochemical tests for diagnosis of liver diseases

1. Liver Function T ests R. C. Gupta M.D. (Biochemistry) Jaipur (Rajasthan), India

2. E M B - R C G Liver perform a multitude of functions Assessment of functional status of liver generally requires laboratory tests The f unctions get deranged when liver is diseased

3. E M B - R C G The multiple functions of liver include: Metabolic functions Synthetic functions Excretory functions Detoxifying functions Storage functions

4. E M B - R C G All the tests need not be performed in every patient The tests should be selected according to the clinical symptoms and signs A number of tests are required to assess hepatic function

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8. E M B - R C G Serum bilirubin

9. E M B - R C G Plasma bilirubin comprises unconjugated bilirubin and conjugated bilirubin Normal concentration of bilirubin in plasma isː Unconjugatedː 0.1-0.6 mg/dl Conjugatedː 0.1-0.4 mg/dl T otalː 0.2-1.0 mg/dl

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11. Jaundice

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13. E M B - R C G Measurement of total, unconjugated and conjugated bilirubin in serum helps in: Detection of jaundice Distinction between different types of jaundice

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15. E M B - R C G Bile pigments in urine

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17. E M B - R C G Urobilinogen in urine

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21. E M B - R C G Bile salts in urine

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25. Haemolytic jaundice Hepatic jaundice Obstructive jaundice Serum bilirubin (total) Raised Raised Raised Serum bilirubin (unconjugated) Raised Raised Normal Serum bilirubin (conjugated ) Normal Raised Raised Bile pigments in urine Absent Present Present Urobilinogen in urine Raised Normal or decreased Absent Bile salts in urine Absent Present Present

26. E M B - R C G Serum proteins and albumin: globulin ratio

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28. E M B - R C G Serum enzymes

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33. E M B - R C G S erum ALP is mildly raised in viral hepatitis due to necrosis of parenchymal cells A marked elevation in serum ALP occurs in obstructive jaundice The rise is due to increased synthesis of ALP caused by irritation of epithelial cells of biliary canaliculi

34. E M B - R C G Prothrombin is synthesized in liver Prothrombin synthesis is decreased in hepato-cellular disease This leads to a decrease in prothrombin concentration in plasma which prolongs prothrombin time Prothrombin time

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38. E M B - R C G Galactose tolerance test

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40. E M B - R C G Hippuric acid test

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45. E M B - R C G Total hippuric acid present in urine is measured Excretion of less than 0.8 gm of hippuric acid show s impairment of hepatic function

46. E M B - R C G Bromsulphthalein (BSP) is a dye which is taken up from circulation by liver It is conjugated and is excreted in bile BSP is injected intravenously in this test Rate of removal of BSP from blood is a sensitive indicator of hepatobiliary function Bromsulphthalein test

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49. E M B - R C G Immunological tests

50. E M B - R C G Blood ammonia

51. Thank you