PRESENTER: SHAMIMA RAZIA BSc.MLT FINAL YEAR MODERATOR: DR.

SHIVANI JASWAL

DETERMINATIONS: Serum bile acids [synthesis & determination]

Serum cholinesterase Plasma coagulation protein

Prothrombin time
Fibrinogen Serum /plasma urea

Serum/plasma ammonia
Total serum cholesterol

TEST FOR EXCRETION OF FOREIGN SUBSTANCES: Bromsulphthalein test TEST FOR DETOXIFYING FUNCTION: Hippuric acid synthesis test

CHOLESTROL
NADP+H++O2 NADP+

 Imp. Determination in the evaluation of a patient

with suspected liver disease.

Increased serum bile acids is a result of decreased

liver uptake or altered metabolism.

 Patient with liver disease, the 2 hr PP serum bile acid

level increase is imp. detectable abnormality.

Increased serum bile acid conc. In the fasting state

suggest impaired hepatic uptake or secretion.

Increased fasting serum bile acid with ratio of cholic

acid:chenodeoxycholic acid is >1 is observed in primary cirrhosis & intrahepatic cholestatic condition

Prealbumin, Ceruloplasm, -1-antitrypsin, Hepatoglobin are synthesized by liver cells.

CLINICAL SIGNIFICANCE-:
In severe liver disease & also in chronic active liver disease low values of all these proteins are observed .

Synthesized by hepatocytes .
Patient with viral hepatitis, cirrhosis, tumors & liver

disease secondary to cardiac disease, low serum cholinesterase values are observed.
Assay may have prognostic value. Serum cholinesterase values return to normal in the

recovery phase of acute hepatitis

 Synthesized in liver . Parenchymal liver disease of sufficient severity to impair

protein synthesis or obstructive disease.

The fat soluble vit.K is a potential cause of bleeding

disorder.
Testing for coagulation defect is conducted to follow the

progress of the liver disease or to assess risk of bleeding .

 May be prolonged due to lack of vit.K absorption in

obstruction or lack of synthesis in hepatocellular disease.

It is abnormal in coagulation defects due to liver

disease.
Imp. Use of coagulation tests in liver disease ,are

patient is in the evaluation of clotting process before liver biopsy.

 Formed in the liver & its normal range in plasma is

200-400 mg/dl .
Only in considerable damage the values may decrease

(below 100 mg/dl).

Low values are reported in severe acute liver

insufficiency, acute hepatic necrosis, poisoning from tetrachloride & in advanced stages of liver cirrhosis.

Patient with end stage liver disease synthesis of urea is affected & low values of serum urea are observed.

 Synthesis of urea from ammonia is decreased with

increase in ammonia concentration in blood .

Excess ammonia exerts toxic effects on the CNS.

 Increased value observed in intra hepatic

cholecystitis or in post hepatic jaundice .

Increase in primary biliary disease.

BROMSULPHTHALEIN (BSP) TEST: Also known as removal of injected substances .

When BSP dye is injected, it circulates in the blood in

combination with albumin.

Most sensitive & dependable liver function test. More useful in the diagnosis of liver cell damage without

clinical jaundice, chronic hepatitis & cirrhosis of the liver.

5mg of BSP dye/kg of body wt. injected intravenously

Almost completely excreted in 30 mins.

In healthy adults not more than 5% of the should remain in the blood at the end of 45 mins. Dye is removed in the bile

HIPPURIC ACID SYNTHESIS TEST: Liver detoxicates benzoic acid by reacting it with glycine to form hippuric acid which is excreted in urine.
Liver is able to synthesize sufficient glycine to conjugate

with benzoic to form hippuric acid.

In normal persons, 60% of the benzoic acid should be

excreted as hippuric acid.

Smaller quantities are excreted in acute or chronic liver

damage.

Test should be begin at least 3 hrs after a light breakfast

Pt. empties the bladder & drinks Na benzoate in about 200ml of water Urine is collected for a period of 4hrs from the time of ingestion of Na benzoate Amount of hippuric acid excreted is determined
Excreted should be 4.5 gms

INFILTERATION DISEASE E.g. Metastatic tumor

CHOLECYSTITIS Common duct stone 6-20

HEPATOCELLULAR Acute viral disease

TOTAL SERUM BILIRUBIN (mg/dl) SGPT(ALT),IU SGOT(AST),IU

Usually < 4

4-8

< 100

< 200

Often >500-1000

SERUM ALKALINE PHOSPHATASE, (IU) PT

2-4 times normal

3-5 times normal

1-2 times normal

Normal

Increased in chronic disease

Increased in severe disease

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