Liver Function Tests

PETER S. AZNAR, M.D., F.P.S.P.

Liver
Hepatic lobule
Jaundice
can be detected clinically when the total
serum bilirubin level rises higher than 2 to 3
mg/dL (34-51 umol/L).
Conversion Factor from
Conventional Unit to SI unit of
Bilirubin
1 mg/dL = 17.1


Kernicterus
When values of bilirubin exceeds 20
mg/dL and will cross the BBB, and be
deposited in the brain leading to
seizures
Computation for Bilirubin
TB = Total Bilirubin
DB = Direct Bilirubin [water soluble]
IB = Indirect Bilirubin [water
insoluble]
TB = DB + IB
Breakdown of Hemoglobin
Hemoglobin
Heme + globin
Biliverdin
Bilirubin
Liver
Albumin
Conjugation w/
bilirubin glucorunide
Indirect
bilirubin
Conjugated
bilirubin
Urobilinogen
Urine
Pre-hepatic
Hepatic
Post-hepatic
Causes of Hyperbilirubinemia
Pre-hepatic (increased IB)
Hemolytic anemias
Burns

Hepatic (increased DB, IB, GGT)
Liver injury
Hepatic carcinoma
Hepatitis
Cirrhosis

Post-hepatic (increased DB, ALP)
Carcinoma of the bile ducts
Gall stones

Post hepatic Jaundice
Chemistry for Bilirubin
Jendrassik and Grof (1938)


Evelyn and Malloy
diazotization method
Bilirubin + diazotized sulfanilic acid = azobilirubin ( purple color)

Liver Enzymology
Alanine Aminotransaminase (ALT)

Alkaline Phosphatase (ALP)

Gamma Glutamyl-Transferase (GGT)
formerly known as Serum Glutamic Pyruvate
Transaminase (SGPT)
Alanine Aminotransaminase (ALT)
if increase is massive (e.g. > 100 units)
indicative of viral hepatitis
Causes of elevated Serum Aminotransferase Levels

Causes Magnitude of ALT or AST
Increase (Multiples or ULN)

Obesity <2
Chronic alcohol abuse
Strenuous exercise

Chronic hepatitis <5
Cirrhosis
Neoplasia

Cholastatic jaundice <10

Acute Viral hepatitis >10
Acute drug-induced hepatitis
Alkaline Phosphatase (ALP)
marker increased in obstructive liver disease

maybe also increased in primary bone tumors

placental ALP (Regan isoenzyme)
Causes of Elevated Serum Alkaline Phosphatase Levels

Cause Magnitude of ALP
Increase
(Multiples of ALP)

Acute hepatitis (viral, toxin, drug, or alcohol-induced) 2
Cirrhosis
Acute fatty liver

Postnecrotic cirrhosis
Infectious mononucleosis 5

Cholestatic hepatitis (especially drug-induced)
Extrahepatic cholestasis (caused by gallstones or neoplasms) 10

Primary biliary cirrhosis 15-20
Carcinoma (primary or metastatic)
Gamma Glutamyl-Transferase
(GGT)
marker increased in alcoholism
Most Sensitive Hematologic
Test Associated with Liver
Function
Prothrombin Time (PT)

Liver Dependent Clotting
Factors:
Factor IX
Factor X
Factor VII
Factor II

Serum Serologic Studies
Hepatitis B Surface Antigen

also known as HBsAg
present in carrier states
earliest marker for hepatitis to be detected
if patient (90%) recovers, it is replaced by
Hepatitis B surface antibody (HBs)

if there is persistence for more than six months
results to chronic carrier state and maybe
associated with hepatocellular carcinoma

Hepatitis B core Antigen
Otherwise known as HBcAg

the only marker for hepatitis present in
window phase
Hepatitis B Envelope Antigen (HBE)
Marker of infectivity
Hepatitis B Surface Antibody
Otherwise known as HBs
if present indicates:
convalescence
recent immunization
Other Serum Protein Markers for
Hepatic Disease
Alpha Fetoprotein (AFP)

Alpha
1
Antitrypsin (AAT)

Ceruloplasmin

Alpha Fetoprotein (AFP)
Marker increased in liver carcinoma

maybe also increased in open neural tube
defects

maybe secondary to aflatoxin
Alpha
1
Antitrypsin (AAT)
Maybe increased with panacinar
emphysema

Ceruloplasmin
Oxidase enzyme and a donor for copper

If decreased, is diagnostic of Wilsons
disease

Maybe associated with Kayser-Fleischer
Rings in cornea
Thank You!