Stredm.
12.6 LIVER FUNCTIONTESTS
Liver function tests are the tests to diagnose and monitor disease or damage of the liver.
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).
Aonitor possible side effects of medications.
Biochemistry and Clinical Pathology (S.Y. D.Pharm) 12.18 Organ Function Tests
The tests are listed in flowchart 12.2.
Liver Function Tests
Serum albumin Blood liver Blood Markers of Blood
enzymes bilirubin liver fibrosis coagulation factors|
Alanine amino Total
transferase (ALT) bilirubin Prothrombin
time (PT)
Aspartate amino Direct
transferase (AST) bilirubin
Gamma glutamyl Indirect
transferase (GGT)
bilirubin
Alkaline
phosphatase (ALP)
Flowchart 12.2 Classification of liver function test
Serum Albumin:
Albumin is present in higher concentrations than other plasma proteins (~40 g/L in
normal adults). Albumin is synthesized in liver and has a half-life of 20 days. Very small
amounts of albumin cross the glomerular capillary wall. Sometimes, it can be
detected in
urine by ordinary laboratory means due to physiological or pathologicalconditions, then it
known as Albuminuria. is
A serum albumin test is a simple blood test that
measures the amount of albumin in
blood. The typical value for serum albumin in blood is 3.4 to 5.4
g/dL. Low albumin levels can
indicate a number of health conditions, namely, liver disease,
malnutrition, nephritic syndrome or nephrotic syndrome, Crohn's disease,inflammation, shock,
celiac disease etc.
Blood Liver Enzymes:
Alanine Transaminase (ALT): ALT is an enzyme
found in the liver that helps convert
proteins into energy for liver cells. When the liver is
blood stream and levels increase.
damaged, ALT is released into the
This test measures the level of
aminotransferase. This test may be performed to assess liver alanine
treatment of acute liver disease, such as function, and/or to evaluate
hepatitis. This enzyme is also known as
glutamic pyruvictransaminase (SGPT). The normal serum
7 to 56 units per litre of serum.
range of values for ALT (SGPT) is about
Aspartate Transaminase (AST): AST is an
AST is normally present in blood at enzyme that helps metabolize amino acids.
low
transaminase. This enzyme is found in liver,levels. This test measures the level of aspartate
red blood cells. This enzyme is kidneys, pancreas, heart, skeletal muscle,
released into the blood stream after arno
problems but especially after acute liver cell liver or heat
damage. An increase in AST levels may
Biochemistry and Clinical Pathology (S.Y. D.Pharm) 12.19 Organ Function Tests
indicate liver damage, disease or muscle damage. This is also known as serum glutamic
Oxaloacetic transaminase (SGOT). The normal range of values for AST (SGOT) is about
sto 40 units per litre of serum (the liquid part of the blood).
Alkaline Phosphatase (ALP): ALP is an enzyme found inthe liver, biliary tract, and bone.
It is important for breaking down proteins. Higher-than-normal levels of ALP may
indicate liver damage or disease and also to find liver lesions that may cause biliary
obstruction, such as tumors or abscesses, blocked bile duct, or certain bone diseases.
Normal level is 3-12 Aunits. This test is used to measure the level ofalkaline phosphatase
(an enzyme) in the blood.
Gamma-Glutamyltransferase (GGT): GGT is an enzyme in the blood. Higher-than
normal levels may indicate liver or bile duct damage. This test measures the level of
gamma-glutamyl transpeptidase. This enzyme is made in the liver, pancreas, and biliary
tract. This test is often performed to assess liver function, to provide information about
liver diseases, and to detect alcohol ingestion. The normal range for adults is 5 to 40 U/L.
Blood Bilirubin:
Bilirubin is a substance produced during the normal breakdown of red blood cells. The
test measures the levels of bilirubin in the blood. Bilirubin is made by the liver and is excreted
inthe bile. Elevated levels of bilirubin (jaundice) may indicate an obstruction of bile flow or a
problem in the processing of ble by the liver and might indicate liver damage or disease or
certain types of anemia. Normal values are about 0.1 to 1.0 mg/dL.
Bilirubin attached by the liver to glucuronic acid, a glucose-derived acid, is called direct,
or conjugated, bilirubin. Bilirubin not attached to glucuronic acid is called indirect, or
unconjugated, bilirubin. AIlthe bilirubin in blood together is known as total bilirubin.
Prothrombin Time (PT):
This test measures how long it takes for blood to clot. Blood clotting needs vitamin Kand
a protein that is made by the liver. A typical PT result is 10to 14 seconds. Higher than that
means blood is taking longer than normal to clot and may be a sign of many conditions,
including:
Bleeding or clotting disorder
Lack of vitamin K
Lack of clotting factors
Liver disease
If the PT value shows a lower number and the blood clots faster than normal, this could
De trom taking supplements or eating foods high in vitamin
K.
Table 12.4 shows normal ranges for different liver function tests and possible
interpretations of abnormal test results.
Biochemistry and Clinical Pathology (S.Y. D.Pharm) 12.20 Organ Function Tests
Table 12.4: Different Liver Function Tests
and Possible Interpretations of Abnormal Tests
Test Normal Ranges Abnormal Results
Alanine Transaminase 7 to 56 units per litre Higher than normal results are a
(ALT)
sign of:
of serum hepatitis
cirrhosis
liver cancer
Aspartate 5to 40 units per litre Higher than normal results are a sign of.:
Transaminase (AST) of serum steatohepatitis
cirrhosis
liver damage due to alcohol
consumption
pancreatitis
thyroid disease
mononucleosis
hepatitis
Alkaline Phosphatase 3-12 Å units Higher than normal results are a sign of.
(ALP) hepatitis
cirrhosis
cholecystitis
problems with bile duct, such
as gallstones, inflammation, or cancer
bone disease
mononucleosis
Lower than normal results are a sign of:
malnutrition
heart failure
certain types of cancer
Gamma 5 to 40 U/L Higher than normal results are a sign of:
Glutamyltransferase alcohol use disorder
(GGT) hepatitis
cirrhosis
liver cancer
blocked bile duct
pancreatitis
diabetes
heart failure
mononucleosis
Bilirubin 0.1 to 1.0mg/dL Higher than normal results are a sign of.
Compromised liver function, which
requires further testing
mononucleosis
Biochemistry and Clinical Pathology (S.Y. D.Pharm) 12.21
Organ Function Tests
Test Normal Ranges Abnormal Results
Albumin 40-60 g/L Higher than normal results are a sign of:
dehydration
severe diarrhoea
Lower than normal results are a sign of:
malnutrition
infection
C
cirrhosis
kidney disease
thyroid disease
Prothrombin Time 10 to 14 seconds Longer than normal results are a sign of.
(PT) compromised liver function, which
requires further tests
blood clotting disorder
side effects of blood-thinning
medications
vitamin Kdeficiency
Markers of Liver Fibrosis:
Liver fibrosis is the final common stage of most chronic liver diseases, which is triggered
by chronic liver iniury and develops from aseries of events including apoptosis or necrosis,
inflammation, tissue remodelling and repair processes. Liver fibrosis markers are
mainly
divided into indirect and direct markers of fibrogenesis and fibrinolysis. The main source of
myofibroblasts. Injury to
fibrosis in the liver is derived from hepatic stellate cells (HSCs) and
activation of HSCs initially causing
the liver leads to the production of cytokines and to the change and scarring within the
liver inflammation, and then to potentially irreversible subcategorized into enzymatic markers,
extracellular matrix tissue. Direct markers are
collagen (and related) markers, glycoproteins
and matrix-metalloproteinase markers, and
qlvcosaminoglycan markers. Class II biomarkers
provide an indirect reflection of liver ECM
activity and fibrosis through the measurement
of liver function or injury.
prothrombin time (PT/INR), bilirubin,
Markers of Synthetic Function, such as
ag-macroglobulin, ceruloplasmin, transferrin and
haptoglobin, albumin, Apolipoprotein Al,
hepcidin. ferritin, and
indirectly measured markers, such as platelet count, a1-antitrypsin,
Other
certain adipokines.
ClinicalSignificance: Table 12.5.
clinical significance are listed in Significance
Liver function tests and their
Tests and their Clinical
Table 12.5: Liver Function Clinical Significance
Liver Function Tests alcoholism
ALT is lower than AST in
ALT measures liver protein synthesis
Assess severity or chronicity
Albumin hepaticinfiltrations
Diagnose cholestasis and
ALP
Earlydiagnosis and monitoring of hepatic necrosis
AST marker of cholestasis
Diagnose alcoholabuse
GGT cholestatic liver disease
Assess severity of protein
Total bilirubin severity of liver disease, measure of liver
Assess
Prothrombin time
synthesis
