Liver Function Test (Autosaved)

LIVER FUNCTION
TEST
P R E S E N T E D BY -A L PA N A R O S H Y T I R K E Y
GUIDED BY- DR. KALPANA
R O L L N O. 1 0 NAYAK DHRUW MA AM
INTRODUCTION
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
 Liver function tests are blood tests used to
help diagnose and moniter liver disease or
damage.
The tests measure the levels of certain

enzymes and proteins in our blood.
Normal functions of the liver
1. Synthetic functions – synthesis of plasma
proteins, cholesterol , triacylgycerol and
lipoprotein .
2. Metabolic function -
protein metabolism,ketogenesis, TCA cycle,
production of ATP.
3. Detoxification and excretion- ammonia to
urine, bilirubin , cholesterol, drug metabolites.
4. Homeostasis- blood glucose regulation.
5. Storage function- vitamin A,D,K,B12
6. Production of bile salts
Why it is done ?
Screening- they are non invasive yet sensitive
modality for liver dysfunction.
Pattern of disease- they are helpful to recoginize
pattern of various disease. Like being helpful in
differentiating between acute viral hepatitis and
various cholestatic disorders and chronic liver disease.
Assess severity- they are helpful to assess the
severity and predict the outcome of certain diseases
like primary biliary cirrhosis.
Liver function test
Bilirubin
Tests for
Urobilinogen
productio
n and Bile acid ( Bile salts)
excretion
Bromosulphtalein
of bile
excretion
1. Bilirubin – bilirubin pigment can be detected in
serum, faeces and urine.
 Serum bilirubin estimation- it is based on van
den Bergh diazo reaction by spectrophotometric
method .
 Water soluble conjugated bilirubin gives direct
van den Bergh reaction with diazo
reagent( reagents consists of diazotised sulfanilic
acid)
 Alcohol soluble unconjugated bilirubin is
determined by indirect van der Bergh reaction.
 The unconjugated bilirubin level is then estimated by
substracting direct bilirubin value from this total
value.
The serum of normal adults contains less than 1
mg/dl of total bilirubin out of which less than 0.25
mg/dl is conjugated bilirubin.
Bilirubin level rises in- disease of hepatocyte
- obstruction to biliary excretion to
duodenum
- Haemolysis
Faeces – excretion of bilirubin is assessed
by inspection of stools. Clay colour stool due
to absence of faecal excretion of pigment
indicate obstructive jaundice .
Urine- presence of biliorubin imparts deep
yellow colour urine.
2. Urobilinogen- * Urobilinogen is normally excreted in
urine * Increased in urobilinogen in urine is
found in hepatocellular dysfunction
3. Bile acid( Bile salts)- *
The primary bile acid( cholic acid and
chenodeoxycholic acid) are formed from cholesterol in
the hepatocyte * The primary bile acid get coverted
into secondary bile acid ( deoxycholic acid and
lithocholic acid) by the action of colonic bacteria
in gut by deconjugation. *
Only about 10% of bile acid are excreted
4.Bromosulphthalein excretion-
* Bromosulphthalein is a dye
injected intravenously and a
venous blood sample 45 min later is
tested for percentage of injected dye
remaining in the blood
* Normally there is <5% retention
* presently it is only used for

diagnosis of Dubin- johnson syndrome
Alkaline Phosphatase
 - Glutamyl Transpeptidase
(GGT)
Serum
enzyme Transaminase
assays ( Aminotransferases)
Other Serum enzyme

1. Alkaline phosphatase -
* It is produced by many tissues especially
bone, liver,intestine and placenta and is
excreted in the bile.
* The greatest elevation (3 to10
times) occurs in biliary tract obstruction .
* Slight to moderate increase is
seen in parenchymal liver disease like hepatitis,
cirrhosis , metastatic liver disease.
2. - glutamyl tranpeptidase (GGT) - * The
primary source of GGT in serum is the liver.
* Used to confirm that the elevated serum
alkaline phosphate is of hepatobiliary origine.
3.
Transaminase( Aminotransferase)- 
Serum aspartate transaminase (AST) or
formerly
glutamic oxaloacetic transaminase(SGOT) * It is
mitochondrial enzyme released from heart ,liver
skeletol muscle and kidney .
( Normal serum level 12-38 U/L)
 Serum alanine transaminase (ALT)
or
formerly glutamic pyruvic
transaminase ( SGPT) * It is cytosolic
enzyme primarily present in liver
( Normal serum level 7-41 U/L)
4. Other serum enzymes

* 5- Nucleotidase -its
determination is useful to distinguish
alkaline phosphatase of hepatic
origine from that of bone tissue.
Amino acid and plasma protein
metabolism
Tests for
Lipid and lipoprotein metabolism
metabolic
function
Carbohydrate metabolism
1. Amino acid and plasma protein metabolism-
> Serum protein – the blood level of
plasma protein are decreased in extensive liver
damage. Normal level
serum protein- 6.7 to 8.6
gm/dl serum albumin- 3.5
to 5.5 gm/dl serum globulin –
2 to 3.5 gm/dl albumin
globulin ratio(A/G)- 1.5 to 3.1
> immunoglobulins
* IgA is predominant immunoglobulin in bile
its level raised in cirrhosis.
* IgG is markedly raised in chronic active
hepatitis
* IgM markedly increased in primary biliary
cirrhosis.
* Polyclonal increase in IgG indicative of
autoimmune hepatitis .
>Clotting factor
* Prothrombin time and
partial thromboplastin , both of which reflect the
activity of various clotting factor , are prolonged
in the patient with hepatocellular disease like
acute viral hepatitis .
>Carbohydrate
metabolism
*Blood glucose level is lowered in fulminant
acute hepatic necrosis.
* Impaired glucose tolerance and relative
insuline resistance in chronic liver disease.
>Lipid and lipoprotein metabolism
* There is rise in total serum cholesterol in
cholestatis ,probably due to retention of
cholesterol which is normally excreted in bile .
Serum triglyceride is also elevated in
cholestasis.
* The values are lowered in acute and
chronic diffuse liver disease and
malnutrition.
Non specific immunologic
reaction
Immunologic
test
Antibodies to specific
etiologic agents
>Nonspecific immunologic test – these include
following
*Anti-smooth muscle actin (SMA) antibody –
formed in autoimmune hepatic disorder.
*Anti-nuclear antibody(ANA), anti soluble liver

antigen, anti-liver-kidney-microsome(LKM)-1 -
formed in autoimmune hepatitis.
*Anti-mitochondrial antibody- develops

in patient with primary biliary cholangitis .
*Anti-neutrophilic cytoplasmic antibody-
develops in patient with primary sclerosing
cholangitis.
>Antibodies to specific etiological agent
* IgM antibody against hepatitis A in hepatitis A.
* Hepatitis B core antibody(HBc) in patient of

hepatitis B.
*HCV antibody and HCV RNA in hepatitis C.
*Amoeba antibody to Entamoeba histolytica

develops in patient with amoebic liver abscess.
Ultrasonography
Other
diagnostic
test FNAC and/or
percutaneous liver
biopsy
1. Ultrasonography- indicated in the following
situation
> Cholestasis of various etiology to see dilated
intra and extrahepatic canalicular
tree.
> Space occupying lesion within the liver to

determine whether they are
neoplasm or non- neoplastic cysts.
>To provide USG guidance for FNAC or biopsy

2. FNAC or percutaneous liver biopsy-
indication of biopsy are
> Hepatocellular disease of unknown
cause
> Suspected case of chronic hepatitis
> Hepatomegaly of various etiology
> Fever of unknown cause
> SOLs visualised in radiological
examination
Thank you……………

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LIVER FUNCTION

The tests measure the levels of certain

* Normally there is <5% retention

* presently it is only used for

Other Serum enzyme

4. Other serum enzymes

*Anti-nuclear antibody(ANA), anti soluble liver

*Anti-mitochondrial antibody- develops

* Hepatitis B core antibody(HBc) in patient of

*HCV antibody and HCV RNA in hepatitis C.

*Amoeba antibody to Entamoeba histolytica

> Space occupying lesion within the liver to

>To provide USG guidance for FNAC or biopsy

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