Liver Function
Liver Function
Liver Function
Anatomy of Liver
Functions of Liver
Tests of Liver Function
Liver Diseases
How to use biochemical tests of
liver functions?
INTRODUCTION
• The liver is divided into four
lobes.
THE STRUCTURE
OF LIVER
LOBES VASCULAR
AND
BILIARY SYSTEMS
The portal vein carries blood that has
already passed through the capillary bed
of the gastrointestinal tract.
Alb 40-55g/L
TP 60-80g/L
Globulin 20-30g/L
Serum protein
electrophoresis
alpha-fetoprotein(AFP): primary
hepatocellular carcinoma
Carcinoembryonic antigen(CEA): ↑liver
metastatic carcinoma or other carcinomas of
the gastrointestinal system.
Reference Value
(AFP)
Hepatitis 25~200ng/mL
carcinoma >400ng/mL
OTHER SERUM
PROTEINS
PRODUCED BY THE
LIVER
Coagulation factors (prothrombin time )
Unconjugated hyperbilirubinemia
Increased heme catabolism
Hemolytic anemia
Hematoma
Impaired hepatic conjugation
Neonatal jaundice
Conjugated hyperbilirubinemia
Impaired hepatic excretion
Hepatocellular disease
Posthepatic obstruction
Dye intake and
Excretion
Indocyanine green retention rate
(ICGR): 15min<10%
Chronic hepatitis: 15-20%
Cirrhosis: 35%
SERUM ENZYME
TESTS
Aminotransferase
1) AST (Aspartate) and ALT (Alanine) is present in a wide
variety of tissues-including heart, skeletal muscle, kidney,
and brain in addition to liver.
Reference Value
AST and ALT: 5~40U/L
SERUM ENZYME
TESTS
MARKERS OF CHOLESTASIS ——Alkaline
phosphatase (ALP)
An indices of a blockage of bile flow Cholestasis,
which maybe intra- or extra-hepatic disease
(tumor, cirrhosis )
ADULT 25~90U/L
CHILD 50~350U/L
Plasma alkaline phosphatase activity as a function of age and
sex(—men ; …… , women). Horizontal lines refer to multiples of
the adult upper reference limit.
SERUM ENZYME
TESTS
1) The reference range for ALP is dependent on
age.
Male 11-50U/L
Female 7~32U/L
SERUM ENZYME
TESTS
1) γ -GT has been localized to the whole hepatobiliary tree-
from hepatocytes to common bile duct in the liver, and
also to pancreatic acini and ductules.
Reference value:
Total Bile Acid : 0~6µ mol/L
Summary of Liver function
tests
•A request for LFTs will usually generate results
for bilirubin, the aminotransferases and alkaline
phosphatase.
• Raised activities of the aminotransferases(AST
and ALT) indicate hepatocellular damage.
•Increased bilirubin concentration and increased
alkaline phosphatase activity indicate the presence
of cholestasis, a blockage in bile flow.
•Serial use of LFTs is of most value in following the
progress or resolution of liver disease.
•Measurement of γ GT can give an indication of
hepatocellular enzyme induction due to drugs or
Tests of Viral Hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Tests of Viral Hepatitis
A
Hepatitis A(HAV) is a kind of RNA
virus. It is transmitted by the fecal-
oral route. It is thus implicated in
most instances of water-borne and
food-transmitted infection and in
epidemics of viral hepatitis.
Serologic markers of viral
hepatitis A
Agent markersdefinition significances
It may resolve
OUTCOME
It may progress to acute hepatic
failure
It may lead to chronic hepatic
damage
Biochemic
al findings
in hepatic
failure
Cholestasis
Cholestasis represents the
demonstrable accumulation in the
blood stream of substances normally
excreted in bile (e.g., bilirubin,
cholesterol, bile acids).
Cholestatic Liver
Disease
Intrahepatic Obstruction
Intrahepatic cholestasis often results
from cirrhosis or hepatitis.
Extrahepatic Obstruction
Extrahepatic cholestasis is usually
the result of mechanical obstruction
of the common bile duct or hepatic
duct.
Chronic Liver Disease
Chronic Hepatitis
chronic active hepatitis
chronic persistent hepatitis
Cirrhosis
Liver enzyme levels in cirrhosis are variably
elevated and can be normal during the terminal
stages of the disease.
Primary biliary cirrhosis /Elevations in ALP
and aminotransferases are expected along with
high titers of antimitochondrial antibody.
Liver Cancer
The liver enzyme results tend to be more
elevated in the active form; however,
differentiation is best made by performing a
liver biopsy.
Fibrosis of Liver
tissues
Fibrosis is common to several chronic
liver diseases and as such is the
leading cause of morbidity and
mortality from hepatic disease.
Pathological evaluation
Hepatocellular injury AST, ALT
Obstruction Bilirubin, alkaline phosphatase, γ-
GT , 5 ’- nucleotidose
bile acids,
Infections
Viral and autoimmune serologies
Malignancies CEA, α-fetoprotein
ALT and AST in acute liver
injury
disease enzyme marker
Ultrasound
Detection
Intrahepatic Extrahepatic
Cholestasis Cholestasis
Case history
A 60-years-old female with a history of breast
carcinoma treated by mastectomy three years
previously is now complaining of general malaise and
bone pain. Biochemistry showed that fluid and
electrolyte, total protein, albumin and calcium values
were all normal. LFTs were as follows:
Bilirubin AST ALT Alkaline phosphatase γ
GT
µ mol/l U/l
7 33 38 890
32
Summary