LIVER FUNCTION TEST

Erwin Taher
Dept.Patologi Klinik
UISU Medan

The liver
Both a metabolic and excretory organ
Has double blood supply:
Hepatic artery-oxygenated blood
Portal vein-nutrient rich blood
Unique anatomic structure:
* Series of plates of hepatocytes that radiate from a
central vein
* Hepatocytes in contact with bloodstream on one side
and bile canaliculi on the other
* Between plates are vascular spaces (sinusoids)
* Kupffer cells phagocytic macrophages

Functions of the liver

Metabolic
Storage
Excretory/Secretory bile excretion
Protective
Circulatory large blood storage organ
Coagulation production of clotting
factors

Liver function tests

May measure synthetic function
May indicate damage to cells:
determination of specific enzymes may be used to show
the location of liver damage (ducts / hepatocytes).

May measure excretory function

Test for Synthetic function

Serum proteins,albumin and prothrompin time

Total proteins: 6-8g/dl
Serum Albumin: 3.5-5gm/dl
Albumin (20 days) indicate chronic changes
non hepatic causes (loss: nephrotic), intake, impaired
absorbtion)
INR (impaired synth. of coag factors, defective
absorption of vit K)
give vit K: respondvit K deficiency
no response liver

Tests that indicate damage to cells

Enzymes that leak when liver cells are damaged
-AST = aspartate aminotransferase
Non-specific to liver: heart, skeletal
muscle, blood
-ALT = alanine aminotransferase (more
specific for liver disease).
-AST: cytosol & mitochondria
-ALT: Only cytosolic, thus in acute hepatitis,
higher AST activities indicate more severe
hepatocellular injury.

 Serum AST and ALT are elevated to some extent in

nearly all hepatocellular disorders. Highest levels (10100 fold) are found in acute viral hepatitis. Lesser
elevations (2-5 fold) are seen in chronic liver diseases
(chronic active hepatitis, cirrhosis and hepatocellular
carcinoma)
Serum AST has a shorter half-life than ALT. Thus in
follow up, AST is a better indicator of recovery.
AST is also present in the red blood cells thus
haemolysis interfere with AST measurements.

Test of excretory function (con.)

Alkaline Phosphatase (ALP):
Enzyme found in many body tissues: liver,
bone, Kidney, intestine and placenta.
>80% in liver and bone.
Component of cells lining bile ducts.
ALP level in cholestasis.
ALP >3- 5X: cholestatic disease
doesnt differentiate intra / extrahepatic

Test of excretory function (cont.)

Gamma-Glutamyl Transpeptidase (GGT):
Enzyme produced in bile ducts,
sensitive and not specific: increase in
other diseases / drugs
used to confirm liver source of ALP
t = 7-26 days
with alcohol ingestion.

Summary
Liver function test

Acute hepatitis

CLD

Obstructive Jaundice

ALT/AST
Bilirubin
Viral markers

Albumin
INR
Bilirubin

Bilirubin / direct
ALP
GGT