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LEARNING OBJECTIVES
Liver function tests Complications of end stage
liver disease
Viral Hepatitis
Ascites
Autoimmune hepatitis SBP
Primary Biliary Cirrhosis Hepatorenal Syndrome
Primary Sclerosing Encephalopathy
Cholangitis
Hemochromatosis
Wilsons
Gallstones and
cholecystitis
LIVER FUNCTION TESTS
ALT
AST (SGOT)
ALKALINE PHOSPHATASE
BILIRUBIN
ALT and AST
Enzymes, found in Hepatocytes
Released when liver cells damaged
ALT is specific for liver injury
AST (SGOT) is also found in skeletal and
cardiac muscle
Transaminitis: < 5 x normal
ALT predominant AST predominant
Chronic Hep B / C Alcohol-related liver dz
Acute A-E, EBV, CMV Steatosis/ Steatohep
Steatosis / Steatohep Cirrhosis
Hemochromatosis
Medications / Toxins Non-hepatic source
Hemolysis
Autoimmune Hepatitis
Myopathy
Alpha-1-antitrypsin
Thyroid disease
Wilsons Disease Strenuous exercise
Celiac Disease
Severe AST & ALT Elev: >15x
Acute Viral Hepatitis Autoimmune Hepatitis
does not predict Wilsons Disease
outcome Acute bile duct obstr
Bili > 20 poor Hepatic Artery ligation
prognosis Budd-Chiari Syndrome
Ischemic Hepatitis Medications / Toxins
hypotension acetaminophen
sepsis CCl4
hemorrhage
MI
ALKALINE PHOSPHATASE
Found in hepatocytes that line the bile canaliculi
Level is raised in Biliary obstruction (causes
stretch of the bile canaliculi)
BUT also found in BONE and PLACENTA
GGT is also found in bile canaliculi and therefore
can be used in conjunction with Alk Phos for
predicting liver origin
BUT GGT can be raised by many drugs
including Alcohol and therefore non specific
BILIRUBIN
Water insoluble product of heme metabolism
Taken up by liver and conjugated to become
water soluble so it can be excreted in bile and
into bowel.
Patient looks Jaundiced if bilirubin >2.5
If patient is vomiting GREEN, then they have
bowel obstruction below the level of the Ampulla
of Vater.
WHAT IS THE DEAL WITH
DIRECT AND INDIRECT
BILIRUBIN?
Prehepatic disease (eg hemolysis) causes
high bilirubin which is non conjugated ie.
Indirect fraction higher
Hepatic disease causes increased
conjugated and unconjugated bilirubin
Post hepatic disease eg. Gallstones have
increased conjugated (direct) bilirubin and
lead to dark urine and pale stool.
So these are markers of
liver disease but are they
tests of liver function?
NO!
TESTS OF LIVER FUNCTION