Chapter 5 Liver Function Tests

Chapter 5
Liver function tests
Liver function tests include the tests of protein

metabolism, the tests of bilirubin metabolism, the
tests of dye intake and excretion, the tests of
serum enzymes and the tests of viral hepatitis.
In general , the tests currently available can be
divided into two categories: the tests of hepatic
function or capacity and the screen-ing tests that
suggest the presence and /or type of liver disease.
Specific diagnostic tests such as serologic tests
for hepatitis infection are also covered in this
chapter.
Tests of protein metabolism

Serum total protein (TP),albumin (A)
and globulin (G)
The normal range of TP, A and G is
60-80g/L, 40-55g/L and 20-30 g/L .
The normal ratio of A to G (A/G) is
1.5-2.5 : 1
Increased G and decreased A
(reversed A/G) can be seen in chronic
hepatitis, cirrhosis, hepatic neoplasm .
Serum protein eletrophoresis

A 0.61-0.71 , a1 0.03-0.04 , a2 0.06-0.1 , B
0.07-0.11 , r 0.09-0.18
cirrhosis and hepatic neoplasms: A , a1, a2, B
decrease , r increase
hepatitis: in acute hepatitis : normal level,
in chronic hepatitis : A decrease, r
increase
hepatic
neoplasm markers:
alpha fetoprotein (AFP): < 25ug/ L , >

500 ug /L : primary hepatocellular
carcinoma
carcinoembryonic antigen (CEA): 0-5 ug
/L , increased CEA: liver metastatic
carcinoma or other carcinomas of the
gastrointestinal system
abnormal prothrombin (APT): < 20 ug/L,
increased APT : primary hepatocellular
carcinoma
Tests of bilirubin metabolism

serum total bilirubin(STB), serum direct
bilirubin (SDB) and serum
indirect
bilirubin(SIB)
STB : 1.7-17.1 umol/L (normal), 17-34
umol/L (latent jaundice), hyperbilirubinemia
SDB: 0-6.8 umol/L (normal), SIB: 1.7-10.2
umol/L (normal), SDB/STB 20% (normal),
urea bilirubin : normal: (-), when SDB > 34
umol/L (+)
urobilinogen: normal : (- ~ +)
Clinical significance of tests in bilirubin metabolism(umol/L)

STB
SDB
SIB
SDB/STB
URO
UBI
normal
1.7~17.1.7 ~10.2 0~6.8
20%
-~+
<20%
++~+++
hepatitis 17~200 medium medium
>35%
+~++
biliary
>60%
++
hemolysis <85
mild
significant
200~500 significant mild
obstruction
Dye intake and excretion

Indocyanine green retention
(ICGR): 15 mim: < 10%
rate
chronic hapatitis: 15~20%

cirrhosis : 35%
Serum enzyme tests

aspartate ( AST, SGOT) and alanine ( ALT,
SGPT) . The serum transaminase are
sensitive tests of liver damage. And the height
of the activity reflects the severity of hepatic
necrosis.
ALT: < 35U/L,
AST: <40U/L
elevated ALT,AST : acute hepatitis (viral or

toxic ), chronic hepatitis and cirrhosis,biliary
obstruction
Alkaline phosphatase (ALP):

Serum levels are elevated in association with
cholestasis, partial or complete bile duct
obstruction, bone regeneration, and also with
neoplastic , infiltrative, and granulomatous liver
disease. An isolated elevated ALP level may be the
only clue to partial obstruction of the common bile
duct.
ALP : 30-130 U/L ( 36-92 U/L)
elevated ALP:
bile duct obstruction, primary
hepatocellular carcinoma, hepatitis
r-glutamyl transferase (r-GT):

3~17U/L(M), 2~13 U/L(F)
elevated r-GT: hepatic neoplasm
obstructive jaundice
hepatitis
Tests of viral hepatitis

Viral hepatitis is caused by five main viruses:
hepatitis viruses A, B, C, D and E. In present,
hepatitis A , hepatitis B and hepatitis C are
more common. The ability to detect the
presence of viral components in hepatitis B
and C and antibodies to components of
hepatitis A,B, C and D has enabled
considerable progress to be made in the study
of the epidemiology of viral hepatitis. These
so-called viral markers can be diagnostic of
the cause of acute viral hepatitis.
serologic markers of viral hepatitis

agent
markers
definition
HAV
anti-HAV
antibody to HAV
IgM type
significance
current or recent infection

or convalescence
IgG type
current or previous infection

, confers immunity
HBV
HBsAG
HBV surface antigen
positive in acute
or chronic infection
HBeAG
e antigen, a component
of the HBV core
transiently positive
in acute Hepitis B ,may

reflects presence of viral
replication and infectivity
anti-HBe
antibody to e antigen transiently positive in convalescence,

may be persistently present in chronic
cases, reflects low infectivity
anti-HBc
antibody to core antigen

IgG type
positive in all acute and chronic cases,

reliable marker of infection ,past or
current
IgM type
reflects active viral replication ,

not protective
anti-HBs
antibody to surface antigen positive in late convalescence,

confers immunity, after injection of
Hepitis B vaccine
HCV
anti-HCV
antibody to HCV
positive after clinical onset(15 week),

not protective, persists in chronic
infection
Automatic biochemistry analyzer:

Using the analyzer, we can detect 14
items of liver and renal function tests
easily.
ALT, AST, CHO, ALP, GGT, TBIL,
DBIL, TP, ALB, GLB and BUN, CRE,
GLU, UA
Case analysis
History and physical examination: This 48-yearold man had complained of abdominal pain and
intermittent fever for 3 months. The pain was
usually felt in the right upper quadrant. His
appetite was not good and lost his body weight
apparently. He once suffered from hepatitis ten
years ago. Physical examination revealed the
patient who appeared chronically ill with icteric
selera. The liver was enlarged to 2 cm below the
costal margin with tenderness, and the spleen
was enlarged to 3 cm below costal margin .
Laboratory data: Hb 90g /L, WBC 8.0109/L, PC

90109/L, ALT 120U/L, AST 200U/L,ALP 255U/L,
TP 55g/L, A 25g/L, Y 40%, TBI 55umol/L, DBI
38umol/L, URO (++), UBI (+),AFP 600ug/L,
HBsAg (+), HBeAg (+), anti-HBc IgM (+)
Question:
What is your diagnosis for this patient?
Which kind of jaundice this patient has?
How to evaluate this patients liver function?
What is etiological classification for his
hepatitis?

Chapter 5 Liver Function Tests

Uploaded by

Copyright:

Available Formats

Chapter 5 Liver Function Tests

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 5 Liver Function Tests

Uploaded by

Copyright:

Available Formats

Chapter 5

Liver function tests

Liver function tests include the tests of protein

Tests of protein metabolism

Serum protein eletrophoresis

alpha fetoprotein (AFP): < 25ug/ L , >

Tests of bilirubin metabolism

Clinical significance of tests in bilirubin metabolism(umol/L)

1.7~17.1.7 ~10.2 0~6.8

hepatitis 17~200 medium medium

200~500 significant mild

Dye intake and excretion

chronic hapatitis: 15~20%

Serum enzyme tests

elevated ALT,AST : acute hepatitis (viral or

Alkaline phosphatase (ALP):

r-glutamyl transferase (r-GT):

Tests of viral hepatitis

serologic markers of viral hepatitis

current or recent infection

current or previous infection

HBV surface antigen

in acute Hepitis B ,may

antibody to e antigen transiently positive in convalescence,

antibody to core antigen

positive in all acute and chronic cases,

reflects active viral replication ,

antibody to surface antigen positive in late convalescence,

positive after clinical onset(15 week),

Automatic biochemistry analyzer:

Laboratory data: Hb 90g /L, WBC 8.0109/L, PC

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.