ASSIGNMENT

BIO-CHEMISTRY

Liver Function Test

Sir Fiaz Ur Rehman

Submitted By:
Saud Ahmad Asif (B.S) 125
Waqas Noor (B.S) 25
Hisham Ahmed (MSc) 45

DEPARTMENT OF BIO-CHEMISTRY
UNIVERSITY OF SARGODHA
 Liver Function Tests
Liver function tests measure various chemicals in the blood made by the liver. An
abnormal result indicates a problem with the liver, and may help to identify the cause.
Further tests may be needed to clarify the cause of the liver problem.

What does the liver do?

The liver is in the upper right part of the abdomen. The functions of the liver include: storing
glycogen (fuel for the body) which is made from sugars; helping to process fats and proteins
from digested food; making proteins that are essential for blood to clot (clotting factors);
processing many medicines which you may take; helping to remove poisons and toxins from the
body.

The liver also makes bile. This is a greenish-yellow fluid that contains bile acids, bile pigments
and waste products such as bilirubin. Liver cells pass bile into bile ducts inside the liver. The
bile flows down these ducts into larger and larger ducts, eventually leading to the common bile
duct. The gallbladder is like a 'cul-de-sac' reservoir of bile which comes off the common bile
duct. After you eat, the gallbladder squeezes bile back into the common bile duct and down into
the duodenum (the first part of the gut after the stomach). Bile in the gut helps to digest fats.

What are liver function tests?

A liver function test (LFT) is a blood test that gives an indication of whether the liver is
functioning properly. The test is also very useful to see if there is active damage in the liver
(hepatitis) or sluggish bile flow (cholestasis).
Liver function tests measure the amount of particular chemicals in the blood. This gives a gauge
of possible damage to liver cells — damage that can be caused by many things including HCV. So
a more correct term for a liver test would actually be a liver dysfunction test.
It’s important to remember that diagnosis of liver disease depends on a combination of patient
history, physical examination, laboratory testing, biopsy and sometimes imaging studies such as
ultrasound scans. Diagnosis of hepatitis C usually also involves antibody tests or PCR tests.

Alanine Aminotransferase (ALT):

Alanine transaminase (ALT), also called Serum Glutamic Pyruvate Transaminase (SGPT) or
Alanine aminotransferase (ALAT) is an enzyme present in hepatocytes (liver cells). When a cell
is damaged, it leaks this enzyme into the blood, where it is measured. ALT rises dramatically in
acute liver damage, such as viral hepatitis or paracetamol (acetaminophen) overdose. Elevations
are often measured in multiples of the upper limit of normal (ULN).

Aspartate Aminotransferase (AST):

Aspartate transaminase (AST) also called Serum Glutamic Oxaloacetic Transaminase (SGOT) or
aspartate aminotransferase (ASAT) is similar to ALT in that it is another enzyme associated
with liver parenchymal cells. It is raised in acute liver damage, but is also present in red blood
cells and cardiac and skeletal muscle and is therefore not specific to the liver. The ratio of
AST to ALT is sometimes useful in differentiating between causes of liver damage.

Alkaline Phosphatase (ALP):

Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. ALP
levels in plasma will rise with large bile duct obstruction, intrahepatic cholestasis or infiltrative
diseases of the liver. ALP is also present in bone and placental tissue, so it is higher in growing
children (as their bones are being remodelled) and elderly patients with Paget's disease.

Gamma Glutamic Transpeptidase (GGT):

Although reasonably specific to the liver and a more sensitive marker for cholestatic damage
than ALP, Gamma glutamyl transpeptidase (GGT) may be elevated with even minor, sub-clinical
levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated
elevation in ALP. GGT is raised in alcohol toxicity (acute and chronic). In some laboratories,
GGT is not part of the standard LFTs and must be specifically requested.

Total bilirubin (TBIL)

Bilirubin is a major breakdown product of hemoglobin. Hemoglobin is derived from red cells
that have outlived their natural life and subsequently have been removed by the spleen. During
splenic degradation of red blood cells, hemoglobin (the part of the red blood cell that carries
oxygen to the tissues) is separated out from iron and cell membrane components. Hemoglobin is
transferred to the liver where it undergoes further metabolism in a process called conjugation.
Conjugation allows hemoglobin to become more water-soluble. The water solubility of bilirubin
allows the bilirubin to be excreted into bile. Bile then is used to digest food.
As the liver becomes irritated, the total bilirubin may rise. It is then important to understand
the difference between total bilirubin, which has undergone conjugation (that is hepatic cell
metabolism), and at portion of bilirubin which has not been metabolized. These two components
are called total bilirubin and direct bilirubin. The direct bilirubin fraction is that portion of
bilirubin that has undergone metabolism by the liver. When this fraction is elevated, the cause
of elevated bilirubin (hyperbilirubinemia) is usually outside the liver. These types of causes are
typically gallstones. This type of abnormality is usually treated with surgery (such as a
gallbladder removal or choleycystectomy).
If the direct bilirubin is low, while the total bilirubin is high, this reflects liver cell damage or
bile duct damage within the liver itself.

Ammonia
Analysis of blood ammonia aids in the diagnosis of severe liver diseases and helps to monitor the course
of these diseases. Together with the AST and the ALT, ammonia levels are used to confirm a diagnosis
of Reye's syndrome (a rare disorder usually seen in children and associated
with aspirin intake), which is characterized by brain and liver damage following an upper
respiratory tract infection, chickenpox, or influenza. Ammonia levels are also helpful in the
diagnosis and treatment of hepatic encephalopathy, a serious brain condition caused by the
accumulated toxins that result from liver disease and liver failure.

Other Common Tests

5' nucleotidase (5'NTD)

5' nucleotidase is another test specific for cholestasis or damage to the intra or
extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for
ascertaining whether an elevated ALP is of biliary or extra-biliary origin.

Coagulation tests (e.g. INR)

The liver is responsible for the production of coagulation factors. The international
normalized ratio (INR) measures the speed of a particular pathway of coagulation, comparing
it to normal. If the INR is increased, it means it is taking longer than usual for blood to clot.
The INR will only be increased if the liver is so damaged that synthesis of vitamin K-
dependent coagulation factors has been impaired: it is not a sensitive measure of liver
function.
It is very important to normalize the INR before operating on people with liver problems
(usually by transfusion with blood plasma containing the deficient factors) as they could
bleed excessively.

Serum glucose (BG, Glu)

The liver's ability to produce glucose (gluconeogenesis) is usually the last function to be lost
in the setting of fulminant liver failure.

Lactate dehydrogenase (LDH)

Lactate dehydrogenase is an enzyme found in many body tissues, including the liver. Elevated
levels of LDH may indicate liver damage.

Preparation
Preparation requirements for all these tests vary from laboratory to laboratory, so it is
generally considered best that the patient be in a fasting state (nothing to eat or drink)
after midnight the day before the test(s).

Aft erc a re
Because many patients with liver disease have prolonged clotting times, it is important to
monitor the puncture site for bleeding after blood is drawn (venipuncture).

Risks
Risks for this test are minimal, but may include slight bleeding from the blood-drawing
site, fainting or feeling lightheaded after venipuncture, or hematoma (blood accumulating
under the puncture site).

Normal results
Reference ranges vary from laboratory to laboratory and also depend upon the method used.
However, normal values can generally be found within the following ranges, unless specified
differently.

Abnormal results
ALT: Values are significantly increased in cases of hepatitis, and moderately increased in
cirrhosis, liver tumor, obstructive jaundice, and severe burns. Values are mildly increased
in pancreatitis, heart attack, infectious mononucleosis, and shock. Most useful when
compared with ALP levels.
GGT: Increased levels are diagnostic of hepatitis, cirrhosis, liver tumor or metastasis, as well
as injury from drugs toxic to the liver. Although the causes are unclear, GGT levels may
increase with alcohol ingestion, heart attack, pancreatitis, infectious mononucleosis, and
Reye's syndrome.
Bilirubin: Increased indirect or total bilirubin levels can indicate various serious anemias,
including hemolytic disease of the newborn and transfusion reaction.
Increased direct bilirubin levels can be diagnostic of bile duct obstruction, gallstones,
cirrhosis, or hepatitis. It is important to note that if total bilirubin levels in the newborn
reach or exceed critical levels, exchange transfusion is necessary to avoid kernicterus, a
condition that causes brain damage.
Ammonia: Increased levels are seen in primary liver cell disease, Reye's syndrome, severe
heart failure, hemolytic disease of the newborn, and hepatic encephalopathy.
PT: Elevated in acute liver injury, vitamin K deficiencies, and disorders with impair the
absorption of vitamin K, including cholestasis.